Mark Miller
Chief Transformation Officer at South Shore Elder Services- Claim this Profile
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Bio
Alice Bonner
Mark is a dedicated, thoughtful, experienced public sector professional and manager. He supports and mentors junior team members and is equally skilled at supporting senior leaders on the team. Mark has deep content expertise in Medicaid, Special Needs Plans (SNPs), Medicare Advantage and other topics related to health care finance. He has experience in health and human services delivery across many programs, including senior nutrition, pharmacy and other health benefits, protective services and others. He is able to oversee complex projects and to supervise project management by junior staff. His writing and verbal communication skills are outstanding. Mark is both an exceptional team player and a stand-out individual contributor. He would be a valuable asset to any organization.
Cindy Nguyen
In the time that I worked with Mark, I was impressed with his grasp of the ever-changing regulatory landscape. He always had a global outlook of legal concerns. His easy-going, pleasant personality made his constant reporting requests feel less cumbersome for all involved.
Alice Bonner
Mark is a dedicated, thoughtful, experienced public sector professional and manager. He supports and mentors junior team members and is equally skilled at supporting senior leaders on the team. Mark has deep content expertise in Medicaid, Special Needs Plans (SNPs), Medicare Advantage and other topics related to health care finance. He has experience in health and human services delivery across many programs, including senior nutrition, pharmacy and other health benefits, protective services and others. He is able to oversee complex projects and to supervise project management by junior staff. His writing and verbal communication skills are outstanding. Mark is both an exceptional team player and a stand-out individual contributor. He would be a valuable asset to any organization.
Cindy Nguyen
In the time that I worked with Mark, I was impressed with his grasp of the ever-changing regulatory landscape. He always had a global outlook of legal concerns. His easy-going, pleasant personality made his constant reporting requests feel less cumbersome for all involved.
Alice Bonner
Mark is a dedicated, thoughtful, experienced public sector professional and manager. He supports and mentors junior team members and is equally skilled at supporting senior leaders on the team. Mark has deep content expertise in Medicaid, Special Needs Plans (SNPs), Medicare Advantage and other topics related to health care finance. He has experience in health and human services delivery across many programs, including senior nutrition, pharmacy and other health benefits, protective services and others. He is able to oversee complex projects and to supervise project management by junior staff. His writing and verbal communication skills are outstanding. Mark is both an exceptional team player and a stand-out individual contributor. He would be a valuable asset to any organization.
Cindy Nguyen
In the time that I worked with Mark, I was impressed with his grasp of the ever-changing regulatory landscape. He always had a global outlook of legal concerns. His easy-going, pleasant personality made his constant reporting requests feel less cumbersome for all involved.
Alice Bonner
Mark is a dedicated, thoughtful, experienced public sector professional and manager. He supports and mentors junior team members and is equally skilled at supporting senior leaders on the team. Mark has deep content expertise in Medicaid, Special Needs Plans (SNPs), Medicare Advantage and other topics related to health care finance. He has experience in health and human services delivery across many programs, including senior nutrition, pharmacy and other health benefits, protective services and others. He is able to oversee complex projects and to supervise project management by junior staff. His writing and verbal communication skills are outstanding. Mark is both an exceptional team player and a stand-out individual contributor. He would be a valuable asset to any organization.
Cindy Nguyen
In the time that I worked with Mark, I was impressed with his grasp of the ever-changing regulatory landscape. He always had a global outlook of legal concerns. His easy-going, pleasant personality made his constant reporting requests feel less cumbersome for all involved.
Credentials
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Leading Virtual Meetings
LinkedInJul, 2020- Oct, 2024 -
Leading at a Distance
LinkedInJul, 2020- Oct, 2024 -
Managing Virtual Teams
LinkedInJul, 2020- Oct, 2024 -
Attorney
Massachusetts Board of Bar OverseersNov, 1992- Oct, 2024
Experience
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South Shore Elder Services
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United States
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Non-profit Organizations
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1 - 100 Employee
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Chief Transformation Officer
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Jan 2021 - Present
Serve on the Senior Management Team to ensure progressive planning, competency building, data accuracy and management, and quality assurance are met with continuous quality improvement. Partner in the development of visionary changes to the strategic plan for the agency and implement a framework for focused growth in enterprise management, fundraising, philanthropy and succession planning. Provide oversight to matters relating to SSES fiscal, information technology, compliance, quality, and Senior Care Options. Accomplishments: * Migrated SSES Policies and Procedures from paper to an Online Policy Library serving as a single source of truth location and developed and implemented a new policy governing the issuance, modification, and decommissioning of policies and procedures. * Revised and updated both the Employee HIPAA and Confidentiality Training and Fraud, Waste & Abuse (FWA) Trainings. * Executive sponsor in overseeing the migration of all-staff, new hire, and management development training into an online learning management system (LMS) environment along with the establishment of a Management Development Curriculum within the LMS to improve management staff skills. * Revised and updated the SSES Conflict of Interest Statement and Acknowledgment and introduced annual certification by Employees, Advisory Committee, and Board members.
