Experience

Maryland Health Services Cost Review Commission (HSCRC)

• Government Administration
• 1 - 100 Employee

• Chief of Revenue and Compliance

  • Nov 2022 - Present

  United States Setting rate for Maryland hospitals using the Global Budget Revenue system and applying and implementing rate setting methodologies into the rate setting process Design rate adjustment models and assist in the development of rate setting automation tools Monitor the charging practices of all hospitals and ensure hospitals are in compliance with HSCRC regulations Supporting and reviewing the calculations of the annual updates to hospital global budgets, as well as unit rates and rate… Show more Setting rate for Maryland hospitals using the Global Budget Revenue system and applying and implementing rate setting methodologies into the rate setting process Design rate adjustment models and assist in the development of rate setting automation tools Monitor the charging practices of all hospitals and ensure hospitals are in compliance with HSCRC regulations Supporting and reviewing the calculations of the annual updates to hospital global budgets, as well as unit rates and rate corridors Assisting in the review and evaluation of Commission initiated or hospital submitted rate reviews Assist in training analysts and answer technical questions Perform analysis on Total Cost of Care data and provide updates to stakeholders on Model performance

• Rates Analyst II

  • Jun 2015 - Apr 2023

  Baltimore, Maryland Implentation of HSCRC Global Budget Revenue (GBR) and Total Patient Revenue (TPR) rate setting methodologies for hospitals. •Evaluation and analysis of monthly unit rate and revenue target compliance; development and implementation of technical changes and modifications to the GBR and TPR to incorporate Commission approved policy changes •The review and analysis of partial rate applications; and assist in performing the review of Full Rate Applications filed with, or initiated by, the… Show more Implentation of HSCRC Global Budget Revenue (GBR) and Total Patient Revenue (TPR) rate setting methodologies for hospitals. •Evaluation and analysis of monthly unit rate and revenue target compliance; development and implementation of technical changes and modifications to the GBR and TPR to incorporate Commission approved policy changes •The review and analysis of partial rate applications; and assist in performing the review of Full Rate Applications filed with, or initiated by, the Commission. •Develop recommendations for HSCRC on the structure of payment models which include: Balance Updates, Guardrails for Model Performance, Market Share and Initial and Future Models



Group Benefit Services

• United States
• Insurance
• 1 - 100 Employee

• Self-Funded Underwriter

  • May 2014 - Aug 2014

  Hunt Valley, Maryland • Calculates standard and non-standard renewal and prospective employer group rates in accordance with regional rating rules and federal and state regulations. Consult and work with the state insurance laws and regulations and/or legislation. • Develop and maintain relationships with brokers. Assist with driving new business flow using a solid understanding of broker’s business plan. • Reviewing RPF for new business request and negotiating prices with Carries. • Manage a portfolio of… Show more • Calculates standard and non-standard renewal and prospective employer group rates in accordance with regional rating rules and federal and state regulations. Consult and work with the state insurance laws and regulations and/or legislation. • Develop and maintain relationships with brokers. Assist with driving new business flow using a solid understanding of broker’s business plan. • Reviewing RPF for new business request and negotiating prices with Carries. • Manage a portfolio of renewal business. (Underwriting, pricing and service with a focus on retention.) • Compose, prepare and generate correspondence, proposals and other reports as required. Strategically assess risk and options and make solid decisions. • Achieve goals as outline in the business plan for assigned brokers around loss ratio, total written premium, new business and renewal retentions. • Negotiate rates and contingencies with the carries. • Interact with GBS departments for support and resources. Coordinate duties with Underwriting Assistants. Maintain well documented and organized files. Show less



CareFirst BlueCross BlueShield

• United States
• Insurance
• 700 & Above Employee

• Underwriter

  • 2011 - May 2014

  Owings Mills, Maryland • Calculates standard and non-standard renewal and prospective employer group rates in accordance with regional rating rules and federal and state regulations. Consult and work with the state insurance laws and regulations and/or legislation. • Gathers and examines appropriate documentation and data required to calculate and produce employer group rate renewal packages. • Interprets actuarial data and applies judgment as to actuarial and underwriting considerations in appropriately… Show more • Calculates standard and non-standard renewal and prospective employer group rates in accordance with regional rating rules and federal and state regulations. Consult and work with the state insurance laws and regulations and/or legislation. • Gathers and examines appropriate documentation and data required to calculate and produce employer group rate renewal packages. • Interprets actuarial data and applies judgment as to actuarial and underwriting considerations in appropriately pricing products. • Analyzes customer specific financial condition, employee demographics and past claim experience to determine degree of risk, benefits and rates for large or complex employers. • In partnership with the sales team, develops proposed rating position and benefit offering strategies while balancing growth and profitability objectives. • Participates in sales negotiates on new and renewal business with brokers and large consulting firms in obtaining important case specific information (e.g., participation rates) and finalizes proposed rate/premium offerings. • Participates in sales presentation meetings as an underwriting subject matter expert in underwriting. • Calculates broker commissions and oversees and enforces broker payment procedures and rules for employer group rating • Serves as liaison with other departments for coordinated projects. • Tests computer applications of new rating methods. • Provides advice on underwriting principles and techniques to other departments and functions including senior management. Show less