Serve as consultant to assist in the founding of a co-occurring disorder intensive outpatient partial hospitalization program. ▪ Performed market research and analysis to determine the location and populations to be served. ▪ Developed and documented all operational processes and established the front end revenue cycle. ▪ Established policy and procedures and led the facility through Certificate of Approval with the Oregon Health Authority. ▪ Coordinated the selection and implementation of the electronic health records system building the encounters and billing rules as well as training associates on its use. ▪ Handled insurance payer credentialing documentation for clinicians. ▪ Provided strategic direction during insurance payer contract negotiations. ▪ Coordinated the selection of the procedure and revenue codes to be used by the facility ▪ Established the charge master for the facility using CMS fee schedules and RVUs to calculate contractual allowed and billed charge amounts for the charge master. ▪ Manage authorization and billing processes. ▪ Provide all data analytics for the facility including financial performance tracking and projections, aging claims tracking, attendance, and claims denial analysis.

Lead the Claims, Configuration, and Eligibility Operations team, Provider Data Management, and Member Engagement & Communications for the Oregon Market supporting Medicaid, Medicare, and Commercial lines of business. Previously led the Project Management Office and the Business Insights analytics team for the Health Plan. Successfully led Medicaid expansion efforts into new markets/regions. Manage projects on new plan product implementations, benefit changes, vendor process and system integration, as well as other cross-functional projects involving multiple functional areas such as Operations, Shared Service teams, IT, Compliance, Provider Network, Finance, and other stakeholders. Manage Health Equity projects from data analysis and ideation to implementation and monitoring. Lead the development of data analytics tools and reporting aimed at providing insights that drive business decisions that are focused on improving member and provider experience, health equity, quality scores (HEDIS/STARS), claims accuracy and timeliness, and fulfillment of contract and compliance requirements. Perform process development and improvement efforts Health Plan-wide. Provide consultation to senior leadership in developing business strategy and operational directives. Previously managed the Value Targeting Team within the Population Health Services, Strategic Initiatives department to evaluate cost savings potential for enterprise-wide quality and affordability initiatives aimed at improving operations while reducing costs. Manage pipeline of over 100 initiatives through ideation process from initial internal policy and competitor research, through financial valuation working with partners within Medical Economics and Claims Review teams, to prepare for implementation by documenting current and future state processes and engagement of key stakeholders. Develop process tracking solutions, project prioritization analytics, and performance metrics reporting.

Direct the Process Improvement Analytics Team responsible for cross-functional process development and improvement initiatives, error prevention, and timely delivery for Anthem's Enterprise Quality department. Lead a team of Process Improvement Consultants, Process Experts, and Business Change Advisors in implementing quality improvement initiatives using Lean Six Sigma methodologies. Coordinate enterprise quality robotics, process automation, artificial intelligence, and machine learning efforts. Create data analytic solutions for uncovering issues throughout the product value stream starting with benefit setup to group/member/provider enrollment to claims processing as well as grievance & Appeals. Develop reporting metrics and tools for executive decision-making. Provide thought leadership to Vice President in organizational changes and strategic planning. Previously responsible for the Patient-Centered Medical Home (PCMH) program for the Amerigroup Florida Plan, a WellPoint company prior to internal promotion. Serving as consultant to primary care providers during their transformation into medical homes to ensure comprehensive patient-centered care is provided to members through coordination, population health management, enhanced access, and dedication to quality improvement and safety. Led quality improvement initiatives to increase member and provider satisfaction and improve HEDIS performance by network providers. Offered Lean Six Sigma training for the plan, and supported staff in their pursuit of Lean Six Sigma certification.

Facilitate process improvement initiatives using Lean Six Sigma tools and techniques throughout the hospital, clinics, ancillary services, research, and support and administrative areas. Provide consultation and training on continuous improvement methodology for organizational transformation. Perform analyses of process lead times, capacity, queuing, and staffing. Conduct process observations, interviews, and surveys to capture the voice of the customer in preparation for rapid improvement events, solution design sessions, 5S events, and other facilitation efforts.

Serve as quality/performance manager for the Division of Law Enforcement. Establish performance management systems (balanced scorecard). Complete Lean Six Sigma projects through coordination and facilitation of project teams. Perform statistical data analysis and lead strategic planning sessions. Provide consultation services to the Division’s executive leadership. Ensure process efficiency and effectiveness in the Division's accreditation efforts.

Led program improvement/change management initiatives. program research, evaluations, and organizational assessments, through workgroup facilitation, focus groups, interviews, and surveys for the Program Review and Improvement Section of the Office of Inspector General. Performed continuous improvement initiatives throughout the Department to increase efficiency and streamline systems. Provided consultation services to the Inspector General and the Department’s executive leadership.

Executed grant evaluations and offered technical assistance based on contract requirements. Conducted focus groups and workshops with diverse populations regarding health related topics and education initiatives. Performed contractual work for the Florida Department of Health on assessing community need and capacity for services. Assisted two Healthy Start Coalitions in community initiatives planning.

Provided program and business planning services to the Health Science Center and its six colleges. Conducted economic impact studies and market/data analyses using external/internal data elements. Drafted presentations/media materials and strategic reports to include: physician net need, market/business trend, and ad hoc analyses to increase market share, enhance product/service lines, and locate optimal geographic locations for hospital expansion.

Represented the Agency as Commissioner on the Florida Commission for the Transportation Disadvantaged. Managed, Planned, and implemented the Medicaid transportation program. Structured transportation program policies and procedures. Directed staff in eleven Medicaid area offices in transportation directives and in resolving recipient and provider issues. Provided technical assistance and consultation to legislators, government entities, private sector businesses, and the public. Managed authorization functions for hospital beds and other durable medical equipment statewide for Medicaid recipients.

Managed grant initiatives and served as the central contact for stakeholders. Developed, in collaboration with other staff, the makeup of a Medicaid Waiver Analysis contract. Facilitated and organized Real Choice Consumer Task Force Meetings and Real Choice Partnership Coalition Meetings. Researched State of Florida system barriers pertaining accessible housing, Medicaid waivers, personal care attendant services, transportation, and other system barriers.

Provided clients with technical assistance and investigations on disability issues. Designed and presented training sessions on disability rights law and disability etiquette for numerous organizations and groups. Performed operations management duties for the Working Group. Assisted in the execution of the Clearinghouse on Disability Information call center.