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Commonwealth of Massachusetts
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United States
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Government Administration
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700 & Above Employee
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Director of Strategic Initiatives and Program Integrity, Executive Office of Elder Affairs
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Aug 2019 - Oct 2020
As a member of the Senior Leadership Management Team at the Executive Office of Elder Affairs (EOEA), responsibilities include:* Analyzing, developing, and implementing business process improvement strategies;* Direct daily administration and oversight of the Assisted Living Residence Program and management during the COVID-19 EOEA response;* Managing program integrity in both minimizing risk to EOEA and determining key metrics across the Aging Services Access Points (ASAPs) to determine compliance and outcome variability;* Ensuring that all external State Auditor Office (SAO) audits are managed from entrance conference through any eventual audit report and post audit report process;* Serve as EOEA’s Internal Control Officer;* Serve as the senior manager responsible for oversight of both the Prescription Advantage Program and the Senior Community Service Employment Program (SCSEP); and* Manage development and implementation of a statutory mandate for LGBTQ Training for EOEA contractors and EOEA-certified entities.
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Director Of Administration, Executive Office of Elder Affairs
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Mar 2018 - Aug 2019
Key Responsibilities:Serve on the EOEA Senior Leadership Management Team having responsibility for:* Procurement planning and strategy, including the re-contracting for the elder services network and will collaborate with agency staff to develop request for responses (RFRs) and other procurement-related documents that reflect intended programmatic design. * Program and operational policy for several key programs including Elder Nutrition (serving over 80,000 consumers) and Prescription Advantage (35,000 consumers).* Complying with new legislative mandates including the establishment of a Home Care Work Registry.* Managing State Auditor’s Office (SAO) audits of the agency, including preparing the agency response.
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Deputy Director, Chief Compliance and Enterprise Risk Management Officer, MassHealth OLTSS
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Feb 2016 - Mar 2018
The Deputy Director of OLTSS supports the Chief of OLTSS in developing and implementing key strategic priorities in both Program Integrity and in Integrated Managed Care Programs while serving as a member of the OLTSS Senior Leadership Team that oversees a budget in excess of $5.6 Billion.Key Responsibilities and Accomplishments:* Thought and strategy co-lead in attacking rapidly increasing costs in MassHealth's Home Health Program that rapidly deployed regulatory revisions producing in excess of $500 Million in aggregate cost savings to the Commonwealth.* Developed and implemented an OLTSS Enterprise Risk Management (ERM) governance structure, including the creation of a Vendor Management Oversight Protocol. * Rewrote the OLTSS Internal Control Plan.* Led the Program Integrity Work Team for implementation of the OLTSS Third Party Administrator (TPA).* Implemented passive enrollment with opt-out for Medicaid-only members into the Senior Care Options (SCO) Integrated Care D-SNP Program.* Received the Commonwealth of Massachusetts Citation for Outstanding Performance for work on the OLTSS Home Health Program Integrity Project, September 2016.* Received the Commonwealth of Massachusetts Citation for Outstanding Performance for work on the Executive Office of Elder Affairs' Protective Services Program Improvement Team, November 2017.* Received the Commonwealth of Massachusetts Citation for Outstanding Performance for work on the Senior Care Options Team, September 2018.Note that from February 2016 through mid-July 2016, job title was Acting Deputy Director of OLTSS.
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Director of Coordinated Care, MassHealth OLTSS
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Jan 2013 - Oct 2016
Lead in the development, management, and evaluation of the Senior Care Options (SCO) D-SNP and Program of All-inclusive Care for the Elderly (PACE) Medicare-Medicaid Dual-Eligible managed health care programs incorporating managed long term services and supports (MLTSS), the oversight of all contracts, and the development of related policies and procedures.Key Responsibilities:* Serve as a senior member of the Long-Term Services and Supports (LTSS) management team.* Design, recommend, and implement program policy, development, and evaluation strategies.* Direct the oversight and management of all aspects of SCO and PACE contractor performance and compliance including quality improvement and management, appropriateness and timeliness of services provided by the contractor and its providers, financial performance, compliance, and member satisfaction.* Participate in the development of annual rate setting activities, including directing work of contracted actuarial services for the programs which exceeds $1.25 Billion.* Oversee financial and program reporting and monitor, analyze, and report on budget expenditures. Accomplishments:* Managed 100% enrollment growth in the SCO Program.* Developed Coordinated Care Programs Monthly Reports providing details on contractor compliance, plan enrollment, and key performance indicators.* Developed an Internal Controls Manual to document compliance and operational processes.* Devised and oversaw implementation of the "Get to Know SCO" and "PACE - Where You Are At The Center" branding campaigns, including the development of the SCO and PACE web sites.* Created the Coordinated Care Summer Presentation series where SCO and PACE organizations present annually on status, goals, challenges, and where OLTSS can be of assistance.* Co-lead the 2015-16 MassHealth Fee-for-Service LTSS Program Integrity initiative which has resulted in significant regulatory and process change in the MassHealth Home Health Program.
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Centene Corporation
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United States
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Hospitals and Health Care
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700 & Above Employee
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Vice President, Compliance and Regulatory Affairs, CeltiCare Health Plan of Massachusetts, Inc.
