Todd Ray Email & Phone Number

Chattanooga, Tn, Us

Government Programs executive responsible for leading our Medicare, Medicaid and Shared Health lines of business.

Chattanooga, Tn, Us

Corporate Executive responsible for all network activities of all lines of business - innovation, contracting, loading, administration. Continued responsibility for the Medicare line of business.• Led the response, rollout and execution during COVID for our provider contracting/reimbursement initiatives• Creation and administration of BCBST's enhanced telemedicine policy and reimbursement• Successful renegotiation, contracting and loading for several health systems in TN• 5.0 STAR rating for 2023• 4.5 STAR rating for 2022• Membership growth to 140,000

Chattanooga, Tn, Us

Medicare business segment profit and loss owner directly responsible for all aspects of the performance of the Senior Products business segment (Medicare Advantage and Medicare Supplemental Products).• 4.0 STAR rating for five consecutive years• 3rd best audit score in the country for 2017 CMS Parts C and D Operational audits (.44) • Membership growth to 130,000 (largest MA plan in Tennessee)

Chattanooga, Tn, Us

Lead the Senior Products division for BCBST, which includes Medicare Advantage and Medicare Supplemental products. Responsible for the overall segment P&L, strategic planning, STARs strategy, risk adjustment, clinical operations, provider engagement, product development and plan operations. Recent highlights include:• Grew MA membership from 75,000 to 114,000 (2014-2017)• Attained 4.0 STAR rating on our PPO plan for three consecutive years through strong collaboration with providers and a focus on clinical data exchange • Improved risk adjustment processes to better align revenue with incurred claims risk• Dramatically improved financial performance (2015 - 2017)• Significantly increased associate engagement scores

Chattanooga, Tn, Us

Responsible for the design and development of our Medicare Advantage HMO and LPPO products, resulting in continued year over year membership growth (53,000 to 75,000). Also responsible for our CMS product filings and developing our required marketing materials.Led the development of engaged provider relationships through enhanced value-based contracting while developing new strategic relationships with key providers in the market.Drove collaboration with Sales, Marketing, Actuary and Network to create a growth strategy for Medicare Advantage and Medicare Supplement products.

Louisville, Kentucky, Us

Led the market Medicare Risk Adjustment (MRA) department for the seven state Intermountain Region, managing a staff of 38. Brought in to reorganize the department operations, increase associate engagement and improve both coding efficiency and accuracy resulting in greater alignment between member medical conditions and reimbursement. First year results yielded a significant increase in both associate engagement and overall risk scores.Responsible for the strategic planning process within the Intermountain Region for 2011-2013 benefit plan years (35 plans in 120 counties). This process consists of: planning and filing benefit level changes for new and existing products with CMS, analyzing competitor positions/changes, forecasting financial viability through premium/benefit analysis positioning, anticipating membership gains/losses, and working with risk provider groups to jointly agree on changes. Additional responsibilities include coordinating and garnering buy-in from the Actuary, Sales, and Network organizations on expansion/retraction counties, benefit changes and network changes.

Louisville, Kentucky, Us

Oversaw Humana’s Medicare Operations for the State of Nevada with responsibilities for overall market growth, market management and profit/loss ($350 million in 2012 annual revenue and $2M budget surplus). The 2012 Annual Election Period resulted in a 22% increase in membership driven through: close coordination with our Medical Providers and our Sales department, provider expansion into new areas, new C-SNP product launches, benefit adjustments, and a targeted/focused marketing campaign. Additionally, championed an overall market commitment to consistent and timely member/provider resolution of problems resulting in the lowest market disenrollment in Nevada to date. Additionally responsible for managing the relationship between HealthCare Partners and Humana, collaborating directly with the CEO.Oversaw Humana’s Medicare Operations for California from 2009-2010, resulting in the implementation of two large provider risk deals and organic member growth of 5,000 new HMO Medicare members in a new market expansion. Managed the Humana relationship for both IPA groups, working to ensure financial and operational success.Improved market profitability and exceeded membership growth for both Nevada and California.

Louisville, Kentucky, Us

Oversaw Humana’s Medicare financial results in Nevada for 27,000 members and $310M in annual revenue (HMO, LPPO, PFFS, and Medicare supplemental products). Responsible for financial analysis and revenue enhancement for all products, including medical expense, underwriting margin, administrative margin and profit.Created the corporate process for analyzing and loading delegated claims into Humana’s claims system, ensuring proper accounting and forecasting capabilities. This process drove a 20% variance in HCC codes down to less than .5%, resulting in additional and appropriate funding from CMS for Humana. Coordinated all financial MRA activity between HealthCare Partners and Humana including HCC changes, logic changes, and procedural changes with data submissions.

Louisville, Kentucky, Us

Reported to the CEO of Humana Europe, providing Strategic and Financial leadershipPrimary architect of the Humana Europe strategic business plan, culminating in the decision by Senior Leadership and the Board of Directors to create Humana Europe as a new business segmentDeveloped, managed, and oversaw the £10M 2007 and £15M 2008 operating and capital budgets, ensuring under budget performance for 2007Responsible for pricing all bid submissions, products and services to the National Health ServiceResponsible for the design and build out of the Finance function, including AP/AR/GL/FA activities and functionsOversaw all AP/AR/GL/FA activities for Humana EuropeContract negotiation lead for all commercial and legal aspects of revenue contracts and strategic partnershipsResponsible for all legal contracts and agreements working with both internal and external counselsCreated the revenue contract terms and conditions for all revenue engagements

Louisville, Kentucky, Us

Master Of Business Administration (M.B.A.), Healthcare Concentration

Bachelor'S Degree, Business Administration - Computer Information Systems And Finance Majors