Director of Commercial Pricing

Large Group Pricing and Product Pricing

Product Pricing

Individual Pricing

• Analyzed encounter, fee-for-service (FFS), financial, and sub-capitation data used to set actuarially sound capitation rates paid to managed care organizations (MCOs) for the West Virginia Bureau for Medical Services (BMS).• Produced a quarterly Dashboard exhibiting program highlights and MCO performance to help BMS monitor access and utilization• Performed network analysis to ensure that the MCO’s networks provide adequate access for members.• Calculated capitation rates and performed network analysis to allow West Virginia to implement a prescription drug carve-in.• Used data from CMS' Medicaid Analytic Extract (MAX) databases to profile state’s Medicaid programs and develop program statistics highlighting utilization, spending, and enrollment trends• Wrote a data brief analyzing the ability to use the MAX data to perform analysis on ambulatory care utilization.• Used Lewin’s Health Benefits Stimulation Model (HBSM) to model anticipated enrollment and morbidity for people who will be newly insured in the individual market or in the small group exchange under the Affordable Care Act (ACA) with the Society of Actuaries. • Wrote SAS and Visual Basic code that automatically produced eleven tables for each of the fifty states and the District of Columbia to simplify the manual work.• Helped write a report that was released by the Society of Actuaries in March 2013, and was referenced by The Wall Street Journal, The New York Times, Kaiser Health News, and several other sources.

• Helped Medicare team to formulate and submit Medicare bids. • Aided in development of Bid Pricing Tools and Plan Benefit Packages.• Produced monthly membership reports showing enrollment in BCBSM plans as well as transfers between plans. • Used SAS and VBA to develop medical and pharmacy trend reports incorporating macro functionality for easy updates and drill down analysis.• Created spreadsheet calculating Benefit Relativities between plans. • Identified discrepancies between trends predicted in Medicare bids and actual trends observed. • Streamlined and enhanced a workbook of Medicare Advantage completion factors to make it more dynamic.