Douglas Hires is a healthcare executive and consultant with a depth of experience spanning 30+years in Healthcare IT, Revenue Cycle and Healthcare Business Process Outsourcing (BPO) working with providers, payers, government, and life sciences.
Doug consults and advises technology/services companies and investment firms in the Healthcare industry sector. Doug provides strategic assessments and development of corporate business plans, conducts reviews of services, product suites, and business operations assisting organizations with competitive market review and opportunities to scale and grow. Doug assists and advises M&A processes including review of CIMs and assessment/commentary on strengths, weaknesses, risks and opportunities. Doug reviews and advises on sales & marketing plans, company growth trajectories, identifying requirements to enable growth and fuel expansion capabilities
Most recently, Doug was Chief Operating Officer (Provider) for OptumInsight. OptumInsight’s portfolio of offerings includes revenue cycle outsourcing and optimization, coding and billing, collections for healthcare providers; risk, quality, and payment integrity analytics and claims processing services for payers; evidence-based analytics for life sciences companies; and data management and technology services for commercial and government health care agencies.
Provider services under Doug’s leadership included managed revenue cycle services (full and partial outsourcing), technology implementation and support, clinical denial management, case management, physician utilization management, patient scheduling, eligibility and pre-registration, nurse triage and customer service call center operations. Doug led a team of 14,000 FTEs in the USA, the Philippines, United Kingdom and India, with a $2.5B P&L responsibility.
Before joining Optum, Doug held healthcare consulting, sales and senior leadership positions with Santa Rosa Consulting as SVP of Strategy, 3M Health Information Systems, leading their national sales organization, and First Consulting Group as a partner for consulting delivery and business development. In each role, he worked directly with healthcare provider organizations managing services delivery of consulting and IT technology selection & implementation, business process outsourcing, and advised C-Suites and Boards on strategic insights and recommendations.
Doug is active in several industry groups including HFMA, HIMSS, and ACHE. He also has been a company representative for multiple years to both CHIME, and the Scottsdale Institute. Doug holds a bachelor’s degree in music performance from the New England Conservatory and a master’s degree in music performance from North Texas State University.
