RICHARD E. SWIFT
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7119 East Shea Blvd #109-489 Scottsdale, AZ 85254
Office (480) 219-8113 Fax (480) 219-8114 rswift@medwisepartners.com
Cell (504) 914-6300 www.medwisepartners.com
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SUMMARY
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A dedicated professional with extensive experience throughout the Managed Care industry. Experience in financial management,
product pricing, and provider reimbursement and network development. Strong financial background and excellent communications
skills with the ability to convey complex financial issues and trends to a non-financial audience.
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EXPERIENCE
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President
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Develop and operate a managed care consulting practice providing financial and risk management to client organizations.
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Serve as Interim Head of Underwriting for a provider owned Health Plan. Scope includes pricing, rate development, managing staff and
product design.
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Provided strategic assessment and analysis for a health plans Medicare risk operations.
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Developed underwriting program and requirements for an HMOs Medicare Supplement product.
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Serve as CFO, including development of Pro Forma, Business Plan and Policies and Processes for a startup health services company.
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Completed a Premium Reserve Analysis and testified in subsequent litigation between the provider owned health plan and outside
management company.
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Completed the first analysis of medical costs and utilization for a startup Medicaid HMO.
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Designed a computer model to enable health plans to analyze their medical cost structure.
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Advised a specialty provider group on managed care contracting strategies.
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Tenet Choices, Inc and Peoples Health Network, New Orleans, LA 1998-2001
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Chief Financial Officer
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Responsible for financial reporting, reserves, enrollment and financial management for a rapidly growing provider owned enterprise
including an HMO, PHO and eight IPAs.
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Developed, presented and implemented turnaround plans for managed companies experiencing significant medical and operational
losses.
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Managed the reduction of administrative costs from 26% to 13% of premium and repayment of over $2 MM of Management Company
debt.
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Prepared and presented monthly financial results for an HMO, Management Company and 24 separate medical risk pools to nine
separate Boards of Directors.
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Restructured Accounting department to improve timeliness, accuracy and credibility of financial reports.
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Chief Financial Officer
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Southeast Medical Alliance, Inc., New Orleans, LA 1998
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Responsible for all financial reporting, reserves, pricing and planning for a 50,000 member HMO and a 450,000 member PPO.
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Implemented a formal process to review claim experience and develop IBNR reserves.
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Instituted policies and procedures related to financial reporting, underwriting and cash management.
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Instituted process to identify high cost claims and secure reinsurance recoveries.
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Managed the year-end audit including external analysis of the Plan's claim reserves.
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Aetna Health Plans, Hartford, CT and Dallas, TX 1986 - 1996
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Financial management of multiple HMOs and Managed Care networks. Scope included HMO Reserving, Underwriting, Provider
Reimbursement, Trend Analysis and Strategic Planning.
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Negotiated settlement allowing Aetna to recoup up to $23 million from the Federal Government's Employee Benefit Plan.
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Coordinated planning and budgeting process for sales offices throughout the Midwest region.
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Initiated process for comprehensive review of medical costs including utilization rates, contracting implications and trend analysis for
numerous HMOs throughout the country.
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Managed Underwriting department for multiple HMO locations to meet profitability and marketing objectives.
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Manager, Actuarial and Risk Management 1991 - 1993
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Developed company's provider reimbursement policies and programs for the managed care segment of the business.
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Developed and implemented company-wide policies and programs for the negotiation and evaluation of reimbursement rates for
providers.
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Director, PPO Reimbursement 1989 - 1991
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Responsible for the development and evaluation of provider payment arrangements for all PPO networks throughout the United States.
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Developed payment arrangements including capitations, risk share programs, bonuses, per diems, case rates, and progressive
fee-for-service programs for diverse provider groups throughout the country.
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Manager, PPO Reimbursement 1986 - 1989
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Developed company's DRG Program; developed and evaluated provider payment arrangements for all PPO networks in the Eastern
United States.
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Blue Cross and Blue Shield of West Virginia, Charleston, WV 1984 - 1986
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Director, Alternative Delivery Systems
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Led the Project for development of the Plan's PPO product.
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Blue Cross and Blue Shield of Florida, Jacksonville and Miami, FL 1980 - 1984
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Manager, Provider Reimbursement
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Jackson Memorial Hospital, Miami, FL 1980
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Administrative Resident
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EDUCATION
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University of Miami, Miami, FL 1980
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MBA- Health Care Administration
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Mercer University, Macon, GA 1979
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BS- Biology
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AWARDS AND ACTIVITIES
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Awarded Aetna Leadership Award - 1995
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Awarded Blue Cross and Blue Shield of Florida Management Award - 1983
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Guest Speaker, American Society of Actuaries Spring Healthcare Meeting - 2002
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Trustee/Treasurer, Not-For-Profit Organization, Hartford, CT - 1993 - 1998
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Guest Speaker, American College of Obstetricians and Gynecologists - 1992
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Guest Speaker, American Society of Actuaries Annual National Meeting - 1992
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