• Successfully managed highest revenue HPS managed care client, i.e., CountyCare Health Plan (CCHP).• Established trusted relationship with the CCHP CEO and executive team that led to genuine business partnership with Evolent, willingness by CCHP to contract for expanded Medicaid and Medicare services, and CCHP becoming a client for reference. Improved operational performance of Evolent delegated services including Enrollment, Claims/ Encounters, Configuration, Call Center, Provider… Show more • Successfully managed highest revenue HPS managed care client, i.e., CountyCare Health Plan (CCHP).• Established trusted relationship with the CCHP CEO and executive team that led to genuine business partnership with Evolent, willingness by CCHP to contract for expanded Medicaid and Medicare services, and CCHP becoming a client for reference. Improved operational performance of Evolent delegated services including Enrollment, Claims/ Encounters, Configuration, Call Center, Provider Relations, Grievances and Appeals (G&A), Utilization Management (UM), ProviderData Management (PDM), Data Analytics and Reporting, Print Fulfillment, Finance, Payment Integrity offerings (FWA, COB, Subrogation and Data Mining) and interfaces with multiple specialty vendors and care management entities (CMEs).• Brokered significantly reduced member rate for a subset of acquired member population during CCHP acquisition of approximately 260k Medicaid members after Illinois MCO re-procurement.• Led market and cross-functional teams in operationalizing plan membership growth from 145K to approximately 330K in several months’ time. • Successfully negotiated the new state contract between Evolent and CCHP based on new HFS MCCN agreement.• Key leader in the organizational transformation from typical third-party administrator (TPA) client-agnostic operating model to a client-centered operating model (CCOM). Established MCO-like structure that included a COO reporting to market president and client dedicated and accountable staff from each functional area. Effectively created a collaboration and communication paradigm that brought together cross-functional staff as One CountyCare (1CC) team. The effect of establishing the 1CC team was month-over-month improvements in SLAs, and a marked increase in employee engagement. Show less

• Managed key operational areas at oldest and most established Centene MCO offering core Medicaid and specialty services. Gained valued experience in credentialing process and workflow.• Managed internal/ external teams in the goal of meeting contractual SLAs for health risk assessments (HRAs), health risk surveys (HRSs) and care plan creation.• Partnered with Texas plan to introduce a data transformation software solution, Astera, that enabled non-technical staff to create custom and… Show more • Managed key operational areas at oldest and most established Centene MCO offering core Medicaid and specialty services. Gained valued experience in credentialing process and workflow.• Managed internal/ external teams in the goal of meeting contractual SLAs for health risk assessments (HRAs), health risk surveys (HRSs) and care plan creation.• Partnered with Texas plan to introduce a data transformation software solution, Astera, that enabled non-technical staff to create custom and repeatable data mapping scripts to transform disparate provider roster files and methods into a standard file inload format.• Led call center staff in operationalizing the management of risk adjustment (RA) member candidates through outbound calling and engagement, appointment scheduling with physicians visiting homes, visit tracking and outcomes, and performance reporting.• Effectively introduced the provider workplan to provider relations staff and created a collaborative process with the claims team which resulted in more efficient and expedient provider claims resolution.• Introduced sophisticated and scalable outbound calling solution, Eliza, that enabled customized scripting for P4P, STARS and other revenue generating initiatives requiring member connection and action. Solution enabled the automatic receiving and translating of member voice response into electronic data that could be loaded into data warehouse. Show less

• Worked closely with plan CEO and collaboratively with fellow senior leadership team to create impactful enterprise strategy and roll out in synchronous and effective manner.• Started the health plan’s first project management organization (PMO) which dramatically reduced the time needed, and increased the success rate of key business initiative implementation.• Supported operations including Call Center, Member & Provider Services, Enrollment, Claims/ Encounters, Configuration, Audit/… Show more • Worked closely with plan CEO and collaboratively with fellow senior leadership team to create impactful enterprise strategy and roll out in synchronous and effective manner.• Started the health plan’s first project management organization (PMO) which dramatically reduced the time needed, and increased the success rate of key business initiative implementation.• Supported operations including Call Center, Member & Provider Services, Enrollment, Claims/ Encounters, Configuration, Audit/ Recovery, PDM and Reporting for multiple lines of business including ICP, FHP/ACA, MMAI and Marketplace.• Effectively managed the exponential membership increase related to becoming TPA for CountyCare, and the introduction of new lines of business including FHP/ACA, within the same year. Rapid hiring, real-estate expansion and the creation and management of new and scalable processes were essential to success.• Created a customized Issue Workflow System using Intuit Quickbase to provide a more effective means for claims and provider relations staff to collaborate, prioritize and resolve issues. • Introduced new process and rigor around the management and resolution of claims issues through formal provider workplans. Solution significantly increased provider confidence and satisfaction and produced more expedient resolution of priority claims issues and projects.• Intentionally and effectively established trusted relationships with Centene corporate leaders supporting health plan functions including claims, configuration, PDM, and encounters. Relationships with these and other health plan leaders were instrumental in maximizing the effectiveness of shared tools, resources and latest corporate developments.• Directed staff and created processes to maximize Marketplace/ Ambetter enrollment through find-a-provider (FAP) auditing and reporting, data cleanup and compliance-related efforts. Show less

