PRISM Healthcare Resources LLC offers healthcare management services aimed at enhancing managed care services and reducing claim costs. Services include provider contracting, specialty network development, network analyses, claim overpayment audits and enrollment audits. The principals have extensive experience and skills in these areas.
James H. Riffle
Jim has gained a broad base of experience within the healthcare industry over the past 25 years. He has worked in management and executive level sales and marketing positions for some of the major brand names within the industry as well as established regional firms and start-ups bringing new and innovative solutions to the market. Products and services experience include data mining, infomatics and predictive modeling, specialized claims software solutions for Other Party Liability, medical management and disease management services, homecare and specialty network management and development. Client segments served include, BCBS Plans, commercial insurance companies, reinsurers, Health and Welfare Funds and self-funded employers.
Leon W. Jalbert, M.B.A.
Leon has broad experience in managed healthcare. He current does work in the claim recovery and audit field. Most recently he spent several years completing most of a national physical therapy network, and a specialty physician network in several states. He managed a regional PPO network and medical management company in the Pennsylvania/New Jersey area, which also offered a state wide HMO. Additionally he was VP of Development for several years for another regional PPO network in the Northeast. He began his career in managed care by developing PPOs for a third party claim administrator. Prior to the managed care business Leon was a clinician and administrator in New England in the behavioral health field. He has a BA from Brown University, an M.Ed. in Counseling Psychology from Northeastern University and an MBA in Marketing from Boston University.
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