Michele Pierce Email & Phone Number

• As part of CalAIM transformation, manage project to develop framework to map and integrate Enhanced Care Management (ECM) eligibility and enrollment processes into existing Transition Care Services (TCS) processes, and.
• Redesigning and expanding approximately 20 ECM program policies and procedures to meet regulatory and compliance requirements, and transition from implementation phase to future state model. Maintain workplan and risk.
• Designed and developed a cross-functional roles & responsibilities matrix for all Provider Engagement teams, including a detailed SIPOC (Source, Input, Process, Output, Control) for 60 responsibilities identified for.
• In support of enterprise reorganization, developed a phased implementation plan for standard operating procedures to create a formal process documentation system for the responsibilities of modified roles
• Developed recommendations on process improvements, with aim to improve cross-functional processes due to high influx of requests being improperly routed (estimated 2,000+ back log requests on Q1 2024)

San Francisco Bay Area

• Manage, develop and implement enterprise strategic initiatives to improve performance, optimize processes, and drive successful program outcomes
• Implemented mitgation processes on population health program that resulted in 50% performance improvement
• Developed and launched ACO program outreach work plan to provider network, that grew lives under management by 7K
• Expanded clinically integrated network by 800 program participants by steamlining internal processes, developing a robust communication plan and scaling program education
• Administer Physician Services strategy and operations for Brown & Toland provider network, ensuring seamless execution and achievement of enterprise goals
• Develop and maintain work plans and refine materials, processes and competencies to enhance operational efficiencies

San Francisco Bay Area

• Responsible for strategy and implementation of organization initiatives and programs to the physician network
• Collaborate with internal departments and key stakeholders to lead the strategy and operational development of programs, process formalization, workflows and escalation pathways
• Identify ways to optimize internal and external relationships to support organizational objectives and key results
• Identify and define network performance trends, set strategy and drive execution on large high profile projects
• Perform monthly and quarterly business reviews, to ensure focus topics and KPIs are aligned with organizational objectives and key results
• Manage relationships with large-scale physician groups and federally qualified health clinics, often with multidisciplinary contracts

Oakland, California

• Liaison and advocate to 300+ physicians
• Provide training on electronic tools in-person or remotely with computer based training
• Directly support company initiatives that contribute to top line revenue
• Support company’s operational performance; 70% increase to EBITA over two year time span
• Analyze and interpret financial reports
• Provide strategic assistance for business growth, development and retention

San Francisco, California

• Responsible for all aspects of provider data management to meet medical group, health plan and NCQA requirements.
• Responsible for updating database and communicating provider changes to contracted health plans and company departments via standardized reports
• Support and maintained database problems and modifications
• Prepare materials and files necessary to comply with external audits
• Maintain ongoing communication with health plan representatives, contracted providers and company departments
• Develop, maintain and provide reports from the department database

San Francisco, CA

• Coordinate all aspects of the billing process
• Examine and evaluate accounts for appropriate follow-up action
• Ensure proper and timely resolution to billing/reconciliation items
• Utilize strong communication, organization and customer service skills
• Apply government and payer regulations in the revenue cycle process

Fresno, California Area

• Review, analyze and interpret monthly ageing reports
• Maintain knowledge of changes to physician fee schedules
• Ability to multi-task and handle multiple accounts
• Perform project management of appeals to Medicare, Medi-Cal, Managed Care and Private insurance companies
• Identify claims processing trends or errors with effects on physician reimbursement
• Provide assistance to physicians and staff regarding billing and reimbursement