Gary Billy Email & Phone Number

Hartford, Connecticut, Us

Hartford, Connecticut, Us

■ Accountable for provider services, claims, member services, grievance and appeals, enrollment operations and informatics for a $1.1 billion and 295,000 lives managed statewide Medicaid and CHIP plans. Membership increased by 60,000 Medicaid lives during operations tenure.■ Achieved an annualized $4.1 million medical cost reduction thru a key hospital renegotiation.■ Expanded CHIP service area by 23 counties and received regulatory approval for the first over the counter card member benefit.

■ Consulted on Virginia Medicaid Medallion and MLTSS product lines for a health plan regarding QNXT claim system configuration. Identified $1 million in overpaid claims, developed criteria for nursing home claim payment accuracy reports and recommended system configuration changes.

■ Provide leadership oversight to the call center and enrollment operations for a 400,000 lives managed Medicaid plan with offices located in Massachusetts and New Hampshire. Achieved a 15% increase in member Medicaid recertification rates from historical rates through process redesign initiative.■ Operations advisor for the Massachusetts Senior Care Options program, a fully integrated dual eligible Medicare and Medicaid product. Developed, implemented and monitored a 13-month strategic plan to stabilize dual eligible product line financial performance.

Long Beach, California, Us

Molina Healthcare acquired Total Care in August 2016.■ Executive Sponsor Team member charged with migrating core system to TriZetto QNXT v5.3 core system.■ Developed strategic framework for value based contracting with key provider groups. Directed provider network re-contracting efforts. Re-contracting efforts improved claims administration and resulted in an estimated $3 million annual savings.

White Plains, Ny, Us

■ Responsible for directing and managing the operation and financial performance, including P&L accountability, for a $144 million and 39,000 lives managed Medicaid plan in Upstate New York.■ Financial improvements achieved thru identification and recoupment of improperly paid transportation benefits, improved system configuration and reduced implementation cycle time of claims editing software. ■ Achieved annual savings of $1.5 million by implementing McKesson ClaimCheck claim editing software.

■ Consulted on Medicare application, operational gap analysis and operational implementation of a start-up integrated Medicare and Medicaid plan that serves dual eligibles.

Cambridge, Ma, Us

Transformed underperforming operational functional areas into four organized high performing departments. Operational transformation was achieved over six years during 17% year over year average growth. Transformation accomplished through hands on leadership; data-driven decision making; identifying, attracting and retaining top talent; developing controls through operational policies and process workflows; measuring key performance indicators and implementing multiple software systems.■ Business executive in charge of system conversion to TriZetto QNXT v5.1 core system. Decision maker for system configuration, Optum iCES claim editing system and data conversion for ten month core system implementation. Project completed on time and under $6 million budget.■ System conversion increased claim auto-adjudication rates by 27%.■ Responsible for claims, core system configuration/model office, enrollment, revenue reconciliation, provider data management, contract oversight and vendor network management departments for a $430 million two state integrated Medicare and Medicaid dual eligible special needs plans (FIDE SNP).■ Reduced Massachusetts Medicaid historical payment discrepancies from $5 million to $1.8 million.

Cambridge, Ma, Us

■ Managed claims, provider data management, credentialing, contract oversight and vendor network management departments.■ Achieved $1.6 million savings by implementing Bloodhound claims bundling system.■ Migrated legacy credentialing database to Intellicred software.

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■ Developed and implemented project plans to streamline business processes and to migrate administrative platforms for acquired Medicare and Medicaid business. ■ Managed cross functional implementation project teams within a matrix organization.■ Completed the AARP Secure Horizons Arizona administrative platform migration in six months.

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■ Responsible for directing the day-to-day operations for a $156 million managed care company, consisting of several Medicare and Medicaid products across multiple markets.■ Led operations start-up of Evercare Senior Care Options program, first dually eligible integrated Medicare and Medicaid product in the country. Responsible for regulatory CMS and MassHealth readiness review.■ Managed provider relations, sales support, enrollment processing, claims resolution and operations staff.

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■ Identified and recovered $2.3 million underpayments from Medicare.■ Supervised provider and member services, enrollment, and referral authorization functions.■ Developed infrastructure for information systems interfaces.

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■ Led MetraHealth provider network information systems integration efforts.■ Audited information systems for claim payment accuracy regarding contracts.

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■ Achieved 12% physician medical cost reduction for the New Hampshire service area.■ Conducted financial analysis for three state service area regarding provider contracts.

Minneapolis, Mn, Us

Patient Focus Care Project Team: ■ Co-led process re-engineering efforts for the Rehabilitation, Orthopedic, Neurology and Epilepsy inpatient units. ■ Implemented improvements to anesthesia clinic admission process.Ambulatory Care Facility Planning Project Team Member: ■ Served as diagnostic work group leader. ■ Determined space, staffing and diagnostic equipment expenses for $15 million ambulatory program.

Master'S Degree, Health/Health Care Administration/Management

Bachelor Of Science (Bs), Health Policy And Administration