L. Todd Dugan Email & Phone Number

San Diego, CA, US

• As the Founder of VB Tech, I am leading the charge in transforming and modernizing healthcare operations through innovative technology solutions. My role involves:
• Strategic Leadership: Setting the vision and direction for VB Tech, focusing on developing purpose-built tools that simplify and optimize healthcare operations.
• Innovation & Development: Spearheading the creation and implementation of VB Pay, our flagship product designed to streamline payment processes within value-based care models.
• Business Development: Building relationships with key stakeholders in the healthcare industry to drive growth and adoption of our solutions.
• Operational Oversight: Overseeing all aspects of the company’s operations, ensuring alignment with our mission to improve efficiency and reduce costs for healthcare organizations.
• Thought Leadership: Advocating for the integration of technology in healthcare to solve complex operational challenges and improve patient care.VB Tech is committed to delivering cutting-edge technology that empowers.

Satellite Beach, Florida, US

• During this period, I focused on conceptualizing and developing the foundation for Value Based Technologies (VB Tech). My efforts included:
• Business Planning: Conducted in-depth market research and analysis to identify opportunities in the healthcare technology space, particularly in value-based care.
• Product Development: Designed and prototyped the initial version of VB Pay, a tool aimed at simplifying and automating payment processes for healthcare organizations.
• Strategic Networking: Engaged with industry experts, potential partners, and stakeholders to gather insights and validate the business concept.
• Operational Setup: Established the initial operational framework for VB Tech, including legal, financial, and technological infrastructure.
• Brand Development: Developed the brand identity and messaging for VB Tech, setting the stage for our launch and market entry.This entrepreneurial phase was crucial in laying the groundwork for VB Tech, allowing me to.

Nashville, US

• In this role, I was instrumental in operationalizing and managing the ACO payment system, playing a hands-on role in both technical implementation and team leadership. My responsibilities included:
• System Implementation & Management: Singlehandedly led the design, implementation, and ongoing management of the ACO payment system, ensuring seamless operation and alignment with value-based care goals.
• Vendor & System Management: Managed the relationship with the primary tech vendor, coordinating all the moving pieces involved in the payment system. This included handling various systems, workarounds, and conversion.
• Team Leadership: Directed and supported a team responsible for ACO Reach Claims and Capitation operations, providing strategic guidance and hands-on management to optimize performance.
• Data Integration: Led the integration of essential data from insurers like BCBSM, Aetna, UnitedHealthcare, and Humana, enabling advanced analytics and enhancing the organization’s operational capabilities.
• Operational Optimization: Developed and implemented processes that streamlined payment operations, reduced manual effort, and improved overall efficiency within the organization.My work at Honest Medical Group focused.

Nashville, US

• In this role, I was tasked with laying the foundation for consolidating and optimizing health plan operations, working closely with senior leadership to prepare for future initiatives. My key responsibilities included:
• Strategic Planning & Consolidation: Worked with senior leadership to develop strategies for consolidating Third-Party Administrator (TPA) and Business Process Outsourcing (BPO) services, focusing on improving.
• Contract Evaluation & Negotiation: Led efforts to evaluate and renegotiate existing contracts, successfully exiting unfavorable agreements and positioning the organization for future operational improvements.
• Operational Preparation: Took on the responsibility of planning and organizing the build-out of critical operational functions, including the mailroom, contact center, and appeals and grievance teams, ensuring.
• Leadership & Knowledge Sharing: Facilitated weekly roundtables with senior leadership to provide insights into health plan development and operations, fostering an understanding of the complexities involved in.
• System Selection & Planning: Led the selection process for the Claims and Capitation platform intended for the ACO Reach line of business, ensuring it was aligned with the organization’s strategic goals and capable of.

Nashville, US

• In this role, I played a critical role in shaping the claims and enrollment operations for Honest Medical Group, focusing on vendor selection, workflow design, and benefit development. My key responsibilities included:
• Vendor Selection & Management: Led the selection process for Third-Party Administrator (TPA) and Business Process Outsourcing (BPO) vendors, specifically for enrollment and claims systems, ensuring alignment with.
• Workflow Design: Designed and implemented group enrollment workflows in collaboration with the largest employer retiree group in the country, enhancing the efficiency and accuracy of the enrollment process.
• Benefit Development: Developed an innovative Maximum Out-of-Pocket (MOOP) buy-back benefit approach to improve the experience for mid-year Employer Group Waiver Plan (EGWP) transfers, addressing a critical pain point.

Nashville, Tennessee, US

• Led initiatives to optimize and scale service operations, focusing on structural improvements, compliance, and customer experience. Key accomplishments include:
• Operational Restructuring: Collaborated with the COO to establish a more scalable structure by separating back-office operations from the call center, enabling focused leadership. Brought on an Appeals Medical Director.
• Leadership & Oversight: Managed senior directors overseeing Enrollment, Premium Billing, Mailroom, Customer Experience, Claims, Appeals, Grievances, and Member Communications for multiple Medicare Advantage plans.
• Compliance & Controls: Partnered with Finance and Regulatory Compliance to implement key controls, ensuring Sarbanes-Oxley (SOX) compliance and robust oversight of financially impactful processes.
• Global Outsourcing: Strategized and operationalized the outsourcing of departments, training and managing offshore teams in Manila, Chennai, and Bogotá, ensuring uninterrupted service across continents and time zones.
• Team Development & Mentorship: Actively mentored direct reports, advocating for career growth, recognition, and promotions.

