Direct bureau operations which include reimbursement policy and methodology development; program and administrative budgeting and oversight; audit coordination for the division; federal reporting and analytics. Implement and interpret pertinent law to ensure compliance including review of proposed changes to current law and regulation. Ensure compliance with federal and state regulations (e.g., Upper Payment Limits). Manage diverse staff of actuarial specialists, financial managers, auditors and other personnel.

Direct bureau operations which include medical policy and scope of coverage determination; pharmacy coverage (DUR, PDL, etc.); reimbursement policy and methodology development; and State Plan and Administrative Rule-making amendments and development. The bureau responsibilities account for over $1 billion in annual expenditures.Implement and interpret coverage policy and ensure that is is in concert with the goals and objectives of the department and division.Ensure compliance with federal and state regulations (e.g., Upper Payment Limits, Access to Care)Manage diverse staff of Medical Doctors, Registered Nurses, Pharmacists, actuarial specialists, and other program personnel.

Designed and implemented rate setting methodologies for Utah Medicaid long-term care providersCalculated fee-for-service rates for Utah Medicaid physiciansPrepared data reports and information sheets for internal use as well as for the Utah LegislatureImplemented changes to the Utah State Plan and Rules regarding provider reimbursementWorked with various provider organizations (e.g., educating on applicable State Plan and Rules, presenting in numerous conferences)Prepared application for federal grant monies

Originated and lead Consolidated Marketing Materials project (change to print-on-demand production) – feasibility, RFP, cost, vendor selection, contract negotiation and implementationOversee Facilities Management contract for five divisions – including new technology research, contract negotiation and renewal, and billing issuesAnalyze, redesign, and automate (Access DBs, Crystal Reports, etc.) internal work processes to improve efficiency and team effectiveness – efforts resulting in reduction of 5 FTEs from Materials team.Research, interview, select, and manage relationships with outsource partnersDevelop functional and technical design, and perform quality assurance of accounting department’s interests in the division’s new computer systemPerform general managerial functions for three FTEsInitiated and implemented change in membership ID cards resulting in $186,000 annual savingsInitiated and implemented on-demand member materials resulting in a reduction of 8.4 percent in the cost of producing the enrollment guides, while also shaving expenditures on developing membership guides by 18.7 percent

Managed seven employees in two major areas of responsibility.Marketing Material Distribution: assured prompt and accurate distribution of marketing and re-enrollment materials, maintained inventory of materials and promotional items and worked with related departments. Realized savings through work flow analysis and implementation of process improvements.Claim Regulation: directed imaging / cold storage (paperless / long-term storage) of health insurance claims.Managed Contract: Copy Management ServicesDesigned and test enhancements to the accounts receivable system.Successfully managed hiring, scheduling, budgeting, payroll and reviews.Chairman, Employee Council

Developed and tested new billing system.Continued to manage the accounting functions for IHC SeniorCare, a Medicare HMO, as revenues rose to $30.3 million annually.Managed the accounting functions for IHC Access, a Medicaid HMO, assuring prompt and proper payment of $64.7 million annually.Managed the Great Basin Physician Cooperative and IHC MD plans. Reduced Accounts Receivable of these products by 84%.Established efficiency gains through use of macros, AS400 queries and MS Office to reduce team staffing needs by three FTEs.Chairman, Employee Cultural Compatibility CommitteeStreamlined accounting functions for IHC SeniorCare, a Medicare HMO, during period of heavy growth as revenues increased from $5.4 million to $25.5 million annually.Reduced Accounts Receivable from 27% of premium billing to 1.4%.Designed and implemented work process enhancements to accommodate a five-fold surge in membership while still performing my job independently.Chairman, Employee Advisory Board