John W. Russo
About John W. Russo
John W. Russo is the Manager of Process Quality and Operational Excellence at EmblemHealth, where he leads a team of Senior Quality Auditors and oversees claim exception analysis. He has extensive experience in claims operations and quality improvement, having previously worked at Vytra Health Plans and Hip Health Plan of New York.
Current Role at EmblemHealth
John W. Russo serves as the Manager of Process Quality - Operational Excellence at EmblemHealth. He has held this position since 2005, accumulating 19 years of experience in this role. He leads a team of five Senior Quality Auditors and is responsible for overseeing the ongoing claim exception root cause analysis process. His work focuses on driving process improvements within the organization.
Previous Experience at Vytra Health Plans
Prior to his current role, John W. Russo worked at Vytra Health Plans in various capacities. He began as a Claims Examiner in Claims Operations from 1995 to 1996, followed by a position as a Continuous Quality Improvement Analyst in Strategic Quality Improvement from 1997 to 2000. He also served as a Senior Claims Examiner in Claims Operations from 1996 to 1997. His experience at Vytra Health Plans spanned a total of four years.
Experience at Hip Health Plan of New York
John W. Russo worked at Hip Health Plan of New York as a Senior Quality Analyst in Business Transformation from 2000 to 2005. During this five-year period, he contributed to various quality improvement initiatives and played a key role in enhancing operational processes within the organization.
Education and Training
John W. Russo studied Business Administration at Quinnipiac University from 1990 to 1991. He completed his high school education at Sachem High School in Lake Ronkonkoma, New York. His educational background has provided him with foundational knowledge applicable to his roles in quality assurance and operational excellence.
Key Responsibilities and Initiatives
In his current role at EmblemHealth, John W. Russo manages several critical initiatives. He oversees the pre-payment audit of high-dollar hospital and medical claims, specifically those exceeding $100,000. He also manages the monthly post-payment corporate end-to-end claim performance audit program for HMO Commercial, Medicaid, and Medicare lines of business. Additionally, he collaborates with the Payment Integrity and Financial Recovery Units to analyze claim audit findings and identify overpayments.