Experience

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  Independence blue cross

  Sept 1999 - May 2010

  Manager, quality assurance

  * Managed a team of 11 business systems analysts responsible for coding and maintaining benefit packages used in supporting health care claims processing.* Continually evaluated and refined quality programs assuring benefit package updates were correct and in alignment with customer contracts.* Developed a Quality Tool allowing for an automated comparison of 100% of all benefit coding changes.* Led annual operational risk assessments and ensured all managerial, manual, and automated key controls were designed effectively, operational, and met regulatory audit standards (SAS-70).* Responsible for all aspects of resource management including staffing levels and work distribution. Efforts resulted in a 35% improvement in productivity. Show less

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  Altarum

  Jun 2010 - May 2016

  Senior management consultant | project manager

  Managed and executed key projects at nonprofit organization driving healthcare improvements for disenfranchised populations. Served as trusted business partner to US federal government agencies, including Department of Veterans Affairs (VA) and Department of Defense to improve coding analysis, ICD-10 implementation, quality, and internal controls. • Created internal controls program offices for VA, working with project management team to develop SOPs and guidebooks for 13 functional areas and assess operations to identify and mitigate risk at highest level.• Implemented effective controls with no material weaknesses and successful ongoing operation by establishing annual risk management and internal control monitoring processes, including corrective action plans. Show less

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  Elevance health

  May 2016 - now

  Spearhead PMO at industry-leading health insurer. Lead the Project Management Office overseeing projects from intake through execution. Deliver robust, transformative deliverables to internal stakeholders and external clients and brokers.• Designed innovative new PMO planning with repeatable processes, accessible data, risk analysis, change management, and clear communication. Improved project cost estimate accuracy 95% by creating formal intake process with detailed form to capture key requirements. • Identified $20M in savings and $50M in revenue as project leader by leading workstreams for underwriting and actuary processes. Leveraged AI to reduce manual intervention, mitigate risks, and generate revenue by presenting more attractive, competitive bids. Show less Recruited by Senior Executive to assess operations, identify issues, and create solutions to rapidly improve process efficiency and quality. Provided strategic guidance to colleagues and team members and made key project decisions on behalf of staff VP. Managed changes in headcount, team communications, and training.• Rebuilt client trust and captured $10M+ in cost savings by identifying critical gaps in reporting and project management. Achieved approval on business case to establish formal intake process with clear interdepartmental communication and project execution oversight, which became company-wide PMO.• Strategically monitored and backfilled open positions as needed, which mitigated departmental reductions in force, by creating detailed headcount change process to document employee exits, former roles, accountability, and backfill status. Show less Partnered with stakeholders primarily in healthcare network management and medical management to capture opportunities to decrease spending. Compiled and delivered key data to identify high-cost trends and develop initiatives to lower cost of care. Generated ROI analysis to forecast costs and savings for each initiative and determine viable options, working with leadership to obtain funding to advance initiatives with positive ROIs.• Achieved cost reductions across all strategic initiatives through improved health plan member outreach and education.• Captured $5M in cost savings by implementing 2 high-impact emergency care initiatives. Partnered with strategic emergency facilities to create daily censuses reporting member visits, significantly decreasing time to acquire this data and advise members on options to reduce cost of care. Show less Recruited by chief medical officer to lead and execute cost-saving initiatives. Assessed medical management process to identify opportunities to lower utilization costs and implemented SharePoint infrastructure to oversee projects. • Established grand rounds with internal multidisciplinary clinical team collaborating to proactively manage admissions and length of stay for plan members generating high, unnecessary costs by offering avenues of care outside of hospitals. • Achieved $12M in cost savings by leading project to prevent unnecessary hospital admissions, utilizing multidisciplinary team to closely evaluate criteria to effectively determine patient eligibility for admission. Show less

  • Chief of Staff | Director, Program/Project Management

    Nov 2020 - now

  • Chief of Staff | Director, Strategy

    Jun 2019 - Nov 2020

  • Director, Cost of Care

    Nov 2017 - Jun 2019

  • Senior Project Manager

    May 2016 - Nov 2017