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A go to person who is dependable, accurate and efficient. You can rely on her to identify the root cause and ensure best business practices are in place. Pays attention to detail, brings order to chaos, and has an appreciation for efficient design and analytical assessment. Has been with Humana since 2001 and has extensive knowledge in Medicare Product Development, IT, Digital and Program Management. Has served in various leadership roles and has a solid member and provider journey understanding - from plan design, actuarial assessment, sales, enrollment, customer service, and claims to provider contracting and provider payment.
Humana
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- 36660
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Humana Insurance It: Portfolio LeadHumana Feb 2021 - PresentDesign Metrics and reports to measure portfolio health; Develop standards to be used across the team for portfolio management; Work with portfolio leaders within the IT team to ensure consistency in processes, methods and data; Actively guiding prioritization processes across multiple teams. -
Provider Development And Analytics: Tools And Process Program ManagerHumana Aug 2017 - Feb 2021Lousivlle, Kyo Develop, manage and align processes and tools related to contract renewals, new contracts and contracting related functions within the National Contracting organization and partners. o Manage cross functional relationships and bring complex projects to closure.Value Delivered o Hospital Contract Renewal Lifecycle: Proactively support hospital contract renewals allowing for tactical input on contract strategies. Ensure contracts pass through the review gates in a timely manner. o Contract Calendar Tool: Medium to share the Strategic Hospital Contracting view at a market, regional and national level, expanding tool to other provider types.o Hospital Cost Increase Simplification: A multi functional process for hospital escalators and chargemaster adjustments (Percent of Charge reimbursement). Analysis and process mapping have identified opportunities to decrease provider and member abrasion, improve data quality and data sharing along with simplifying the market’s administrative responsibility. o HCAP Accountability and Metrics: Creates an approval and escalation process for Hospital Contracts to mitigate financial or legal risks. Contracts that did not go through HCAP had a $14.9M increase from prior allowed dollars, based upon a repricing model for contracts. o Escalator analysis: – Identified opportunity costs ~ $16 M for 11 Systems/facilities over 2 yearso Chargemaster Increase Detection (CID): Tool compares facility claims data before and after a targeted month to detect changes in billed rates, alerting us to any suspect Chargemaster increases and potential financial offsets. Saves 1.7 hours per audit ~ 1,200 audits per year. Rule enhancements have saved another 75 hours per year.
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It Business Thought Leadership - Healthcare Services - HitHumana Jan 2016 - Jul 2017Lousivlle, Kyo Aligned HIT Business team to best support multiple external connection relationships and have an integrated solution delivery. o Revised internal reporting to efficiently share information and have the most current information.o Driving towards a reputation of collaborative, proactive, easy to work with, gets results and enjoys their work.o Leading a team of 20 through multiple changes – Strategic Corporate direction, potential merger with Aetna and team leadership modifications.
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Digital Program Manager, Digital Center Of ExcellenceHumana May 2013 - Jan 2016Lousivlle, KyAccomplishment: As the IDE Program Manager, was a key team member that integrated dozens of websites into a single responsive website with a best-in-class user experience personalized to different segment experiences. The multi-year program presented one face to our users, personalized the individual user experience, infused new branding throughout all digital assets and presented foundational technology platforms for seamless multi-channel service and community engagement. Established and refined monthly Release Reviews to ensure Development teams were on track for delivery and had the necessary support to work through any barriers. Provided broad visibility within a matrix business and IT structures. Led and mentored a staff of 10 Project Managers (contract and FTE). Responsible for hire, training and mentoring. Accountable for $10MM budget and associated controls. Controls included aligning Digital Center of Excellence scope, schedule and budget with IT. Facilitated Digital Center of Excellence and IT strategy and planning sessions for collaborative solution development. Responsible for program prioritization, dependency management and escalations. Established and maintained PMO standards and project auditing process. -
Product Implementation - Director And Process ConsultantHumana Oct 2004 - Apr 2013The conduit from Product Development to all operational areas (partners). Provided appropriate product education that compliments the partners business process ensuring an exceptional member and provider experience. Applied efficient and automated Product Development processes that guaranteed timely and accurate information to partners. The first line of support for the member experience working with partners to assess and resolve any abnormalities.Coordinated annual build of 500+ Medicare Advantage (MA), Prescription Drug Plan (PDP), Medicare Supplement and Medicaid plans. Worked with 4 Primary build partners and with over 16 ancillary partners to ensure plans are built on Humana’s systems on time and accurately. Developed detailed processes, procedures and task lists to ensure quality and timeliness. Includes change control process to manage the CMS filing and go live schedule. Team and build partner processes are merged to create an end to end process. Conducted annual process analysis to identify and implement improvements. Removed 42 days of keying and increased quality through New Plan Document (NPD) improvements.Managed annual benefit feasibility to ensure new or modified benefit concepts can be supported operationally. Sponsored and managed over $2.5 Million of IT spend for 2010. Led annual departmental business prioritization and justification for IT spend. Represented Senior Product Development on the Medicare IT steering committee that was responsible for a $15 million budget. Developed and implemented the Well Dine Food Program. This program provides meals to our Medicare members after an in-patient stay. Operationalized and managed the day to day operations and annual new market implementation. Oversaw vendor operations delivering 42,500 meals per month. Negotiated and implemented a revised contract that had a projected savings of $3 million while providing same services. -
Project ManagerHumana Mar 2001 - Sep 2004IT Project Manager and PMP certificationo Assigned to various IT projects and initiatives throughout Humana. Projects included Unique Member Identification, Humana FirstRate, Medicare 2005 Drug Transitional Assistance and Financial Recovery. o Applied all phases of Project Manager Principles. o Obtained Project Manager Professional certification in 2002. -
It And Business ConsultantKeane, Inc Oct 1996 - Mar 2000
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Mathematics EducatorShelby County Schools Aug 1989 - Sep 1996Shelbyville, KyMiddle School Math and Algebra Teacher – Taught over 150 students per day.KETS County Coordinator – Trained all math teachers on Mathematics Portfolio development and trained all teachers on Mathematics Portfolio scoring.Served as Middle School Girls Basketball Coach.Finalist for Shelby County Middle School Teacher of the year.
Beth Bates Skills
Beth Bates Education Details
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Mathematics And Computer Science -
Mathematics
Frequently Asked Questions about Beth Bates
What company does Beth Bates work for?
Beth Bates works for Humana
What is Beth Bates's role at the current company?
Beth Bates's current role is Humana Insurance IT: Portfolio Lead at Humana.
What is Beth Bates's email address?
Beth Bates's email address is bb****@****ana.com
What is Beth Bates's direct phone number?
Beth Bates's direct phone number is +150276*****
What schools did Beth Bates attend?
Beth Bates attended Belmont University, University Of Louisville.
What are some of Beth Bates's interests?
Beth Bates has interest in Children, Walking And Biking, Education.
What skills is Beth Bates known for?
Beth Bates has skills like Health Insurance, Process Improvement, Pmp, Medicare, Insurance, Business Analysis, Management, Employee Benefits, Business Process, Program Management, Vendor Management, Strategy.
Who are Beth Bates's colleagues?
Beth Bates's colleagues are Joanna Agin, Paula Wallace, Kanesha Tribble, Ryan Massa-Mckinley, Topaz Burres, Hang Cao, P Loving.
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