• Develop, implement, and lead enterprise risk adjustment programs for Affordable Care Act(ACA) and Medicare Advantage business• Lead program vendor relationships, establishing clear performance goals and expectations • Apply knowledge of ACA and Medicare Advantage risk adjustment payment methodology to partner with enterprise stakeholders in improving care management • Build and lead cross-functional teams to develop processes for analyzing and responding to CMS data submission requirements• Analyze enrollment and claims data for patterns and trends to identify opportunity to improve documentation and coding

•Manage team to provide reporting and analytics for pilot programs in new venture, a subsidiary of Horizon Blue Cross Blue Shield of New Jersey

Created new department to manage submission of Medicare Advantage risk adjustment dataResolve claims and enrollment issues to maximize Medicare Advantage revenue Work with external partners to improve workflow efficiencies and ensure compliance with CMS guidelinesExplore opportunities for increased revenue using clinical, pharmacy, and other related data sources