Responsible for oversight of all operations functions from centralized areas: enrollment, billing, claims, member services, informatics and others through establishing relationships and contact with other leaders, attending scheduled meetings on behalf of the health plan and reviewing various reports and activities. Represent KY Medicaid Health Plan on various calls with Division of Medicaid Services (DMS) for Commonwealth of KY. Overall leadership of various projects as they arise such as PBM implementation, creation of a new Third Party Insurance information transfer process, creation of a daily information transfer process for prior authorizations, transition of FTP process to new vendor, and others. Participation as health plan contact in Compliance/Regulatory process and execution of certain tasks and deliverables that fall to me. Overall leadership of various cost saving and efficiency activities within the health plan such as review of claims inventory and pend process, review of overall load process for daily enrollment update file sent by DMS (834), review of internal process to generate 75 compliance reports and others

• Executed Humana strategy through multi-disciplinary projects and teams including product implementation and business process improvement initiatives.• Represented segment interests to prioritize, approve, monitor, and conduct cost/benefit analysis for a $1B budget including capital investments for buildings ($400M), technology ($400M), and equipment ($200M).• Oversaw day-to-day operations team including budget planning, goal development, priorities and performance evaluation. Reduced costs by $10M annually.• Identified inefficient processes, created innovative and effective solutions, and implemented on time and under budget.• Directed financial analysis operation to track, analyze, and report expenses allocated to Employer Group segment from shared business areas, including Provider Network Operations, Human Resources, Information Technology, and Facilities.

• Led the data intelligence department for Medicare Advantage.• Directed technical support, information analysis and systems management as well as operations for Medicare billing operations.• Oversaw standalone SQL server with automated batch loading jobs, self-service reporting menus, and ad hoc reports.• Orchestrated 24/7 systems support of reconciliation software, as well as oversaw budget and financial analysis, project management, software development, and consulting.• Led large initiative to automate enrollment and billing processes for 3 pilots for Medicaid product. Met with state officials and developed programming. Pilots resulted in landing multiple Medicaid contracts nationwide.• Headed data gathering process for multiple CMS audits of Medicare Advantage product line. Met with CMS staff and Humana leadership to identify criteria and formatting requirements. Resulted in successfully passing of audits which was crucial to maintaining MA contracts.

• Directed 40 seat outbound call center, coordinated claims audit and analysis and managed client relations in an analysis and collections division responsible for collecting health claims overpayments for health insurance clients based on coordination of benefits, claims processing errors, and Medicare primacy issues.• Created protocols to assimilate claims audit files into a 3-tiered evaluation and action process which increased volume of claims processed by 35% with no added staff.

• Directed product delivery, support services and client relations for healthcare technology/service company providing credentialing and Provider information services.• Led in-bound call center, data processing, billing functions, and human resources.• Directed strategic planning, market research, product development, marketing and sales activities supporting revenue base of $24M.