Rich Balest has served as a health industry consultant utilizing over 25 years of experience in data mining, data modeling, data warehousing, and information delivery. Rich has comprehensive experience analyzing detailed claims and eligibility from CMS, insurance companies, and managed care organizations including prescription benefit managers (PBM), and account and medical record detailed patient data from hospital patient accounting systems, clinical ancillary systems, and professional and institutional billing systems.

Rich has supported the actuarial departments of health plans projecting the impact on provider payments resulting from amended contracts, measuring prescription drug trends, preparing Medicare Part D bids, and developing process specifications for the actuarial analytic platform.

On behalf of several consulting firms, Rich has supported the pharmacy practices on client engagements measuring the administrative and financial performance of employer sponsored prescription drug benefit plans as defined by the contractual arrangements with the PBMs. For PBM clients, Rich completed Medicare Part D process assessments and specialty network assessments.

Education

  • BS, Economics, Pennsylvania State University