Patsy Montana Maxim, MHA

Experience

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  Congressman Tim Ryan

  May 2014 - Aug 2014

  Intern

  Wrote press releases to be published in local newspapers Created and implemented projects such as the Downtown Wellness CommunityDeveloped and maintained the monthly grant list

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  UPMC Health Plan

  Jan 2015 - May 2017

  Administrative Resident, Government Programs

  Created an expansion analysis tool based on economic, social, and environmental factorsIdentified and created innovative, strategic recommendations, with an implementation plan, in accordance with CMS regulations to meet the Medical Loss Ratio requirements – such asrestructuring the physician fee schedule and development of new programs, such as the UPMC Health Plan mobile care vanPerformed a competitor and cost analysis, and implemented new benefits to addressmembers full continuum of needs, such as post discharge meals and expanded DME benefitslike night lightsStrategically developed departmental goals, objectives, standards of performance, and policiesand procedures in compliance with state and federal regulations for CHC Show less

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  Ballet Academy of Pittsburgh

  Jul 2015 - Jun 2019

  Intermediate Level Ballet Teacher
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  University of Pittsburgh Graduate School of Public Health

  Aug 2016 - May 2017

  Graduate Teaching Assistant

  Planned, evaluated, and revised course content and materials. Taught students how to use Excel and Tableau as analytical tools. Worked with health insurance executives to develop class projects using predictive analytics.

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  UPMC

  May 2017 - May 2019

  Project Coordinator

  Drafted and executed physician contracts.Developed and reported on the physician incentive program.Created interactive excel dashboards to track and analyze data such as monthly utilization reports, physician compensation models, productivity reporting, and grant funding analysis.Developed business plans and ROI analysis for site expansion and renovation – including the new UPMC Vision and Rehabilitation Institute.Managed teams during the planning process of the UPMC Vision and Rehabilitation Institute. Worked with revenue cycle and finance to identify bottlenecks and create innovative solutions.Utilized EPIC for reporting and analysis and communicate trends to leadership. Show less

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  UPMC Health Plan

  Jun 2019 - now

  Work cross functionally with teams across the organization for Medicare Employer GroupsManage large strategic accounts and new business relationshipsManage and optimize the Medicare Employee Group team and process by implementing procedures and systems such as Salesforce Grew Medicare Employer Group business by over 14% for membership and 17% for new accountsContracted with vendors such as SunFire and HealthPilot to increase AEP sales and decrease paper applicationsWorked collaboratively with our IT teams on building and later enhancing our Salesforceenvironment Show less Led operational migration effort to move 12,000 medical providers from paper to electronic Explanation of Payments saving UPMC Health Plan at least $500,000 annually and supporting environmental sustainabilityDirected operational workflow of 30+ PAEs to reduce inefficiencies and increase reporting capabilities with Salesforce which permitted supervisors to monitor accountability and staff to handle increased volume Optimized project tracking and reporting of various Health Plan initiatives through the adoption and use of SalesForce – reducing staff time spent entering activities into tracking systems by 50% Producing Monthly Program Reporting for the Vice President, Network Dept. by compiling project updates from SalesForce, Encounter Tracking System and Power BI which resulted in on-time completion of efforts and reduction in duplicative meetingsCollaborated with key stakeholders across the Health Plan for provider contracting by recommending Medicare travel state opportunities based on the historical claims analyses I performedPartnered with Lines of Business to strategically create and operationalize new benefits for 2023: Advised Commercial Product to plan one of the only wig benefits for Alopecia patients offered by any health insurer Show less Managed vendors, such as SkyGen, to create transition and operational plans for our dentalNetwork expansionOptimized current processes by redesigning a highly manual welcome letter process and the department’s ADA site visit procedures by researching requirements and current standards; reducing the number of required office visits by approximately 34,000 annuallyDeveloped a virtual provider orientation series of ten How-To videos for providers and office staff; saving UPMC HP Network colleagues 3,600 hours annually across 30+ PAEsSpearheaded vital company efforts such as monitoring Telehealth utilization in the early days of pandemic and transitioning providers from faxing Prior Authorizations to electronically uploading clinical data to the Provider OnLine portal Show less

  • Manager, Medicare Business Development

    Mar 2022 - now

  • Senior Project Manager, Operations and Strategic Development

    May 2021 - Mar 2022

  • Project Manager - National Network Development and Strategic Expansion

    Jun 2019 - Apr 2021
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  March of Dimes

  Aug 2020 - Dec 2023

  Young Professionals Board Chair

  March of Dimes Young Professionals Board Vice-Chair and Movement Committee Chair