Management Team
WayMark Associates is led by a seasoned management team with more than thirty five years combined health insurance experience.
While working together for a major U.S. health insurance company, the team gained valuable, first-hand experience in areas that include audit design and implementation, overpayment detection, claims data analysis, claims processing policies and procedures, collection strategies, and fraud and abuse prevention.
Rodger F. Smith, Jr., Principal
As Director of the Special Investigations Unit (SIU) and the Provider Compliance Group (PCG), Rodger was responsible for managing fraud and abuse prevention and recovery for Oxford Health Plans, a United Healthcare Company. An attorney and practicing commercial litigator, Rodger joined Oxford in 2000 and quickly provided the company with leadership in proactive initiatives to detect provider-billing abuse, including building Oxford’s Initiative addressing abuse of Evaluation & Management Service codes, which recovered over $5 million in overpayments, and prevented future overpayments of over $40 million over its 6 ½ year life. He formed the PCG in 2002 to develop and pursue broad audit initiatives designed to identify, recover and deter systemic claims abuse.
Under Rodger’s leadership, PCG recovered overpayments totaling more than $5 million in 2005 and saved Oxford an additional $12 million as a result of the group’s deterrent impact on dishonest providers. Oxford’s SIU also had its best year ever in 2005, saving and recovering over $5.3 million. Prior to joining Oxford, Rodger practiced law at Shearman & Sterling and Christy & Viener (currently the Salans Firm), both in New York City.
Rodger is a graduate of Stanford University and New York University School of Law, where he received a Juris Doctorate, Cum Laude.Steve M. Palma, Principal
Steve joins WayMark Associates from Oxford Health Plans, a United Healthcare Company. At Oxford, Steve was most recently Director of the Provider Compliance Group (PCG), where he was responsible for developing and implementing specialty based provider audit programs. Under his leadership, Oxford initiated an extremely successful High Cost Drug audit program that was a major factor in PCG’s record 2005 financial performance, and recovered over $5.8 million in overpayments over its 2 year life. Prior to this, Steve was manager of Oxford’s Special Investigations Unit, overseeing a major reorganization that emphasized a strategic shift of focus toward financial results and the hiring of individuals with healthcare project management, claims processing and audit expertise.
Steve joined Oxford in 1997 and held various project management and supervisory positions within the Claims/Operations organization before moving to the Special Investigations Unit. Prior to joining Oxford, Steve worked as a licensed group health insurance broker which, combined with his experience at Oxford, has provided him with a well-rounded understanding of differing facets of the health insurance industry.
Steve is a graduate of Southern Connecticut State University.
Nicola S. Coleman, Principal
An IT and data analytics specialist, Nicola most recently served as a Senior Systems Analyst at Oxford Health Plans, a United Healthcare Company. In that role, she supported the company’s Special Investigations Unit and Provider Compliance Group, for which she was the primary claims data facilitator and analyst. That included an instrumental role in data analysis and technology strategy for Oxford’s Initiatives focused on High Cost Drugs and E&M coding abuse. She was responsible for major technology improvements in each area that led to significant financial returns. Nicola was instrumental in developing specialized claims data analysis tools that assisted Oxford in identifying millions of dollars in claim overpayments.
Nicola joined Oxford in 1997 and held various positions in the Claims/Operations organization relating to claim adjudication and technology. She later served as an Investigator in Oxford’s Special Investigations Unit where she pursued a number of major cases for Oxford, a number of which were initiated based on “data mining” techniques she developed.
Nicola is a graduate of Skidmore College and is currently pursuing a Masters of Science in Computer Information Systems.
Lou Gianquinto, Jr., Principal
Lou Gianquinto joins WayMark Associates from United Healthcare. At United, Lou was the Vice President of Affordability Operations, where he was responsible for key national initiatives to address claims overpayments and recoveries, including Coordination of Benefits and Hospital Bill Auditing; and most recently, Fraud and Abuse Investigations and Claims Cost Management. By the end of 2007, under Lou’s leadership, United reached total dollar savings of over $800 Million in its Coordination of Benefits Program and over $23 Million in its Hospital Bill Audit Program, an increase of over $232 Million and $8 Million respectively over a 2 year period.
Prior to his role at UHC, Lou was the Director of Cost Containment and Recoveries for Oxford Health Plans, overseeing all claim cost savings initiatives, including Coordination of Benefits, Hospital Bill Auditing, Recovery Operations, Pricing and Discounting, and Pre-Payment Auditing. As a result of Lou’s leadership and innovations, the Oxford Cost Containment and Recoveries unit yielded $157 Million in aggregate incremental savings from prevention and recovery efforts over a 3 year period.
Lou joined Oxford in January 1995 and worked in several leadership positions, mainly in operations and quality, prior to his extensive work in affordability with both Oxford and United.
Lou is a graduate of Southern Connecticut State University and the University of New Haven, where he received a BS in Business Management and an MBA.
