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Carl Rainey

@carlrainey

I lead healthcare claims configuration and operations teams to deliver accurate, timely system changes.

United States
Message

At Buckeye Health Plan, I lead the analysis and configuration of claims information systems, delivering pricing, benefits, and payment changes within the core claims payment system.

I manage staffing, hiring, performance management, and career development while aligning team goals to organizational priorities. I also build tools, processes, and methodologies that streamline change requests and support accurate, timely implementation.

Previously, at Management and Network Services, I managed patient accounts, collections, cash posting, refund requests, and accounts receivable operations. I supported days sales outstanding goals and hired Reimbursement Specialist candidates.

I bring experience in medical claims, revenue cycle management, root-cause analysis, data analysis, healthcare coding and billing, and cross-functional project delivery.

Experience

Work history, roles, and key accomplishments

Buckeye Health Plan logoBP
Current

Contract Implementation Manager

Buckeye Health Plan

Jan 2020 - Present (6 years 8 months)

Plan, manage, and coordinate the analysis and configuration of claims information systems to meet business needs. Lead department staffing activities, including hiring, performance management, and career development, and oversee the architecture, design, coding, testing, and implementation of claims pricing, benefits, and payment changes.

Education

Degrees, certifications, and relevant coursework

Union Institute & University logoUU

Union Institute & University

Bachelor's Degree, Leadership

Earned a Bachelor's Degree in Leadership with a concentration in Sport Management.

Columbus State Community College logoCC

Columbus State Community College

Associate's Degree, Sport Management

2009 - 2012

Completed an Associate's Degree in Sport Management.

The Ohio State University logoTU

The Ohio State University

2007 - 2009

Completed coursework at The Ohio State University.

Tech stack

Software and tools used professionally

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