Director of Risk Adjustment for Molina Corporate over Medicaid and Health Insurance Exchange for 12 states.

Reporting up to SCAN’s Senior Vice President, I was brought onboard as the Manager of HCC programs and RADV operations. Leading 2 supervisors and corresponding teams, I am responsible for the performance of our capitated provider’s Risk Adjustment Factor scores, development and implementation of Risk Adjustment Programs and the completion and compliance of CMS sanctioned and internal RADV audits.

As a Business Consultant with WellPoint, I have been charged with the responsibility to support P&L owners by providing recommendations on ways to increase revenue through Risk Adjustment Programs. Networking and maintaining working relationships with all capitated PMGs and IPAs to ensure accurate claim and encounter data as well as keeping a good rapport and strong business relationships with their leadership. I directly oversee the accuracy, submission and financial forecasting of CMS risk adjustment data as well as monitor and trend data informatics programs for Medicare Risk Adjustment. Manage the development and implementation of the Risk Adjustment Data Warehouse and Physician incentive program.

I was promoted from program manager to manager of risk adjustment programs and as a result I managed a team of 14 Registered Nurse Program Managers and a Data Specialist. Managing a large team required me to developed clinical and monetary reporting standards and keep to the standards and budgets set forth by the company. My team and I successfully generated a $32.1M ROI from the Nurse Practitioner Risk Adjustment Program, and Secured 234,607 suspected Hierarchy Condition Category diagnosis. Departmentally the success of my team came from an encouragement of team synergy that allowed for a positive and productive work environment.