• Strategic account management of highest revenue clients; assets under Morningstar management exceeded $20B.• Built trusted relationships with key decision makers, creating solutions to meet client’s business needs and priorities.• Ensured client solution success through the effective management of all aspects of the relationship including product development, operations, quality assurance, marketing, legal and compliance.• Negotiated the best terms for contracts through detailed… Show more • Strategic account management of highest revenue clients; assets under Morningstar management exceeded $20B.• Built trusted relationships with key decision makers, creating solutions to meet client’s business needs and priorities.• Ensured client solution success through the effective management of all aspects of the relationship including product development, operations, quality assurance, marketing, legal and compliance.• Negotiated the best terms for contracts through detailed understanding of terms and agreements, benchmark analysis, risk evaluation, variable revenue forecasting and effective compromise.• Project management of new client solutions through detailed project planning, collaboration and cross-functional management of internal and external resources. • Served as product subject matter expert, understanding feature details and investment methodology in order to demonstrate to current and prospective clients in a clear and convincing manner. Show less

• Managed the successful implementation of Morningstar’s web-based defined contribution suite of advice products for large revenue, business-critical institutional clients. Effectively led implementation teams in product definition, client relationship management, technical management and quality assurance.• Developed deep understanding of products and investment methodologies to effectively lead implementations, train and support clients, and present superior product capabilities to… Show more • Managed the successful implementation of Morningstar’s web-based defined contribution suite of advice products for large revenue, business-critical institutional clients. Effectively led implementation teams in product definition, client relationship management, technical management and quality assurance.• Developed deep understanding of products and investment methodologies to effectively lead implementations, train and support clients, and present superior product capabilities to prospective clients. • Partnered with business development leaders to ensure solution and product proposal alignment with client needs and internal operational capacity. Advised senior leadership regarding operational progress and audit issues.• Effectively partnered with marketing and design teams; worked closely with legal and compliance to ensure solutions met SEC and NASD regulatory requirements. Show less

• Served as SBU’s technical leader in the requirements and design phase of $10M web site initiative with Microsoft IT partner.• Led application and database development teams in the design and development of a web-based solution to collect prospectus data from mutual fund companies. Also, led multiple technical/ QA teams in a variety of new development and system support efforts.• Successfully presented value proposition to CEO and incorporated a vendor software solution, FileAid, that… Show more • Served as SBU’s technical leader in the requirements and design phase of $10M web site initiative with Microsoft IT partner.• Led application and database development teams in the design and development of a web-based solution to collect prospectus data from mutual fund companies. Also, led multiple technical/ QA teams in a variety of new development and system support efforts.• Successfully presented value proposition to CEO and incorporated a vendor software solution, FileAid, that eliminated reliance on programmers and enabled non-technical staff to create high-revenue custom financial data feeds for institutional clients. Solution dramatically reduced the time, cost and effort to produce custom data feeds.• Hands-on experience using Oracle, Microsoft SQL Server and .NET application development framework. Show less

• Led team of software and database developers in the creation of a homegrown, mission-critical Cash and Portfolio Management System for Asset Management personnel and CNA traders. Product aggregated data in a real-time manner from disparate information sources including Bloomberg, the DTC and Maximus investment accounting system. Solution capabilities exceeded expectations of business leaders and parent company, Loews Corporation, which enabled generous funding of future… Show more • Led team of software and database developers in the creation of a homegrown, mission-critical Cash and Portfolio Management System for Asset Management personnel and CNA traders. Product aggregated data in a real-time manner from disparate information sources including Bloomberg, the DTC and Maximus investment accounting system. Solution capabilities exceeded expectations of business leaders and parent company, Loews Corporation, which enabled generous funding of future releases.• Managed the design and development of a new Securities Settlement system. Responsibilities included business discovery, requirements definition, vendor management, project planning, hardware acquisition and quality assurance testing. In addition, led business and technical teams in the creation of multiple investment software solutions.• Evaluated a plethora of software solutions for enterprise data and reporting needs and implemented new solution, Forest & Trees, as new and improved corporate solution standard.• CARE Award recipient; annual company-wide award involving nomination by business, technical leaders and peers. Show less