Phil Moser Email & Phone Number

Greater St. Louis

The Senior Director CMS Applications and PBP Submissions is responsible for and will direct the team to perform, any needed CMS governmental filing associated with any existing and/or new clients. The Sr Director will lead the effort to create and submit any associated filings with governmental agencies such as CMS Applications and benefit filings (PBP), assist with and lead the organization/prep/administration for Bid Submission client meetings, provide implementation support to the project management team, direct/lead/perform the benefits reviews for ANOC/EOC and benefit related marketing materials, as well as perform market research and market mapping as needed, as well as provide assistance to other departments or clients as needed/directed by the SVP.Direct/Lead the CMS Applications and PBP Submissions Department, to:• Work with each MAPD client and be fully responsible for its success, to become an MAPD, expand its service area, expand its product portfolio, and build and submit benefits annually: Analyze, produce, and submit, annually to CMS, any necessary client Notice of Intent to Apply (NOIA) filings Analyze, produce, and submit, all necessary client CMS Applications. Analyze and produce benefit plans in CMS PBP system, validate with Actuarial BPT documents, and then submit all necessary client CMS Plan Benefit Package / Benefit Designs with CMS, including all supplemental re-submissions. Build, obtain approval from client(s), and distribute internally to key stakeholders - Benefit Summary and PBP Data Report files for every client and benefit plan, based on PBP software files or EGWP client benefit information, annually or as new EGWPs are sold Provide direction, organize, and lead the annual Benefit design meetings with each client. Participate in and make recommendations for benefit changes/enhancements during the annual BID development process and assist actuarial department in review/edit of documentation and changes.+Additional duties

Greater St. Louis

Responsible for MA implementations for external clients and new market operations, Centers for Medicare and Medicaid Services (CMS) expansion market applications, benefits/bid filings with CMS, Network Adequacy analysis for all markets, and market research and analysis for expansion markets. Program Manager over the simultaneous implementation of Lumeris’ first two external client MAPD stand ups (Blue Cross plans) – oversaw 5 project managers as well as 15+ subject matter experts, built and ran project plans over 17 month implementation, Prepare and file necessary documents with CMS for initial applications and/or service area expansions, for some existing clients as well as all new clients, and resolve any questions with CMS, Prepare and file necessary documents with CMS for benefit designs/bid filings, for some existing clients as well as all new clients, and resolve any questions with CMS, Prepare market research associated with potential new markets, and/or service area expansions, including network adequacy analyses, Consult with and oversee existing client’s work related to CMS application filings, as well as CMS benefit designs/bid filings, Participate in and make recommendations for benefit changes during the annual BID development process for all existing clients, and assist actuarial department in review/edit of documentation and changes, New product research and/or development, Developed with IT an automated method of loading CMS report data to perform Medicare market competitive growth charts.

Greater St. Louis Area

Responsible for market research and analysis for expansion markets, state Certificate of Authority application filings, Centers for Medicare and Medicaid Services (CMS) expansion market applications, and implementation of new market operations. Development, implementation, follow-up and oversight of market business plans and associated physician group dashboards, to ensure market success, Development, implementation, follow-up and oversight of the Physician Group Incentive Contract Master Calendar, to ensure timely completion of contract requirements, Prepare market research associated with potential new markets, or service area expansions, including network adequacy analyses, Prepare and file necessary documents with CMS for initial applications and/or service area expansions, and resolve any questions with CMS, Coordinate and conduct meetings with physician group partners to discuss benefit designs for the following calendar year, and to obtain their buy-in on the entire benefit package, Participate in and make recommendations for benefit changes during the annual BID development process, and assist actuarial department in review/edit of documentation and changes, New product research and/or development, Prepare and submit annual benefit analyses versus competitors, Prepare and submit monthly analyses related to competitor growth, Prepare and submit ad hoc reporting and analysis for business development department, Prepare administrative budgets and analyze budget versus actual on a monthly basis, Prepare and file necessary documents with state departments of insurance for Certificate of Authority licensing

Greater St. Louis Area

Greater St. Louis Area

Greater St. Louis

Director of Finance 2002-2007Responsible for analysis of medical plan costs, comparisons and devising and implementing competitive cost solutions. Coordinate and implement contracts for financial reconciliation with State of Illinois State Pharmacy Assistance Program for affected Medicare members. Supervised as many as 7 professional and technical employees.  Coordinate staff activities and analyze Incurred But Not Reported (IBNR) reports for monthly financial close, including analysis/reserve for high dollar claimants, representing approximately 40-60 % of total liabilities of company.  Perform profitability and medical cost trend analysis for Medicare and Commercial products, including recommendations to Medical Expense Review committee for cost savings initiatives. Cost Savings obtained for 2006 represented over $4 million. Implemented new Medicare product analysis for Part D pharmacy benefit in 2006. Coordinate and analyze monthly Medical Loss Ratio (MLR) reporting by employer group, and by medical practice and county, for Medicare and Commercial products. Coordinate and implement quarterly and annual provider incentive settlement reporting for nine (9) different entities/contracts. Coordinate and analyze all data warehouse validations and reconciliations. Coordinate and review all financial filings, issues and contact for Medicare product with the Centers for Medicare and Medicaid Services (CMS). Over twelve (12) years of annual filings and five audits by CMS or the Office of the Inspector General, with no substantive findings ever reported.Director of Medicare Operations 1995-2002Project manager for implementation, start-up, and ongoing Medicare operation. Manage, coordinate and lead all aspects of current Medicare Advantage and former Medicare HCPP products, member services, enrollment, analysis, policy and compliance areas, up to 20 employees.

Greater St. Louis Area

Responsible for implementation and maintenance of system security access for all new system development in process as well as establishing control over existing systems. Handled requests for service process and coordinating ongoing issues related to process, including the prioritization of enhancements and utilization of EDS programming resources. Responsible for project management of A/R and Billing Systems applications: Monitor and control progress of application development: coordinate tasks, manage issue resolution, manage vendor activities, and conduct Implementation Team Meetings Supported all testing and conversion activities including development, sign-off and execution of QA, User Acceptance Test Plans and Implementation Plans. Developed business policies, as required, with input from management personnel.

Greater St. Louis Area

Responsible for analysis of actual versus plan results for medical and administrative costs, surfacing issues related to these comparisons and devising and implementing solutions to issues and problems. Acted as the local underwriting and pricing liaison with Corporate Office. Supported hospital contract negotiations.  Performed profitability and medical cost trend analysis.

Greater St. Louis Area

MetLife Healthcare Management CompanyServed as financial liaison for IT to local health plan accounting functions. Responsible for all user support, training, enhancements and new financial systems utilized by accounting personnel at six Accounting Centers. Performed liaison role between management information systems and accounting departments for design, testing and prioritization of enhancements to financial systems. Planned, organized and completed several system conversions relating to general ledger and financial systems. Performed the monthly consolidation of 23 subsidiaries. Prepared all parent company reports for corporation and subsidiaries.

Greater St. Louis Area

Responsible for the planning and implementation for all phases of the audit engagement. Duties included the evaluation of internal accounting controls, supervision of personnel, utilization of audit software and overall coordination of substantive audit procedures.

Bs, Accountancy

Activities and Societies: Beta Alpha Psi accounting fraternity, Phi Gamma Delta social fraternity

Education record