Beth West Email and Phone Number
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I am a highly accomplished executive who is able to gain trust and confidence at all levels internally/externally to spearhead new objectives. I am skilled in brainstorming, developing, and leading Medicare Advantage (MA) products for measurable success. As an accomplished talent developer, I effectively improve the skillset of professionals to champion daily objectives with confidence. I am devoted to leveraging experience to create successful risk mitigation solutions and drive organizational goals. I demonstrate a comprehensive knowledge and understanding of health planning as well as cross-functional strategic initiatives and related impacts. I have been recognized for a strong work ethic, integrity, and a high degree of personal initiative.In 2020, I began a new role as Plan President with NextBlue of North Dakota, an affiliate of Blue Cross Blue Shield of North Dakota. Connect with me at bethann.west@nextbluend.com.A selection of career highlights includes:- At Humana, oversaw P&L and operations for 23 MA health plan products (HMO, PPO, DSNP, CSNP & PFFS) over two states with 90K members resulting in the largest MA plan with ~$72M annual revenue.- Pushed successful MA implementations for five HMO plans within five markets in a single year and supported resolution to various contract interpretation disputes. - Directed the development and operationalization of two Medicare Advantage Health Plans in two markets, utilizing several third-party vendors in under 18 months resulting in successful go-live within each market, meeting CMS/State compliance requirements.- Nominated and attended Humana’s Women in Leadership program and led Perfect Service program for region, which received Perfect Service Champion Award.
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Plan PresidentNextblue Of North Dakota Jan 2019 - PresentFargo, North Dakota, Us
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Vice President - Medicare Operations And ComplianceMercy Jul 2016 - Jan 2019Chesterfield, Missouri, UsApplied versatile experience to drive Medicare marketing initiatives, MA compliance, guidance, and performance/quality initiatives. Successfully provided leadership to health system for CMS provider compliance requirements. Drove teams to focus on financial and operational efficiencies and improvements. - Strengthened MA payor alliances, performance, and operations resulted in improved quality reporting, and improved accuracy in risk adjustment documentation and coding. o Stimulated growth and retention of Medicare beneficiaries by creating and establishing reliable Medicare Provider Marketing campaign resulting in resulting in ~2,000 new Medicare Advantage patients in first year and ~3,800 in second year. o Enhanced compliance program to meet CMS specifications for providers and employee compliance requirements. - Architected and instituted program to adhere with regulatory specs for health plan licensure. - Guided large health system with locations in four states into CMS/Medicare Advantage Compliance for providers, first tier/downstream entities. - Gained efficiency, accuracy, and organization of all health plan attestations resulting in the ability to identify and rectify areas of non-compliance and risk exposure. - Instituted a new training program by integrating new-hire and annual training modules.- Developed external notification and oversite requirements for downstream entities while mitigating risk.- Identified and drove key independent broker partnerships to support patient growth initiatives while remaining compliant. Resulted in gaining alliances with key brokers and increasing senior community presence and support. -
Plan President - North DakotaEmergent Holdings Nov 2019 - 2019Lansing, Michigan, Us -
Top Performing Healthcare Executive | Director Of Operations | Strategic & Visionary LeaderLumeris Nov 2014 - Jun 2016Maryland Heights, Missouri, UsServed as collaborative partner and advisor with multiple regional payors in creation and establishment of combined MA plan and population health management solution. Formulated plan to merge accountable care expertise and tools with MA provider network onboarding. - Improved professionalism of accountable care advisors and other operational leaders/teams to successfully service multiple clients. - Coordinated multiple internal teams, third party vendors, and customer (health plan) teams/departments organizations to create and implement operational plans to facilitate best-in-class service, compliant, and expected results for MA plans. - Successfully recruited through extensive industry network an experienced staff to build top-performing teams. -
