Tony Pelezo, MD
President of Reimbursement Policy & Chief Medical Officer
Prior to coming to work at Equian, Dr. Tony Pelezo held important positions where his broad spectrum of knowledge in healthcare—coding and reimbursement, analytics, finance, clinical knowledge, project management, product development, marketing, revenue cycle, and comprehensive Medicaid and health plan knowledge—was utilized to save time and money. A few of those engagements are highlighted below:
• Revenue Cycle Consultant and ICD-10 implementation lead for Sacred Heart Health System.
• Advisor to Ascension Health on ICD-10 revenue risk mitigation strategies.
• Director of Policy and Reimbursement for the State of Indiana Office of Medicaid facilitating the State of Indiana’s transition to ICD-10, and leading the implementation of code auditing logic in the Medicaid claims processing engine as well as the revision of the system to comply with the federally-mandated conversion to ICD-10.
• His work efforts for the state focused on reducing total reimbursements through optimization of rate structure and adjustments to cost-to-charge ratios.
• He was personally responsible for saving the State of Indiana more than $60 million dollars per year.
• Consultant for McKesson Health Solutions to develop significant advances in code logic for McKesson related solutions, including ClaimCheck, ClaimsXTen, and the InvestiClaim Fraud and Abuse software. The advances were achieved through Dr. Pelezo’s large-scale analysis of claims populations and an understanding of the foundations and rules of coding and reimbursement.
• Medical Director/Chief Medical Officer for several health plans including Centene Corporation and Harmony Health Plan of Indiana (WellCare).