Monique Pierce Email & Phone Number

Londonderry, Nh, Us

Boston, Massachusetts, United States

As Head of Payment Integrity, I built the payment integrity organization from the ground up, shaping the vision, strategic direction, and operations to deploy a suite of payment integrity programs realizing unprecedented medical cost savings. I also steer the payment integrity product strategy to drive program/product innovation including Subrogation, COB, DRG Audit, Home Health, Skilled Nursing, High-Cost Drug, DME, Provider Behavior Modification, Prepay Edits, FWA, Credit Balance, and Pre- & Post-Pay Data Mining and Clinical Audits. My work entails strategizing with cross-functional teams including claims, configuration, network management, clinical operations, compliance, and legal to assess initiatives, improve payment accuracy, and ensure regulatory compliance. KEY HIGHLIGHTS: ➣ Stewarding a MM$ budget to support staffing while ensuring cost efficiency and program reporting ➣ Directing and motivating a high-performing team of 23 professionals driving innovation and change ➣ Championing multi-vendor performance and strategy emphasizing transparency and partnership➣ Improving operations to align with corporate strategy and comply with government requirements➣ Currently constructing an AI/ML interface with a feedback loop from post-pay vendor file feeds to lift the hit rate and applications featuring natural language processing to review medical records and bills ➣ Creating 20+ full-scale prospective/retrospective data mining/clinical programs to deliver an ROI of 11:1, saving 5.6% in medical expenses and 79.52% through prepayment avoidance vs. post-pay recovery➣ Devising and rolling out a centralized executive savings dashboard to reflect net savings ➣ Crafting a highly successful RFP and negotiating favorable terms and SLAs to maximize revenue and cost savings while overseeing ongoing program governance ➣ Delivering simultaneous implementations in under 6-12 weeks, representing less than half the industry standard

New Hampshire, United States

As VP of Business Optimization & Client Engagement, I headed all business optimization and client engagement to elevate client satisfaction, lessen administrative costs, and maximize savings. I was also recognized for transforming the organizational culture as well as driving change management and continuous improvement. Finally, I collected performance data to identify new business opportunities and leverage for benchmarking purposes.KEY HIGHLIGHTS: ➣ Catapulted productivity, expanding projects by 126% without incurring additional personnel costs ➣ Directed cross-functional teams designing and delivering innovative client implementation projects, reducing turnaround time (TAT) by 88.9 days or 11% and LOE by 296 hours or 18% ➣ Paved the path for continued success, guiding the client engagement team to support 35+ clients, garnering 100% client retention while markedly improving TAT of recovery collection by 39%➣ Took charge of the team driving technology, automation, and process improvement projects, generating a 71% improvement in automated audit assignments ➣ Standardized improvements and enhanced systems to strengthen selection/management of medical records, increasing findings by 12-40% depending on programs and decreasing admin expenses by 30%

Led business optimization for all payment integrity product service lines and supported company acquisition and integration activities. Led Client Engagement team

Delivering innovative solutions, I drove product adoption and management while leading a top-flight team developing trailblazing analytic and technology products for the company's reimbursement optimization business unit. I acted concurrently as product owner and product manager, building the product management function from ground zero. I also shaped and implemented the payment integrity product strategy to ensure program and product innovation for technology and programs across multiple areas and assessed the existing product portfolio and analytic capabilities. KEY HIGHLIGHTS: ➣ Established the product management function, leading the assessment of the existing product portfolio and data analytics capabilities ➣ Played a pivotal role in a go-to-market strategy that lifted the number of clients by 23%➣ Influenced a unified data strategy that streamlined the data process and reduced time to implement ➣ Introduced, built, and spearheaded a robust opportunity assessment process that centralized and managed intake and prioritization, lessening the development lifecycle in the first year by >15%➣ Conceived and executed the product roadmap; recommended building, buying, or partnering based on cost-benefit analyses, stimulating a 20% gain in productivity and auto-prioritization ➣ Delivered thought leadership for market forums, crafted white papers, and contributed content to the new website

Prior to being promoted, I designed two new innovative solutions including a pre-payment and provider behavior modification that expanded audit service offerings and increased revenue opportunities.

Nyc /Trumbull Ct

As senior program director, I built the program governance structure and selected and led a new analytics team charged with developing innovation solutions to achieve marked cost savings. Serving in a leadership capacity, I emphasized strategic thinking to solve complex problems and mitigate prompt-pay interest. I also delivered insights into root-cause drivers and critical performance management. KEY HIGHLIGHTS: ➣ Conceived, planned, and orchestrated effective solutions that lessened interest expense by $9.6M ➣ Curated and implemented the strategy to develop new interest information systems to optimize the effectiveness of interest-reduction programs

Trumbull Ct

Fueling record-breaking savings of $1.4B, I integrated acquired businesses and expanded Commercial, Medicare, and Medicaid COB proactive identification programs. I led unprecedented cost reductions in enterprise-wide medical and operational costs by implementing emerging technology and innovative business solutions. KEY HIGHLIGHTS: ➣ Designed and executed a new COB system and applications that centralized and integrated data, processes, and policies across 14 claim payment systems ➣ Concurrently steered two large system pharmacy/eligibility projects ➣ Pioneered industry-trailblazing initiatives for COB identification and verification, boosting efficiency by 20% and realizing $70M+ in incremental savings for two consecutive years ➣ Directed a high-performing team of 200+ to achieve peak performance results ➣ Recognized with the UHG 2011 Claudia Market Leadership Award for superior achievement in leadership and 2009 Silverlink Communications “Innovator of the Year” Award➣ Hailed by senior-level management for superior performance, earning multiple annual awards