Joann Peck Email & Phone Number

Canton, Massachusetts, United States

- Manage team of Operations Specialists, Claims and Provider Appeals Analysts, with oversight responsibility for escalated provider claims issue resolution, provider appeals management, vendor management and internal, cross-functional operational projects. - Oversee the daily management of other Operations Support functions such as Ika claims system role management, high dollar claim reviews, provider termination notices to members, Corrective Action Plan (CAP) tasks and other operations support activities.- Manage cross functional Claims Issues Resolution Workteam and the Harvard Pilgrim/Beacon Claims Configuration Workgroup, and provide management support for the Beacon Joint Operating Committee and the Medicare Advantage Operations Committee. - Provide technical support, direction and guidance to ensure delivery of compliant operations, with a focus on continuous improvement, efficiency and constituent satisfaction. - Lead implementation of new product, regulatory and process improvement initiatives in accordance with budget and target time frames. - Investigate and facilitate resolution of broad, high impact claims issues identified by internal and external stakeholders.- Plan and prioritize work plans to ensure completion of Medicare Advantage Operations business processes and reporting.

Greater Boston Area

Minuteman Health Inc. (MHI), offered innovative, narrow provider network, cost effective products in Massachusetts and New Hampshire through 2017. MHI unfortunately did not receive approval to sell health insurance plans on the Massachusetts and New Hampshire state exchanges, as of January 1, 2018. Therefore, its previous vendor and my former employer, Provider Network Alliance, closed down its operations, effective December 31, 2017 and MHI also closed down its operations in mid-2018. In order to support the run-out of the organization, I continued as Director of Provider Relations for MHI, in the same capacity as while I was employed by their previous vendor, Provider Network Alliance.

Greater Boston Area

Provider Network Alliance (PNA), the exclusive network partner for Minuteman Health, Inc. (MHI), was a group of innovative, cost-effective providers in Eastern Massachusetts with a commitment to coordinated, community-based care. PNA closed down its operations, effective December 31, 2017, when MHI, its sole client, announced its upcoming organizational closure.- Effectively established and maintained strong, positive relationships with PNA's largest and most critical contracted provider organizations in Massachusetts, instilling credibility and trust.- Successfully led provider education and communications initiatives, including the development and distribution of provider satisfaction surveys, educational presentations/tools and the implementation of enhancements to web content.- Conducted new and existing provider orientation sessions, including training on narrow provider network, products, provider web portal, and processes/policies for claims submission, prior authorization, utilization management and care/disease management.- Resolved escalated contractual payment and service related issues for providers, including root cause analysis and collaboration with client and vendors to implement service improvements.- Acted as point person for client regarding escalated provider network access issues and monthly performance reporting on enrollment, contracting, escalated issue resolution, credentialing and re-credentialing.- Following organizational restructuring in early 2017, acted in a leadership capacity, collaborating internally to document and redesign all existing processes, to achieve operational efficiency through automation and process improvement.- Effectively represented PNA on cross-functional committees, including Quality Improvement, Appeals and Grievances and Provider Credentialing Committees.- Collaborated with client to create formal responses to regulatory requests from NCQA and state regulators.

Quincy, Massachusetts

- Effectively led the Member Appeals and Grievances team, responsible for researching, resolving and responding to appeals and grievances, including regulatory, legislative and executive inquiries/complaints.- Implemented formal appeals and grievances quality audit program to ensure compliance with all state, federal and NCQA regulatory requirements.- Effectively collaborated with the Blue Cross Blue Shield of MA executive office and public affairs to communicate potential public relations risks, specific to appeals and grievances.- Applied superb written and verbal communication skills to clearly and concisely communicate complex concepts and policies, internally and externally.- Successfully defused potential escalated case and facilitated complex, sensitive discussions with internal and external business partners as necessary. - Tracked and trended appeals and grievances data and decisions in order to make recommendations for improvement related to product, benefit and medical policies.

Quincy, Ma

- In addition to continued management of Provider Communications and Education functions, promotion by Vice President, Provider Network Services, significantly expanded responsibilities to also include management of vendor contracting and departmental business planning and administration functions, oversight of key initiatives project management, responding to strategically important employer RFPs and tracking of departmental goals and accomplishments. - Successfully managed team responsible for provider communications and education, including newsletter writing, training, policy/process documentation and redesign, web management, Provider Manual maintenance, project management and vendor contracting (behavioral health, high end radiology, sleep management and national network vended contracts.)- One of several project leads responsible for successful expansion into CT and launch of Medicare Advantage provider network, to support product implementation. Collaborated closely with provider enrollment, credentialing and provider network contracting to ensure compliance with all CMS regulations and network adequacy prior to product launch.

- Effectively led team of Communications and Education Specialists responsible for internal training of provider network-facing staff, external communications to Harvard Pilgrim’s contracted provider network, end-to-end communication planning and project management, publishing Harvard Pilgrim’s monthly provider e-newsletter, targeted provider communications, employer RFP responses and maintenance of HPHC's Provider Manual and internal/external provider Web sites.- As a result of provider focus group and survey results, successfully led five-month implementation to consolidate two print provider newsletters into one e-newsletter for the entire contracted provider network, achieving savings of $70,000/yr.- Effectively led First Seniority Freedom product cross-functional provider marketing and communications team, working collaboratively with management and executive level staff in Sales, Marketing, Provider Network Services, Provider Relations and Medicare Compliance, to ensure adequate product awareness/acceptance and provider network participation.- Implemented several significant process improvement/cost savings initiatives, including updating claim system mailing file specifications to ensure provider mailing list accuracy, resulting in a significant reduction in returned mail, redesign of the Provider Manual updating process to support real-time accuracy of content, redesign of the external Provider web site, and cross training efforts to support staff development and targeted efficiencies.- Successfully negotiated ongoing cost reductions with external print vendors to achieve projected departmental savings, when the audience for the provider newsletter grew at a more significant than anticipaed rate.

Quincy, Ma

Successfully negotiated and managed contractual arrangements with strategically significant vendors that administered behavioral health services, radiology imaging, cardiac, high risk and rare disease management, and national provider networks.

- Held sole responsibility for management and oversight of all operational aspects of the Behavioral Health sub-contract and relationship, including ongoing vendor performance management and monitoring.- Acted as a key direct contact for internal customers dependent upon the daily work and general performance of the Behavioral Health vendor, and for external customers seeking information and problem-resolution. - Acted as key leader responsible for all internal and external communication related to the 2005 Behavioral Health Contract Implementation, while managing Harvard Pilgrim’s previous Behavioral Health vendor throughout 2004.

Quincy, Ma

Boston, Massachusetts

Graduate Program Certificate, "Leadership For Change"; Sociology And Business

Bs, Psychology

Mathematics

Activities and Societies: Womens Gymnastics Team