Nashville, Tennessee, US

• Led the daily operations across multiple Medicare Advantage plans, overseeing key functions such as Enrollment, Premium Billing, Mailroom, Customer Experience, Claims, Appeals, Grievances, and Member Communications. My.
• Operational Oversight: Managed day-to-day operations across multiple departments, ensuring interdepartmental synergy and compliance with CMS guidelines while supporting the company’s goals toward becoming a publicly.
• Global Outsourcing: Planned and operationalized the outsourcing of key departments, including the training and management of offshore teams in Manila, Chennai, and Bogotá, to maintain service continuity across.
• Team Leadership & Development: Actively mentored direct reports, fostering high performance and advocating for their career advancement, including merit increases and promotions.
• Contract Negotiation: Renegotiated the Claims BPO vendor contract, securing necessary SLAs to improve management effectiveness.
• Member Communications: Established an internal Member Communications team, ensuring consistent messaging across all forms of member correspondence companywide.

Nashville, Tennessee, US

• Led the daily operations for Enrollment, Premium Billing, Mailroom, and Customer Experience (CX - Member & Provider) across multiple Medicare Advantage plans. Key accomplishments included:
• Operational Oversight & Excellence: Maintained high standards in Enrollment and Premium Billing while successfully outsourcing CX and Mailroom operations within a six-month timeframe.
• Vendor Management: Enhanced CX and Mailroom BPO vendor contracts by incorporating stringent SLAs and penalties to ensure accountability and performance.
• BPO Oversight: Architected and implemented internal reporting systems necessary for effective BPO oversight and SLA validation.
• Custom Workflow Console Development: Engineered and wrote business requirements for a custom Customer Experience and Mailroom Workflow Console, developed by an offshore Salesforce vendor. The project was delivered.
• Efficiency Improvements: The new CX console significantly reduced Average Handle Times, cutting member call times by approximately 4 minutes and provider call times by 5 minutes, enabling the team to manage increased.

Nashville, Tennessee, US

• Relocated to Nashville, TN, to establish the Nashville Office as Clover Health’s National Operations Headquarters. Key responsibilities and accomplishments included:
• Office Establishment: Successfully opened and set up the Nashville office, transitioning it into the National Operations Headquarters.
• Enrollment & Billing Management: Oversaw Enrollment and Premium Billing operations for multiple Medicare Advantage plans, ensuring smooth transitions and process optimizations.
• BPO Transition & Vendor Management: Led the transition from an internal team to an outsourced BPO model within a tight 9-week timeframe. Enhanced the BPO vendor contract to include stringent SLAs with significant.
• Process Optimization: Streamlined premium billing processes with NJ SPAP, recovering $800k in premium revenue previously unclaimed due to eligibility discrepancies.
• BPO Oversight: Designed and implemented internal reporting systems for effective BPO oversight and SLA validation.

Philadelphia, PA, US

• Led Medicare Enrollment Operations for five Medicare Advantage plans, focusing on process improvement, compliance, and operational efficiency. Key responsibilities and accomplishments included:
• Enrollment Operations Management: Oversaw enrollment processes for five Medicare Advantage plans, ensuring accurate and efficient operations across all plans.
• Gap Identification & Remediation: Conducted root cause analysis to identify gaps and implemented both short-term and long-term mitigation plans, ensuring continuous improvement and compliance.
• Process Improvement & Automation: Led efforts in process improvement, automation, and development of business requirements for Change Requests (CRs) to support necessary technology changes.
• Documentation & Readiness: Developed Business Requirements Documents (BRDs), workflows, policies and procedures, desk-level procedures, and materials for Medicare-Medicaid Plan (MMP) readiness reviews.
• Material Development & Testing: Managed the creation, implementation, and testing of member and provider materials to ensure clarity and compliance.

Philadelphia, PA, US

• Managed Enrollment Operations for five Medicare plans, focusing on ensuring compliance, operational readiness, and effective communication with members and providers. Key responsibilities included:
• Enrollment Operations Management: Oversaw the day-to-day enrollment processes for five Medicare plans, ensuring accurate and efficient management.
• Material Development: Led the creation, implementation, and testing of member and provider materials to ensure they met all regulatory and operational requirements.
• AEP Readiness & Staff Training: Prepared the organization for the Annual Enrollment Period (AEP) by conducting staff training, system testing, and executing readiness plans. Ensured compliance with CMS directives and.
• Regulatory Compliance: Interpreted and implemented CMS directives, annual guidance changes, and quarterly software updates to maintain compliance across all enrollment operations.My role was pivotal in maintaining.

Philadelphia, PA, US

• Focused on process improvement, technology support, and vendor oversight to enhance operational efficiency. Key responsibilities included:
• Process Improvement & Automation: Led initiatives to improve and automate business processes, developing business requirements for Change Requests (CRs) to support necessary technology changes.
• Reporting & Analytics: Provided comprehensive reporting and analytics to support decision-making and track operational performance.
• Vendor Oversight: Managed vendor relationships, ensuring that vendors met performance standards and complied with contractual obligations.My role was instrumental in driving operational improvements and ensuring that.

Conshohocken, PA, US

Conshohocken, PA, US

Process improvement, automation, business requirements development for CRs to support technology changes.Lead the redesign of TRR automation and the workflow management database.Reporting and analytics

Randolph AFB, TX, US

Randolph AFB, TX, US

Successfully completed and graduated from USAF Basic Military Training in July, 2011.Upon successful completion of Basic Military Training, transitioned into Special Forces Technical Training.Entry-level Separation (ELS) discharge due to medical ineligibility.

Conshohocken, PA, US

Conshohocken, PA, US

Supported the re-engineering of the retro database and retro reporting requirements to both internal and external clients.Report creation and automationProcess improvement

Mha, Health/Health Care Administration/Management

Bs In Computing And Security Technology, Computer Science

Leading Strategic Growth

Leadership Linc