Thomas Woo, Mba Email & Phone Number

Burlingame, California, United States

Serves in a leadership capacity, leading associate resources, special projects/initiatives, network development planning and troubleshooting issues among the various operational areas impacted by provider network inadequacy.Responsible for overseeing the managed care provider network development and operations, which includes developing and expanding the MSO specialist network through contract negotiations, relationship building, planning, and resources management to meet network adequacy requirements established by DHCS and CMS for the managed Medi-Cal and Medicare Advantage programs.Responsible for the oversight management of the health plan delegated claims processing and Payment Disputes Resolutions (PDR) functions, ensuring compliance with CMS and DHCS regulations, health plan contractual requirements, and MSO policies and procedures.Monitor and identify needs of provider recruitment in the MSO specialist network; maintain an adequate size of panel provider for each specialty to ensure smooth MSO risk business operation.Develop and evaluate parameters in measuring provider network adequacy, managed care business margins, and to evaluate operational efficiency and effectiveness.Interpret high level statistical and trend reports and analyze complex problems and recommend effective courses of actions to NEMS executives to facilitate decision-making.

Burlingame, California, United States

Responsible for the planning, organizing, and directing of all administrative, financial, andmanagerial activities for NEMS managed care business operations, areas include contractand DOFR review, claims operation, eligibility and capitation, utilization management andcase management, and provider relations.Ensured compliance in accordance with CMS, DHCS, DMHC and MMCD regulatory andHealth Plans’ contractual requirements for risk contract businesses operations includingACO REACH, Medicare Advantage, and Medi-Cal managed care programs.Responsible to interpret EOC, DOFR and other standard reference materials, publications,Policy Letters developed and published by CMS, DHCS, DMHC for the multiplemanaged care programs; responsible to implement, evaluate and adjust processes asnecessary.Understand the fundamental of managed care payment structure; able to developreconciliation system to analyze and support changes in capitation and/or FFS rates.Responsible for the oversight of development, update and review to policies andprocedures relate to Medical Management processes in MSO business, including SystemControl, Claims and Payment Processing, Utilization Management and QualityImprovement Program, Credentialing Program and Provider Dispute Resolution, andMember Grievance and Retention.Responsible to develop oversight auditing structure and implement improvementstrategies to ensure business success.Developed and evaluated parameters in measuring MSO business margins and productivity,and to evaluate operation efficiency and effectiveness.Developed systems to ensure quality measures are aligned across all managed care programs;collaborate with participating clinics/providers to optimize and achieve qualityimprovement goals.Monitored and identified needs of provider recruitment in the MSO provider network; maintainednetwork adequacy per regulatory standards.

San Francisco, California

Responsible for running the internal operations within the Jade Health Care Medical group.Negotiated local provider payor contractsEnsured the execution of the organization’s strategy in the areas of: quality, service, people, efficiency, reputation and growth.As a member of the leadership team, I shared accountability for developing and implementing approaches and solutions to improve the performance of key areas of operations, and collaborates with other departments.Accountable for integrating operational efficiency across the organization.Coordinated and acted as a liaison for TPA functions.Provided physician orientations to new members of the IPA.Resolved inquiries from physicians, contracted health plans or other providers.Maintained physician profiles across multiple tiers of membership within the Jade IPA network.Oversaw Finance, Provider Network Management and Contract Management Depts.

San Ramon, California, United States

Established and led multi-departmental work groups to operationalize provisions of new health plan contracts. Established and facilitated work groups to provide oversight of existing health plan contracts. On an ongoing basis, monitored, and ensured accurate and consistent interpretation of existing products and programs, and facilitated correction plans when necessary. Acted as key liaison from the Contracting Department for health plan issues and questions for contracted health plans.Monitored health plan’s product design, program changes and provided guidance to internal clients. Established and maintained strong relationships with key HPMG departments and facilitated the translation of business needs to technical staff.

San Francisco, California, United States

Managed the cycle of provider network and vendor contracting from strategic development, inquiries, engagement, negotiations, implementation and renewal.Resolved provider issues related to administration of contracts.Facilitated new product development, benefit or network recommendations to senior management.Managed CCHP's product portfolio (Individual and Family, Employer Group, Covered California and Medicare Plans)Participated in California DMHC and CMS product filings. Participated with collecting, monitoring, and compiling results of responses to advertising and promotional campaigns. Accountable for developing and implementing marketing, communications, and public relations strategies.

Emeryville, California, United States

Led selected projects to collect, analyze, validate data, and build reports using analytic programs using physician performance, patient medical record and other clinical data to support client clinical data initiatives.Lead liaison/contact person for ambulatory care/urgent care clinics in regards to data reportingWorked collaboratively with hospital administrators, management consultants, and other departments to improve efficiencies, quality of care, patient satisfaction and data management.Provided support to over 50 emergency departments and clinics in various states in the U.S. Involved in various business development/operation projects

Berkeley, California, United States

Provided data analysis reporting/forecasting services to various on-campus departments. Team lead in program/curriculum planning.Lead Instructor for various on-campus workshops.Project Manager in various grant-writing projects and marketing campaigns for new programs. Initiated a new campus/parent relations program for the Berkeley campus.Involved in employment recruiting for various on-campus departments and non-profit programs.

Richmond, California, United States

Team leader in Health Net's managed care data analysis unit.Responsible in generating and servicing ad-hoc reports, analyzing, reviewing, trending, presenting information for management needs.Supported short-term operational activities; developing, enhancing, maintaining budget or financial planning models; surveying, and benchmarking. Worked closely with sales and marketing team in generating various RFP reports to various markets and provided market research data in new developed areas. Evaluated and presented exceptional information in a manner that will facilitate management’s understanding of the results and impact.

Ba, American Studies

Activities and Societies: Young Entrepreneurs at Haas (YEAH), Circle K International, Asian Business Association, Student Learning.

Mba, Marketing

Activities and Societies: Graduate Business Association, Network for Teaching Entrepreneurship (NFTE)

Certificate, Business Management

Activities and Societies: Network for Teaching Entrepreneurship (NFTE)Rutgers Institute for Management and Executive Development