Managed Accountable Care Organization strategy by being responsible for the development and oversight of both performance and engagement plans between the ACO and Tufts Health Public Plans ensuring that our MassHealth population has the appropriate access and tools available to them to overcome daily challenges•Selected to develop and lead Tufts Health Plan’s largest ACO through all facets of EOHHS contractual requirements, inclusive of DSRIP reporting and payments, MassHealth rate setting, and compliance reporting•Responsibilities included overseeing cross-functional teams tasked with improving performance across financial as well as clinical initiatives, adhering to budgets totaling $45 million •Developed a strategy to identify members which were inaccurately assigned to either a PCP or an entirely incorrect ACO and facilitated the repatriation to the member’s selected ACO •Developed Prior Authorization Denial Reporting for ACO’s to facilitate an expected decrease of denials by 10% across certain procedures where PA’s are required•Conducted provider education training for ACO and Managed Care populations providers on referral circle and prior authorization logic•Oversight of all Joint Operating, Quality, Finance and Compliance Committees, inclusive of reporting, facilitation of discussion, as well as ensuring that deliverables arising from meetings were completed.

Strengthened Tufts Health Public Plans ability to compete with other Managed Care Organizations (MCO) by providing actionable reporting by marrying data and analytics with integrated case management for our Medicaid population. Tasked with streamlining Medical Loss Ratio with assistance of medical management, provider contracting and Integrated Care Manager leads, I utilized data mining and trends to reveal members who could benefit from greater medical care from both the MCO and Provider. Utilized strong project management skills for strategic planning initiatives within the corporation including on-boarding new partners, revamp old processes and created new ways to enhance our provider network. • Analyzed and validated reporting to provider network, senior medical leadership as well as the Commonwealth of Massachusetts. • Leader of our provider engagement initiative which sought to partner with Tufts Health Public Plans providers in managing patient care to achieve superior outcomes in terms of both cost and quality to benefit members, providers, the diverse communities we serve.• Worked with Case Management and Senior Medical Management to discover root cause, educate members/providers and decrease the utilization of high cost emergency room visits for low acuity events. • Understanding and presentation of medical economics cost and utilization reporting data for all alternative payment methodology clients. Ensuring that data is vetted and presented on a regular basis while being the first point of contact for all subsequent follow up queries. • Created policies and governance which standardized processes in roster reconciliation, claims and payment analysis process, government relations processes, high provide provider and escalated claims issues. • Oversaw web based data application which assists provider partners in monitoring leakage, high cost and high risk members, PCP membership and HEDIS quality metrics.

Streamlined and reorganized fund accounting teams and executed an end to end review of processes and workflows, identifying gaps and working with senior management to rectify. Mentored and led accounting teams ranging from two to sixteen direct reports, training them in methodologies and industry regulations. Established the Audit & Oversight team and successfully developed the audit arm of our clients business, as well as spearheaded the departments training needs. Ran daily and weekly client calls between auditors, client, tax departments and Financial Reporting through the end of each audit cycle successfully negotiating findings on behalf of our accounting and custody teams.• Coordinated and delivered reporting for internal and external audits including running communications between PwC auditors and our client. Established schedules, timeframes and deadlines in adherence with industry regulations and client demands.• Oversaw complex audit growth of fund base by 25% and 14% assets under management, historically decreasing expense to the client through LEAN practices, decreasing costs in reproducing financial statements. • Managed parallel transactions in two highly visible operations conversions at State Street, interfacing with IT to identify errors; followed by drafting procedures and ensuring go live transactions were accurate and seamless. • Liaised with confidential Client Capital Markets Custody teams in execution of trades, audits, testing and process management ensuring client satisfaction. • Created policies and governance which standardized processes in both derivative (futures) and Financial Account Standard Board regulation 157, eliminating errors (90% reduction) and gaining efficiencies across division and extending through the client relationship.• Developed and maintained Excel based recordkeeping system which ensured division compliance with all industry regulations including anti-money laundering, confidentiality and clean desk adherence.

Recruited by the internal Process Management Office, developed programs and exercises championing LEAN and Kaizen methodologies. Practical experience included the interpretation and explanation of statistical process control charting across functional operating units, effective business reporting and explanation of findings through Visio. Established a centralized intranet repository, creating the framework for reporting, training and organizational communication. Earned Advanced Mutual Fund Industry Certification; Mastery with Highest honors.• Lead exercises that follow process improvement methodologies to uncover root-cause, implement change and measure improvement, carrying over results throughout the organization. Utilized LEAN, Kaizen/PDCA and Benchmarking methodologies to achieve data and drive business strategies.• Worked collaboratively with IT to design and maintain web based process improvement tools.• Proved flexibility by stepping into a senior role and covering a vital operating unit when business needs dictated, ensuring service levels were maintained and operations team remained fully functioning.

Augmented a newly established mutual fund call center, quickly becoming one of the group’s supervisors; implemented a measureable focus to determine success, standardize training and rectify ongoing issues. Trained and mentored new hires and promoted employees • Ensured regulatory compliance across all nine separate mutual fund groups.• Monitored metrics to ensure that service levels were maintained on a daily basis, creating reports at month end for senior management. • Facilitated client and shareholder issue resolution through escalated items, maintaining service levels for response time and accuracy.

Processed defined contribution transactions for our plan administration teams. Earned the Trustar Superstar Award, the highest honor given by the company, for my accuracy, professionalism and work ethic. Commenced a client facing role as the liaison between corporate plan administrators, fund sales representatives, brokers and financial institutions. • Knowledgeable in IRS compliance rules and regulations set forth for defined benefit plans. Utilized knowledge of plan and contract documents, manuals, procedures, and company products to increase client base and profits.• Delivered timely and accurate retirement plan consulting to clients in small to mid-sized market.• Excellent comprehension, interpretation, analytical, and negotiation skills to resolve situations.

Oversaw data and voice markets sales processes for New England region, which included opportunity generation through cold calling and references, proposal presentation to identified decision makers, developing appropriate pricing plans and once sale is closed ensuring that installation is timely and accurate. • Sales performance- revenue generation for Fortune 500 Company through cold calling and networking. Once relationship established, responsible for client satisfaction and cross/up-selling.• Liaison between customer and self-appointed sales support team where I implemented orders and ensured that installation and porting/switchovers were seamless. • Sales quota overachievement for all 23 months, averaging at 110% across my tenure.