Lead the department responsible for analysis of health plan's financial performance, reporting and data analysis of medical and operational performance, as well as improving Medicare and Medicaid risk adjustment scores. Responsible for financial and analytic components of the successful Medicaid expansion and Medicare-Medicaid Dual Demonstration programs. Evaluate and negotiate rates with the Department of Community Health.

Corporate oversight of data analysis and reporting for Medicare Advantage and Medicare Supplement business. Managed IBNR reserves in conjunction with actuaries. Performed detail cost, profitability, clinical, operational analysis including STAR performance, re-admit rates, provider effectiveness. Improved reporting package and developed/produced dashboard reports. Performed revenue, risk, and cost trend analysis. Performed profitability, price / volume / mix, and actual vs. budget/bid analysis. Data analytics / reporting with detail medical and pharmacy claims, membership, and Medicare files.

Financial and operational analysis for Medicare Advantage healthplan. Reporting results to senior management and external partners. Responsible for reserve adequacy. Implemented risk score coding resulting in significant revenue and profit growth. Responsible for financial component of Medicare Part C bid. Performed revenue, risk, and cost trend analysis. Performed profitability, price / volume / mix, and actual vs. budget/bid analysis. Data analytics / reporting with detail medical and pharmacy claims, membership, and Medicare files.

Disease management company grew revenue from $28M to $246M. Managed team who provided data and financial analysis for sales opportunities. Worked with business development to successfully sell and negotiate agreements. Provided financial expertise on developing new and redesigned products.

Start up of new disease management industry. Developed, analyzed, sold, and reconciled risk based arrangements to enable proof of concept for business. Performed financial and data analysis, responses for request for proposals, and negotiated sales contracts.

Career with Caremark/Baxter involved developing and growing a new industry - Home Infusion. This started with home IV nutrition and grew to include antibiotic, chemotherapy, HIV, and more. This start up business required flexibility and creativity to define the needs of the market and then respond to those needs. My involvement ranged from budgeting, planning and analysis, to operating market support, to financial management of physician partnerships, to developing new business investments and arrangements.Director Finance role included responsibility for all financial operations, analysis and reporting for start up integrated managed care business with revenue of $40MM in second year. Developed and implemented accounting methodology for capitated home health and DME business resulting in accurate and timely management tools and financial records.

Analyzed and negotiated new initiatives and acquisitions encompassing financial, strategic, tax and legal issues. Provided financial support for start-up businesses including oncology and women’s health.

Directed all accounting, tax and banking services for partnerships. Assured partnerships were established and managed appropriately. Grew staff from 6 to 13 and managed department budget of $750,000.

Provided financial support to drive profitability. Oversaw reimbursement activity in 10 branches. Monitored the financial results for geographic area with $95MM in sales.