Beth West Email & Phone Number

Fargo, North Dakota, Us

Chesterfield, Missouri, Us

Applied 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.

Lansing, Michigan, Us

Maryland Heights, Missouri, Us

Served 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.

Louisville, Kentucky, Us

Senior 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).

Headed 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.

As 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.

Bachelor Of Science In Management - Cum Laude, Business Administration And Management, General

Associate Of Arts