Alida Dodd Email & Phone Number

Bedford, Nh, Us

Springfield, Massachusetts Metropolitan Area

Responsible for budgeting, forecasting, analysis of value based and shared savings arrangements with medical groups, regulatory reports

Bedford, Nh

• Responsible for budgeting, forecasting, monthly financial close, state, and federal compliance and presentation of financial results to senior management.• Create detailed finance analysis to determine adequacy of state Medicaid rates offered to the health plan.• Key member of Senior Leadership Team reviewing and acting on strategic opportunities.

Bedford, Nh

Responsible for the financial oversight of two healthplans which provide insurance administration for the MA and NH Medicaid contracts. Annual premiums exceed $.5 billion covering 121,000 lives. Financial responsibilities include profit and loss accountability, long-term planning, annual budgeting, monthly forecasting, data and provider contracting analysis.

Hartford, Connecticut

National leadership responsibility for risk score and revenue projections, analytic analysis and reporting for $6B Medicare Advantage segment (694,000 members). Provided risk scores and revenue trends for nationwide business at a local market level for individual MA products and 147 large National Accounts for pricing.Led development of analytic models for bid pricing, forecasting and management analyses. Accountable for monthly booking of risk adjustment receivable forecast and identification of risk to forecast. Served as cross functional subject matter expert. Led collaborative process to develop the annual plan working with Actuarial, Underwriting and Finance for two planning cycles. Created metrics to drive focus and accountability. Reported financial yield of medical chart retrieval efforts for each local market and National Account. Benchmarked Aetna against MA industry risk scores utilizing blinded carrier data facilitating competitive insight and targeted improvement opportunities.Partnered with a Medicare specialized vendor to build an Aetna-exclusive data mart resulting in accurate, timely reporting of risk adjusted revenue, robust data analytics and sophisticated, state-of-the-art business intelligence reporting tools.

Tri-state responsibility for financial modeling of acute care hospital, physician and ancillary contracting encompassing management of $1.8 billion in payments to healthcare providers. Responsible for a professional staff of up to 18 people.Prepared summary analyses of participating provider unit cost trends for 208 hospitals, approximately 100 physician fee schedules and over $176M in third party vendor capitation. For the first time, the company had standardized contract performance data to accurately price its products.Financial oversight of a Medicare Advantage IPA risk arrangement leading to early identification and avoidance of significant claim liability for an insolvent business partner. Identified $2.6M of Medicaid claim overpayments to hospitals which were successfully recovered.

Management responsibility for the Appeals & Grievances Departments (47 FTEs) and project leadership.Led development of a regional Cardiac Centers of Excellence program, which served as a tool in Medical Management’s offerings to empower member healthcare decisions.Addressed a severe Grievance Department backlog situation. Wrote and implemented a new business plan to more effectively manage cases. Improvements included inventory and case flow reporting, team reconfiguration, work assignment and quality monitoring and establishment of productivity standards.Updated and enhanced the Physician Office Manual which required leading a large-scale cross-functional team over a four-month timeframe.

Support role to the Connecticut General Manager. Analyzed medical cost drivers and led action plan initiatives.

Controllership duties supporting a $100M administrative cost and project budget for the National Network Operations group (Clinical and Medical Management, Appeals, Network Management). Prepared cost/benefit analysis for national initiatives while managing a staff of 7.

Responsible for management of Accounting, Underwriting, Actuarial, MIS and Provider Settlement departments for this wholly-owned subsidiary of Via Christi Health System. Accountable for a group of 46 employees.