Experience

S&S Healthcare Strategies, Ltd

• Director of Reporting & Analysis

  • May 2016 - Present

  Cincinnati, OH Maintained & Enhanced Reporting, standard and ad hoc, to support Clients • Increased data integrity of information, establishing processes to review and validate data. • Defined report catalog, categorizing types of reports and information available to Clients. • Drove Reporting Committee standardization process, defining standardized list of codes and descriptions, facilitating information consistency in reports. • Partnered with Stop Loss Committee, outlining processes and… Show more Maintained & Enhanced Reporting, standard and ad hoc, to support Clients • Increased data integrity of information, establishing processes to review and validate data. • Defined report catalog, categorizing types of reports and information available to Clients. • Drove Reporting Committee standardization process, defining standardized list of codes and descriptions, facilitating information consistency in reports. • Partnered with Stop Loss Committee, outlining processes and activities, evaluating opportunities and efficiencies. Show less



Anthem, Inc. (previously WellPoint, Inc.)

• Senior Provider Contract Cost of Care Consultant

  • 2015 - Apr 2016

  Cincinnati, Ohio Sustained development and implementation of Bundled Payment Program • Engaged providers in contract discussions by producing interim reports to illustrating the bundled payment experience of select provider organizations. • Outlined methodology to calculate Bundled Payment target that creates an incentive for a provider organization to manage cost, but reducing the risks related to outlier cases.

• Director, Provider Economics

  • 2012 - 2015

  Cincinnati, Ohio Oversaw contract negotiations, including reporting and analysis, to facilitate expansion of active ACO or PCMH provider contracts across enterprise. • Implemented interim solution for producing a medical cost target (MCT) that resulted in over 100 provider agreements to be signed during initial 12 months, while supporting a transition to automated process. • Created reporting tools and metrics to monitor performance, providing an early signal of material changes in experience that… Show more Oversaw contract negotiations, including reporting and analysis, to facilitate expansion of active ACO or PCMH provider contracts across enterprise. • Implemented interim solution for producing a medical cost target (MCT) that resulted in over 100 provider agreements to be signed during initial 12 months, while supporting a transition to automated process. • Created reporting tools and metrics to monitor performance, providing an early signal of material changes in experience that warrant further analysis.



Wellpoint Anthem

• Insurance
• 700 & Above Employee

• Healthcare Economist, Sr.

  • 2009 - 2012

  Cincinnati, Ohio Served as key representative of the Provider Reimbursement Strategy & Analytics organization on the ICD-10 implementation team responsible for evaluating impacts to provider contracting and cost of care trends. • Consulted with Deloitte, developing methodology and strategy for estimating the financial impact associated with transition from ICD-9 to ICD-10 coding on claims. • Developed initial assessment of the financial impact with a transition to ICD-10 that included an outline of… Show more Served as key representative of the Provider Reimbursement Strategy & Analytics organization on the ICD-10 implementation team responsible for evaluating impacts to provider contracting and cost of care trends. • Consulted with Deloitte, developing methodology and strategy for estimating the financial impact associated with transition from ICD-9 to ICD-10 coding on claims. • Developed initial assessment of the financial impact with a transition to ICD-10 that included an outline of high-impact procedures. • Created test cases to evaluate the impact of the transition to ICD-10 based on the coding submitted by partner provider organizations for each scenario.

• Director & Actuary Associate

  • 2004 - 2009

  Cincinnati, Ohio Provided reporting and analytic support on regional and Enterprise initiatives or ad hoc requests. Managed data integrity and defining key success metrics of project. • Increased potential recoverable by more than $20 million by improving contract compliance efforts. • Developed the ROI / savings estimates, and tracked performance, for large-scale and complex enterprise-wide cost initiatives, requiring broad collaboration and consensus-building on investment.



Anthem

• Management Consulting
• 1 - 100 Employee

• Sr. Business Consultant

  • 2000 - 2004

  Cincinnati, Ohio Coordinated and managed information/analysis needs for the Ohio market to support leadership in strategic decision-making. • Collaborated with local management teams to evaluate, manage, and forecast cost trends over an 18 – 24 month time horizon, supporting accurate and profitable product pricing. • Led audit of underwriting policies and practices where recommended changes resulted in a $15 million increase to operating margin.