Denise O'Driscoll Email and Phone Number

• Served as IT Lead for Claims & Encounters, Product & Benefit, and Premium Billing and Enrollment project triads in global design and “ready to bill” phases of internal FACETS system transition.• Coordinated with stakeholders to facilitate resolution of any dependencies.• Partnered with Product BA’s, Enterprise Architects, Solution Architects, the externa vendor and operational SME’s to ensure seamless transition planning and prioritization.

• Led Provider Network and Configuration teams managing legacy PACE clients as well as existing and new implementation of Medicare Advantage clients.• Spearheaded automation efforts enabling batch processing and creating auto-adjudication rules to speed payment turnaround time and reduce claims backlog.• Partnered with Cognify to transition several key support processes to PEAK.• Created documentation and work processes for multiple departments in the organization to enable cleaner processing of claims• Partnering with Calibrated on system enhancements, auto adjudication efforts, and other system functionality in order to become EZNet “Super User” • Key player in onboarding four new clients since December (Pace, Medicare Advantage, and MLTC products)• Heavily involved in research and root cause resolution for new implementation Configuration, Claims, and Provider Data challenges for both Pace and Medicare Advantage/MLTC clients.

• Identified approx. $7.4M in overpayments, and resolved the underlying root causes and process gaps to ensure future cost avoidance and ongoing accuracy• Partnered with executive leadership and front-line claims at Magellan’s TPA to automate multiple claims processes and increase Auto-Adjudication rates by 20%• Led successful implementation of Medallion Medicaid 4.0, and Virginia Medicaid Expansion in January 2019• Represented Health plan for readiness review activities with HSAG and the state of Virginia. Worked with state officials, plan executives, and Provider associations, as well as internal IT, Configuration, Training, and Reporting teams to ensure all deliverables were clearly documented and timelines were met

*Assist in Resolution of Resolution of Operational Issues for MMP, LTSS, and ABD Plans throughout the Enterprise for all areas of Health Plan Operations including Provider Data Management, Claims, Medical Management, Call Center, Configuration, EDI, Encounters, Regulatory & Compliance, and IT Operations.*Development of Cost-Savings initiatives and Overpayment Recovery Opportunities for Complex Care Plans*Process Improvement and Automation Optimization to increase Auto Adjudication rates and decrease claims payment errors*Implementation and RFP Support for New Plan proposals and Implementations*Interfacing with internal and external partners to ensure prompt resolution of operational issues and to ensure that any identified issues are communicated enterprise-wide to maximize visibility and minimize customer impact.*Led Implementation of Claims Operations for PA Health & Wellness Health Plan*Worked extensively with Nursing Facility Association & State Partners to partner on rate setting methodology and system set up*SME on Claims & Configuration for PA Market

•Management of Configuration, Claims Liaison, and Provider Data Management staff dedicated to Multiple product lines including Medicaid, Nursing Home Diversion, and Long Term Care •Lead team of Subject Matter Experts to ensure accurate and timely system configuration and Provider setup to minimize claims payment errors•Lead Claims implementation efforts for statewide MMA expansion, while continuing support and ongoing implementation efforts around Long Term Care ImplementationWork with Multiple Health Plan and Corporate partners to ensure efficient and timely claims operations

•Management of Configuration, Claims Liaison, and Provider Data Management staff dedicated to Multiple product lines including Medicaid, Nursing Home Diversion, and Long Term Care •Lead team of Subject Matter Experts to ensure accurate and timely system configuration and Provider setup to minimize claims payment errors•Lead Claims implementation efforts for statewide MMA expansion, while continuing support and ongoing implementation efforts around Long Term Care ImplementationWork with Multiple Health Plan and Corporate partners to ensure efficient and timely claims operations

•Management of Configuration, Claims Liaison, and Provider Data Management staff dedicated to Nursing Home Diversion and Long Term Care product lines.•Lead team of Subject Matter Experts to ensure accurate and timely system configuration and Provider setup to minimize claims payment errors•Lead Claims implementation efforts for Long Term Care expansion and support ongoing Nursing Home Diversion operations

•Management of several Key Provider relationships as it relates to claims payment issues and A/R management•Identification of configuration issues and root cause analysis to determine underlying problems driving incorrect claims payment•Research and processing of claim overpayment recoveries•Ad Hoc reporting needs•Quality review of submitted claims projects•Administration of Compliance 360 workflow for plan claims projects•Various other duties and research projects as needed

•Reporting and Analysis for Centene Specialty Companies•Processing of Long Term Care Referral Lag Estimates and Long Term Care Paid dollar reporting to support month end close.•Processing of monthly Compliance Claims Dashboards•Other various analyses as requested to support Claims and Financial Operations.

• Analyze the performance of the claims operation and identify the root cause of any deficiency. • Develop and implement root cause solutions. • Work cross functionally to manage solutions to completion. Interact with Configuration, Provider Data Management and the Claims Operation to ensure overall solutions are deployed. • Work directly with assigned plan to deliver the services required for excellent claim service. • Perform financial and operational analysis at the specific plan level. • Maintain detailed project documentation such as action items and issues lists. • Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and company’s objectives. • Perform user acceptance testing for claims. • Develop and implement required process documentation.

Responsible for collections of aged Home Infusion therapy claims. Top collector Dec 2000-March 2001