Tom North Email & Phone Number

Apple Valley, Ca, Us

Orangevale, Ca, Us

Oakland, California, Us

Bengaluru, Karnataka, In

Oversight of inventory management for multiple Medicaid states in support of primary client, Molina Healthcare. Ensuring all KPIs and compliance and regulatory metrics are met or exceeded. Collaborating with Molina Healthcare in supporting Health Plans. • Analysis of inventory trends to provide optimal client support and develop process improvements.• Automation of manual processes to increase quality and maximize efficiency.

Long Beach, California, Us

Directed Medicaid Enrollment team and responsible for oversight of multiple states. Direct liaison to Health Plan leadership and provided support, feedback, and information as needed. Provided medium to long term strategic planning. Responsible for maintenance and enforcement of policies, standard operating procedures, and regulatory practices. Ensured that all KPIs and compliance and regulatory metrics were met or exceeded.• Led ID Card task force focused on improving quality and performance.• Organized cross-functional teams to ensure issue visibility and awareness.• Served as primary contact for internal/external audits.

Rancho Cucamonga, Ca, Us

For this company, I directed lean operations and supervised a team of 30. I ensured accuracy and timeliness for dissemination of eligibility data into the IEHP network, internal IEHP systems, and ancillary providers. I regularly monitored enrollment transactions to CMS and ID card printing and mailing, and vendor relationships in cooperation with external vendors. Additionally, I supported eligibility operations.My key contributions follow:● Earned lean bronze certification.● Maintained constant compliance and efficiency during execution of Medi-cal, Medicare, and additional programs.● Developed and implemented strategic process improvements in collaboration with the Chief Operations Officer.

In my last position for this company, I managed two teams with a combined total of 30 employees. I recruited, hired, trained, and mentored three direct reports including two Managers and a Senior Project Coordinator. Additionally, I oversaw a budget of $2.2M and ensured compliance with company guidelines. I collaborated with stakeholders to drive revenue and resolve issues. I also tracked KPI's, service levels, and operational performance and presented to executive management.My key contributions follow:● Awarded United Health Group Collaboration Cup in July 2013.● Led the largest membership project in company history successfully migrating 14M lives from prior PBM.● Achieved 99%+ accuracy rate and 99%+ clean data files processed within 24 hours after received.● Facilitated 20% one day implementation increase without additional employees.● Accomplished 1.2B eligibility records and 45M Near Real Time (NRT) transactions annually.

As Eligibility Manager, I oversaw eligibility operations leading a team of 25 employees. Assisted in audits and SOX/SAS70 compliance activities. I collaborated with Senior Management and Directors to develop processes to for company improvements and increased efficiency. I also hired, trained, and mentored employees. I ensured compliance with HIPPA, ARRA, and additional privacy regulations. I processed 12K enrollment files annually.My key contributions follow:● Earned United/Ovations Public and Social Markets Group Team Innovations Award in July 2007.● Increased the team 400% from five to 25 in eight years.● Developed an automated processing model to support expected 300% client growth within 18 months.● Introduced processes for data encryption.● Spearheaded custom programs for Medicare Part D, DDP, and additional key initiatives.● Maintained over 99% accuracy with more than 98% completed within 24 hours of receipt.

In this position, I led daily operations ensuring accuracy and timeliness for eligibility files. I cooperated with Account Managers to maintain control of client eligibility issues. I also presented operational and implementation status reports to senior management. My key contributions follow:● Performed as primary eligibility expert and key member of new client set-up teams.● Mitigated AS/400 and network issues in collaboration with the IT, system operations, and network teams.