• Developed and led cross-functional teams to support all contractual agreements (Claims Processing, Customer Service, Quality, Payment Policy, Production, Process & Innovation). • Fostered work culture of collaboration and inclusion to increase morale and reduce turnover, creating a positive work environment with clear expectations and support systems in place.• Supported Product leadership with the review, prioritization and execution of strategic initiatives. Liaised with leadership team to drive initiatives contributing to monthly/annual metrics.• Implemented cost-saving measures through process improvements, automation, effective resource allocation and budget management. • Developed strong relationships with key industry partners, fostering collaboration and mutual growth opportunities.• Created an agile working environment, enabling rapid response to changing business needs without sacrificing quality or performance standards.• Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.• Successfully managed budgets and allocated resources to maximize productivity and profitability.• Streamlined and monitored Quality programs to alleviate any potential compliance issues

Oversee Audit Operations for 14 Commercial and Medicaid clients, resulting in the maximum identification of valid claims and overpayment recoveries achieving company goals.• Develop and maintain departmental budgets and monthly forecasting.• Achieve Continuous Improvement objectives for efficiency, productivity and operational costs• Develop and implement process improvements to achieve cost-effective mechanisms for increasing results (Bulk Loading, Automation, off-shore resources).• Troubleshoot and resolve client problems and conflicts, including direct communication with clients to reach mutually acceptable resolutions and lead the implementation of all applicable solutions.• Ensure compliance with all HIPAA regulations regarding the safeguarding of Protected Health Information (PHI) through best practices and effective communication with all associates involved in the audit process.• Assume a leadership role in ongoing efforts to research, plan and implement innovative solutions and audit concepts to optimize results and efficiencies.• Partner with Cotiviti client-facing colleagues on contract renewals and RFP responses process by identifying gaps in current contracts to increase potentials for contract renewals, recommending contract terminations or scope changes, through problem definition and client profitability analysis.

Lead and manage a team of policy analysts and clinical coders responsible for HPHC’s annual and quarterly code updates, the development and management of 90+ payment policy and billing guidelines, implementation and maintenance of HPHC’s clinical/coding editing software; iCES (generating an estimated savings of $50+ million/year) and the IC process requiring review of over 30,000 claims annually. Responsibilities also include Chair a cross-functional team that includes manager level representatives from across the company responsible for approving the evaluation, proposal and recommendation to HPHC Senior Leadership for Payment Policy change. Serve as a SME on various corporate initiatives such as Systems Migration, Cost Savings and Containment, ICD-10 conversion, Medical Policy coding and implementation, Code Governance, Network Operations and other initiatives as needed. Act on behalf of the Director, when required.

Provide strategic direction for the audit and recovery staff with an annual overpayment recovery goal of $15M+. Responsible for the financial management and integrity of the department’s recoveries. Identify, develop and lead business processes and workflows that achieve improved organizational performance (including root cause, corrective action plans, technical improvements and identifying corporate resources required for remedial action). Provide subject matter expertise to BCBSRI internal and external stakeholders. Ensure compliance to all federal and state regulatory mandates, BCBSRI policy, Correct Coding Initiatives and ethical standards. Successfully implemented an audit documentation and integrated workflow system, eliminating hard copy documentation and storage cost. Results included increased recoveries from $3.7M in 2005 to $10.2M in 2011, with an incremental savings of $8.1M due to root cause resolution.