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Dec 2011 - Jan 2013
Ensure compliance with state health care contractual and regulatory requirements as well as serve as a liaison to state government entities to improve the legislative and regulatory environment for the state health plan, Centene Corporation and its business subsidiaries. Key Responsibilities: * Serve as a member of the CeltiCare senior management team. * Develop and maintain records of contracts, contract amendments, compliance measures and improvements, policy, procedure and process documentation. * Develop policies, procedures and processes to comply with state law, federal law and state contract requirements. * Identify, evaluate and analyze the impact of state legislative and regulatory issues and advise management concerning their impact. * Oversee the health plan privacy program, including conducting annual all-staff and new hire HIPAA training. * Investigate areas of non-compliance and initiate corrective action where necessary. Accomplishments: * Designed and implemented a progressive disciplinary policy associated with HIPAA work area and desktop audits that produced significantly improved compliance. * Coordinated the first two external audits in the company’s experience resulting in no findings requiring corrective action. * Implemented an electronic State Public Records request and retrieval process.
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Assistant Commissioner for Program Integrity, Department of Transitional Assistance
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Sep 2008 - Dec 2011
Provide leadership, innovation, and direction to a start-up division consisting of 80+ employees that is dedicated to ensuring program integrity for the nearly $2 billion Massachusetts Public Welfare Agency while serving in the capacity of a Chief Compliance Officer and participating as a member of the Department's senior management team.Key Responsibilities:* Lead 5 operational units engaged in fraud investigations and data matching, collections, internal controls, compliance, and quality control.* Lead the annual Single State Audit of the Department's operations and the co-lead in any other external audit of Department activities.* Resolve a myriad of issues including, but not limited to, security and privacy breaches, asset misappropriation or misuse, and compliance for new and existing Department agreements and contracts. Accomplishments:* Developed and produced a monthly, division-wide performance report containing updates, analysis, and financials. * Transformed the Department’s Internal Controls process from paper to electronic as well as wrote the Department’s Internal Control Plan.Note that from September 2008-September 2009, job title was Associate Commissioner for Program Integrity.
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Acting Deputy Assistant Commissioner, Department of Transitional Assistance
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Feb 2007 - Sep 2008
Coordinate staff responsible for administrative operations, financial systems and accounting, financial program management, human resources, budget, and fraud investigations and recoveries for the Massachusetts Public Welfare Agency.
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Director of Fraud Investigations and Recoveries, Department of Transitional Assistance
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Jun 2005 - Sep 2008
Lead 22 staff in realizing successful fraud investigations and overpayment collections for the Food Stamps and cash assistance programs. Accomplishments:* Increased aggregate revenue by 20%. * Reduced fraud investigations case backlog by 83%. * Increased aggregate cost avoidance savings by 90%. * Introduced monthly, quarterly and annual unit reporting.* Introduced a Six Sigma Quality improvement program.* Closed two federal corrective action plans within one year of hire.* Partnered with the Department of Probation to restate accounts receivable that had been in error exceeding $10 Million.
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ForHealth Consulting at UMass Chan Medical School
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United States
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Business Consulting and Services
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200 - 300 Employee
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Revenue Operations Manager
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Jan 2002 - Jun 2005
Manage the Massachusetts Medicaid Agency’s $14 Million cost-avoidance and recovery contract and ensure vendor compliance. (From 2002-2004 performed same function for the Division of Medical Assistance prior to a mass staff transition to UMass Chan Medical School) Manage the Massachusetts Medicaid Agency’s $14 Million cost-avoidance and recovery contract and ensure vendor compliance. (From 2002-2004 performed same function for the Division of Medical Assistance prior to a mass staff transition to UMass Chan Medical School)
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Assistant General Counsel, MassHealth
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Apr 1996 - Jan 2002
Manage and litigate estate recovery, accident/trauma, and other revenue recovery cases while providing statutory and regulatory analysis, including HIPAA analysis, and serving on the agency team for designing and implementing Senior Care Options (SCO) for the Massachusetts Medicaid Agency. Manage and litigate estate recovery, accident/trauma, and other revenue recovery cases while providing statutory and regulatory analysis, including HIPAA analysis, and serving on the agency team for designing and implementing Senior Care Options (SCO) for the Massachusetts Medicaid Agency.
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Attorney At Law
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Jan 1993 - Apr 1996
Maintain a full-time solo practice of law with an emphasis on elder and municipal law, including serving as a per diem Assistant City Solicitor for the City of Revere, Massachusetts. From February 1996 to October 2011, practice had been maintained on a part-time basis with a focus on real estate and estate planning. Maintain a full-time solo practice of law with an emphasis on elder and municipal law, including serving as a per diem Assistant City Solicitor for the City of Revere, Massachusetts. From February 1996 to October 2011, practice had been maintained on a part-time basis with a focus on real estate and estate planning.
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Education
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1989 - 1992
Boston University School of Law
JD, Law -
1986 - 1989
Questrom School of Business, Boston University
BSBA, magna cum laude, Management with a Finance concentration -
1981 - 1985
Revere High School
Valedictorian
Community