Director Of Medicare Senior OperationsHumana Health Plan, Inc Jan 2003 - Oct 2014Louisville, Kentucky, UsSenior leader for central region Medicare segment with 150k+ MA members. Drove operational effectiveness and led development, organization, and implementation of multiple new HMO, PPO, SNP (Special Needs Plans), DSNP (Dual Special Needs Plans or Medicaid MA Plans) and CSNP (Chronic Special Needs Plan) product offerings across four states. Instituted and delivered visionary leadership of provider consulting team and activities. - Successfully orchestrated the development of the provider network, training providers, and sales agents/brokers.- Sold the HMO model/concept to both the providers and brokers/agents by ensuring all the tactical operational needs were met including claims, authorizations, referrals, and member/provider materials in order to meet CMS requirements, deadlines, and timelines.- Pursued and gained acceptance and cooperation of physicians and hospitals in five states for new MA products. - Recruited new team, and implemented new initiatives and programs to augment physician performance in quality, coding/documentation, and cost management. - Parlayed with influential health systems and key providers allowing for a progression from fee-for-service models to pay-for-performance models to partial and full risk contracts which resulted in providers obtaining financial incentives and improved health plan financials. - Coordinated implementation of initial Medicare Risk Adjustment program to yield increased premium of $10M+ per annum. - Spearheaded provider acceptance of multiple PFFS products across four states which exceeded company target of 95% and established the acceptance of managed care products (HMO & PPO). -
Director Of Market AdministrationHumana Health Plan, Inc. Oct 1998 - Dec 2002Headed all commercial and MA product regional operations. Focused daily on delivering exceptional leadership of multiple departments, including provider relations, contract administration, referral authorization, credentialing, and office operations. Transitioned and subsequently led referral process unit and supported multiple service center transitions. Strongly involved in restructuring the company focus from Commercial to Medicare by successfully assessing, recommending, and executing changes. Acted as company representative throughout several lawsuits resulting in all three being settled. All three were settled. - Employed negotiation skills to rectify multiple disputes regarding contract interpretation, administration and settlements, as well as legal cases impacting market position. - Improved efficiencies by automating and streamlining administrative functions resulting in significantly reduced administrative costs.- Boosted provider e-enablement initiatives to yield 20% increase in electronic claim submissions. - Elevated financial performance by completing and strategically operationalizing new and amended contracts.
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Director Of Contracting & OperationsHumana / Med-Pay, Inc. Apr 1994 - Sep 1998As Director of Contracting and Operations, I pursued and secured contracts with physicians and ancillary providers. I served as key leader and contributor in negotiations with large health systems, and led operations in acquisition and sale of third-party administrator (Med-Pay). Below is a small sampling of my achievements in this position: > Established and managed multiple provider networks to meet needs of Humana and Med-Pay (TPA). Led Med-Pay sale divesture and Humana departure from market. > Developed and led transition plan for closure of market office and business distribution and run-out. > Developed and led local Customer Service team. > Operationalized, managed and maintained global risk arrangement. > Facilitated commercial sales and renewal activities. > Envisioned and implemented plans that successfully enlarged provider network by > 20%. > Established first satellite office for statewide operations to support commercial business expansion.
Beth West Skills
Beth West Education Details
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Baker UniversityGeneral -
Metropolitan Community College, Kansas City, MoAssociate Of Arts
Frequently Asked Questions about Beth West
What company does Beth West work for?
Beth West works for Nextblue Of North Dakota
What is Beth West's role at the current company?
Beth West's current role is Plan President | Simplifying Medicare plans for North Dakotans.
What is Beth West's email address?
Beth West's email address is be****@****ods.com
What is Beth West's direct phone number?
Beth West's direct phone number is +181635*****
What schools did Beth West attend?
Beth West attended Baker University, Metropolitan Community College, Kansas City, Mo.
What are some of Beth West's interests?
Beth West has interest in Senior Care And Support, Gardening And The Outdoors, Reading, Challenges And Opportunities, Leadership Growth Opportunities.
What skills is Beth West known for?
Beth West has skills like Medicare, Health Insurance, Insurance, Process Improvement, Provider Relations, Healthcare, Leadership, Hospitals, Employee Benefits, Managed Care, Healthcare Industry, Physicians.
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