Led an effort to procure and implement a company-wide engagement management system from requirements development and contracting through user-acceptance testing and post go-live training and workflow.
Member health statements design and implementation.
Managed the design and implementation of member health statements that contain claims and banking information related to each member’s consumer direct health plan. Coordinated the implementation effort across marketing, sales, IT, testing, member online services, benefits, account implementation, and vendor resources. Health statements are currently available online to each member with a CDH plan.
Led data mining and business intelligence effort for insurance product.
Analyzed and prepared a unique report on premium and loss trends in the New Jersey market for personal injury protection automobile insurance. The report was published on a New Jersey political lobbying website and garnered positive feedback from numerous activists.
Led a variety of contractual audits and process improvement initiatives for a national behavioral health and imaging services corporation.
Developed corrective action plans and prospective audit tools that have been implemented to streamline the client’s management of its contractual obligations.
Managed a project at a large Blue Cross Blue Shield plan to assess the plan’s level of compliance with the terms and provisions of the Thomas Litigation Settlement Agreement and implement required changes.
This project included development of an online fee schedule accessibility application for providers; changes to appeals and billing dispute procedures; updates to the sales process for self-insured accounts; development of revised, systematic interest calculations on multiple claims processing systems; revisions to contract language; and creation of Web-based communications and training materials.
Led a client team as the business delivery manager for the implementation of an automated pricing tool with primary focus on operational impacts to claims adjudication workflows and provider reimbursement.
Performed an analysis of claims payment accuracy for a national commercial payer.
Determined the size of overpayments in the northeast region and the effect of those overpayments on medical costs. Developed a process for determining the root cause of the claims payment inaccuracies and an organizational methodology for getting those issues escalated and resolved.
Litigation support for a national health plan.
Assisted a national health plan to defend against one of the most significant class action lawsuits of its kind related to industry collusion in claims reimbursement methodologies and systematic adjudication edits. Led all phases of electronic discovery: client interviews, data gathering, and data management and analysis. Worked with the joint defense team to process, standardize, and evaluate several TB of claims history data.