Designs and launches successful new businesses, including business startups, new subsidiary launches, and merger and acquisition due diligence and integration
Led a cross-functional team to design business operational services for a start-up health plan. Working closely with senior executives and board, developed operational and financial strategies to support a business that grew to 210K members and more than $1B in revenues in first 18 months of market launch.
Designed and implemented integrated clinical care management, consumer engagement, and operational processes for a national health management service that launched a new business subsidiary focused on managing the behavioral, physical, pharmacy, and social care for persons with severe mental illness. Worked collaboratively with client to launch a first-of-its-kind, fully integrated health maintenance organization for persons with severe mental illness (special needs population). Health plan grew to 50K special needs members within 24 months of launch.
Led and provided senior advisor expertise to several merger and acquisition targets and post-acquisition integration in government programs (Medicare/Medicaid), pharmacy benefit management, and behavioral health management spaces. Provided reports on operational synergy, financial efficiencies, transition risks, product/service alignment, and revenue scalability/capacity.
Develops operational strategies to accelerate flawless product launches, new service paradigms, drive optimal business process sourcing options, and attain expected operational performance drivers (cost, quality, revenue, satisfaction, outcomes, compliance, etc.)
Facilitated Medicare Part D strategy and launch for a national health management services firm with a PBM. Strategy included developing administrative sourcing partnerships, identifying clinical program priorities, product development and market segmentation, and distribution strategy.
Led greenfield operations and technology strategy for a regional managed care organization transforming for marketplace changes and new government program product launches. Successfully designed and deployed a new private marketplace platform with integrated enrollment, billing, and service components.
Led digital member experience strategy facilitation for a 5.3M member Federal Employees Health Benefit Program (FEHBP) administrator. Advised on roadmap development, sourcing, and implementation that resulted in a successful launch of innovative health and wellness services and tools, mobilized platform capabilities, and integrated member experiences based on data asset management and distribution strategies.
Drives aggressive operational expense reduction and overhauling of business processes to improve administrative efficiency, productivity, and revenue growth.
Led marketing, sales, operations, and IT for a new consumer driven health product segment, mitigating claims administration and service issues. Managed enrollment-service-claims operational scalability to accommodate 400,000 member growth over two-year period. Reduced customer issues by 80% over a 12-month period. Reduced 50% of manual claims adjustments.
Drove overall operational performance and efficiency strategy for service, claims, and enrollment for large regional payer through sourcing, organizational realignment, and LEAN/Six Sigma re-engineering. Reduced PMPM operational costs by 12%. Increased automation of claims by 7%. Reduced service handle times by 10% while maintaining first call resolution and customer service satisfaction survey measures. Membership retention topped 93% (from low 80’s prior) for the 12-month period following operational strategy implementation. Facilitated sales and operations transformation of paper to online benefits portal and automated processing of quoting, medical underwriting, account installation, enrollment, and billing workflows. Increased electronic installation and renewal by 300%. Maintained 95% retention rate.
Identifies, analyzes, and resolves diverse operational issues while maintaining optimal productivity and customer service satisfaction.
Provided technology planning and risk advisory services for a 2 million member State Medicaid disease and case management outsource vendor implementation. Program successfully transitioned in less than 12 months. Worked with vendor to reduce data management and performance guarantee issues by 50% over a 6 month period post transition.
Directed claims payment accuracy services for Managed Medicaid client. Resulted in a 2% (over $10 million) of claims spend over payment identification and recovery.
Innovates revenue generation, administrative cost reducing initiatives that support new customer engagement and improved member servicing strategies.
Led the technology design and planning for regional employer private exchange platform for employer sizes 2 to 100. Successfully rolled out to market resulting in adoption of 20,000 employers representing 300,000 enrolled members. Migrated enrollment and eligibility operations to paperless environment saving $1 million annually.
Assessed business and clinical competencies of a large hospital and physicians network seeking to transition to an ACO operating model. As part of the assessment, conducted a feasibility study of partnering, buying, or building an insurance subsidiary. Presented organizational, financial, and operational process opportunities for the hospital and physician system required to evolve into a quality and cost-based revenue and delivery model.
Conducted a people, process, and technology clinical operational assessment for a subsidiary of a large behavioral health company. Targeted significant administrative cost savings while maintaining high customer satisfaction and expected clinical yield results. Gained organizational and executive agreement on organizational restructuring, information technology investments, and process changes to drive a higher performing and more cost efficient clinical operations.