I have been the interim leader of Risk Adjustment since November of 2022. Since that time, I have accomplished the following:• Lead strategy and process to gain 100% more Risk Adjustment revenue than the prior year in Medicare Advantage.• Lead the largest supplemental campaign completed, with nearly 5% RAF lift for the ACA program.• Lead Discovery, negotiation, and implementation of a Natural Language Processing tool for Risk Adjustment Coding.• Created and published encounter and supplemental analytics dashboards monthly.• Lead the selection of a Risk Adjustment Analytics suite to position a comprehensive prospective risk adjustment programOther duties:• Leads a team of technical and clinical resources to drive the Neighborhood Health Plan Risk Adjustment program.• Architected/Designed/Developed all processes and technology to capture coded Risk Adjustment data, reconcile, and produce the needed regulatory files to submit to CMS for both Medicare Advantage and Affordable Care Act (ACA) products.• Architected/Designed/Developed processes to receive and process return files from CMS. This includes process for analyzing rejected records, correcting, and resubmitting risk adjustment data• Created Tableau dashboards to track encounter/supplemental submissions to CMS including data error rates, HCC recapture, HCC gaps closed vs target• Leads discovery of external AI tools to enhance HCC capture and drive revenue• Leads predictions of risk score lift and revenue for financial budgeting

Managed a team of developers, business systems analysts, and QA engineers to support the Claims/Finance/Sales/Marketing business areas.

Leads discovery and implementation of requirements into well developed and functioning solutions for Saas payer products.

• Managed work for a team of business systems analysts (10) responsible for a portfolio of clients on a SaaS Health & Welfare Administration system• Became an expert on the Outsourced Benefits Administration (OBA) platform and mentored analysts on conversion, implementations, and ongoing projects.• Founded/Administered Analyst SharePoint intranet• Led configuration of the OBA system using XML and Javascript• Performed extensive data analysis of client benefit data using self developed SQL queries.• Mentored analysts throughout the organization to improve individual and team performance.• Met with direct reports periodically to provide direction, motivation, and general guidance• Attended on-site meetings with clients to kick off projects• Attending meetings with senior management to provide input on future enhancements of the OBA product• Responsible for performance reviews for merit and bonus for direct reports• Hosted hour long daily Q/A calls for associates

Led the discovery and implementation of functional business requirements for CVS Health Procurement and CRM systems.