WHO WE ARE
An Industry Leading Third Party Administrator Working With You, For You.
ABOUT MEDEGY HEALTH SYSTEMS™
Our story originated in 1982 when Dr. Sidney J. Stern began his career in managed care. After founding an eye care network with only 15 providers in South Florida, Dr. Stern grew the network into one of the largest, most successfully managed in the state of Florida.
In 2001, with a proven track record, he developed his processes into a proprietary managed care software platform.
As a licensed Third Party Administrator, Medegy Health Systems has provided proprietary managed care software and processes since 2007.
Today, we continually add value to our clients across many disciplines in the health care industry, implementing the same quality services and success to specialty managed care provider networks in the country.
MEDEGY™ - PAST & PRESENT
MEET OUR FOUNDER
Sidney J. Stern, OD, is a recognized leader in eye care worldwide with a 30-year focus on Eye Care Managed Care including both Optometry and Ophthalmology. Dr. Stern serves as President of two acclaimed managed eye care companies, iCare Health Solutions and Florida EyeCare Corporation. Dr. Stern is the President of Medegy, a multi-specialty Third-Party Administrator, and OptiLab, a Miami Florida based Optical Laboratory. Additionally, he is the founder and president of Florida’s most prominent and progressive eye care physician practices, Dr. Stern’s Visual Health Centers, with 30 locations in Miami-Dade and Broward Counties. He has served as President of the World Optometry Foundation, the fundraising arm of the World Council of Optometry, an international organization based in London, England with 46 member countries representing more than 250,000 optometrists. Dr. Stern has served as President of the Florida Optometric Association and President of SECO International, an international optometric educational organization based in Atlanta, Georgia. Dr. Stern has been recognized not only by his peers but community organizations with numerous awards and institutional naming’s for his outstanding contributions.
Dr. Stern’s outcome-based philosophy employing, integrated quality care and service first, has proven to be the “gold standard” for successful managed eye care globally.
MEET THE TEAM
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Lee R. Stern serves as Medegy's Chief Executive Officer. A seasoned managed care executive with wide-ranging experience in today's outcome and quality driving managed care "eco systems," Lee has extensive industry knowledge and a mastery of managed care plan contracting, operations, labs, provider network management, claim adjudication, physician practices, and business intelligence. The valuable range of experience allows Lee to coalesce knowledge into winning financial strategies and client partnerships.
As a practicing optometrist specializing in medical optometry and pediatric patients, Dr. Stern provides important input for customizing benefits programs to meet individual health plan parameters and streamlining claims adjudication and submission. She helped develop and implement utilization management reporting systems, quality assurance programs, provider training programs, a billing integrity program, a Fraud, Waste & Abuse program, appeals program guidelines, and the Physician Advisory Committee.
With 20+ years in healthcare, Sherry provides a range of expertise in health plan management, operations, and healthcare analytics with a focus on customer service and process improvement. She provides business development support, application development management, and department oversight for claims, EDI, client services, system configuration, enrollment, and more. Before joining Medegy Health Systems™, Sherry worked as a data management manager, providing Medicare risk adjustment analysis.
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Gisell Hernandez has been with Medegy Health Systems for over 9 years. She has been involved with and responsible for several departments, including: Credentialing & Contracting, Recruiting, Provider Relations, Claims, and Delegated Audits.
Juliette Navarro brings 10 years of management experience in areas such as insurance verification and healthcare. Prior to working with Medegy for the past 4 years, Juliette was in the optometry field as a billing manager, overseeing an optometry office for 7 years.
A focused leader with 10 years of management experience, Marian Castellano’s operations and staff oversight has helped her improve the company training process, productivity, and customer satisfaction. Marian has collected and analyzed data trends to develop call center operations. Her understanding of strategic planning leads to effectively tracking emerging trends in call center operations management, initiating corrective actions, and exploring new opportunities to add value to her department.
Before joining Medegy, Shawn Sao worked as a business intelligence consultant for a broad range of industries: manufacturing, insurance, healthcare, and more. He provided solutions for the clients’ common problem: reporting. Shawn joined Medegy in 2013 as the company’s first business analyst. When the company looked for their first project manager, his experience made a perfect fit. Shawn used the same approach from his consulting days to understand the operations of business and its problems.
Tiffany Solis has over 25 years in the healthcare industry. One of her major accomplishments was establishing a fully functional and structured claims department, which processes an average of 55,000 claims per month. Tiffany creates structure and processes within the department. She streamlined the claims department’s role in preparing for payor audits, ensuring SLA agreements for each customer/payor are met. This resulted in 100% compliancy for delegated audits.
Bringing 10+ years of experience, Yolanda Amaya provides leadership for all EDI-related transactions, including in-depth analysis, process improvement, issue resolution, effective management information systems, and client onboarding. Yolanda has analyzed trends in claim rejections/denials, provided solutions to facilitate claims processing, and guided IT toward resolution of EDI transmission problems. Prior to this position, she served as a Transactional Business Analyst.
