Strategic Consulting Manager with an extensive record of success in over 15 years across the healthcare industry. Adept at leveraging a strong command of managed care operations, including claims, billing, member services, systems and plan implementations, sales, vendor relationships, pharmacy benefits management, medical management, utilization management, network management, provider data management and quality management, coupled with the ability to develop and implement technology-based solutions to solve for complex problems within the operating model. Medicare and Medicaid expert. Effective communicator with the ability to influence change. Proficient driving large-scale initiatives, and effective in leading within centralized and decentralized organizational structures.
- Optimized understanding of program requirements related to provider data and claims processing to implement standard provider configuration across Medicaid segment, and built the provider standard governance process as Senior Director, Provider Data Integration.
- Built automated loads and processes to ensure provider data was loaded according to the standard and remained in- synch with the standard. Developed a central surveillance process to monitor data.
- Created new, intelligent, actionable, interactive dashboards and metrics for presenting Key Performance Indicators (KPIs) to senior leadership and stakeholders.
- Collaborated across all operations departments, directing a group of report developers and application developers in providing regulatory and operations reports to support company goals as Director of Informatics.
- Utilized expertise in primary applications and configuration of tools and vendors used by the Medicaid Division (QNXT, Dynamo, DAG, ECHO, AAWEB, Inovalon, DentaQuest) to drive effective delivery.
- Led a group of report developers and application developers in completing and providing regulatory and operations reports to support company objectives as Manager, Operations Business Intelligence.
- Bachelor of Theology
Christian Life College