Led $100M+ program to prepare a large regional Blues payer for ACA Exchange operations.
Served as the Business Architecture and overall Program lead to define and manage the program scope to deliver strategic value to the organization while mitigating compliance risks. Drove successful implementation through effective stakeholder engagement with a clear focus on end-to-end solutions across the client’s operations, including sales, enrollment, billing, claims processing, customer service, and actuarial.
Redeveloped sales, enrollment, and renewal platform serving 32K+ small groups for Blues payer.
Led overall business solution design to redevelop an existing quoting, sales, and renewal application in advance of the Affordable Care Act. This market facing application required a consistent and guided user experience to support 2K+ brokers that subsequently served 32K+ employer customers and 200K+ employee subscribers. Redevelopment accounted for improved user experience and preparation for ACA product designs, rating requirements, market segment dynamics, and the need to support legacy products.
Developed program requirements governance model for 11 projects at a regional Blues payer to provide consistent processes, quality, transparency, and timeliness.
Led requirements development and management for within the client’s ACA Exchange implementation program. As a large, multi-state Blues player the organization was tasked with complying with regulations of from the Federal government and multiple states, each with different Exchange models. Mathew provided Program-level guidance establishing consistency in requirements process, quality, and scope.
Designed integration between claims processing and payroll systems for Medicare Third Party Administrator to automate employee payroll based on client’s strategic reimbursement model.
Retained by a Medicare business process outsourcing organization to design new application to automatically calculate payroll data for 70+ employees based on data in existing systems, replacing a manual process requiring multiple FTEs. Mathew drafted both high-level and detailed-level application designs, as well as designing an underlying database to support the entire process based on the client’s business and technical requirements.
Provided procurement guidance for dual eligible (Medicare/Medicaid) plan administrator in selecting new medical management solution.
Organized team to procure a medical management solution to support client’s new line of Medicare/Medicaid business, serving the physical and behavioral health of dual eligible members. Mathew was responsible for leading requirements gathering, creating the request for proposal, evaluating vendor responses, and guiding the organization through the procurement.
Conducted compliance impacts assessment and remediation plan for California Medicare/Medicaid plan in advance of ICD-10 implementation
Served as lead technical resource for a California Medicare-Medicaid plan to and remediate business processes and systems for ICD-10.