Denison University

Director, Value Based Payment Products at Beacon Health Options

Researched, conceptualized, developed, and monitored innovative Commercial, Medicare and Medicaid payment solutions that included Pay-For-Performance, Bundled Payment, and Risk-Based models for Behavioral Healthcare providers, by framing and validating business requirements to support provider collaboration and strategic planning. Solutions were primarily focused on SUD, OUD, Autism, ADD, and ABA.
Responsibilities:
• Developed and scaled solutions to support provider partners in transitioning from fee-for-service to value-based care.
• Performed complex market and competitive analysis to identify key provider groups.
• Engaged providers’ executive, clinical and operational teams, along with Beacon Health Options’ cross-functional teams, including Network Management, Provider Relations, Provider Quality, Legal, Claims, Information Technology, Sales and Analytics in developing and implementing the programs to effectively accommodate the resulting partnerships.
• Compiled business requirements to create Value-Based concepts.
• Monitored contract performance and helped develop tactics for remediation of under-performing contracts.
• Developed, led, and delivered value-based program operationalization training to internal and external stakeholders.
• Responsible for value-based care program maintenance, including provider roster management, government program database entry, and tactical performance.
• Managed payer/partner relationships and ensured deliverables were met.
• Developed presentations for and facilitated effective Joint Operating Committee (JOC) meetings with Executive Leadership of provider groups.
• Created business case and ROI analysis. Teamed up with business partners to guide and support solution development, pilot, and launch activities and, develop strategic roadmaps to drive business solutions.
• Developed, designed and documented processes and systems to support business needs.
• Led special projects/initiatives.

Beacon Health Options

Director, Value Based Programs

Researched, conceptualized, developed, and monitored innovative Commercial, and Medicare Value Based Programs, including Accountable Care Organizations, Bundled Payment Arrangements, Pay-For-Performance, Patient Centered Medical Homes and Risk-Based models with key provider groups, to support provider collaboration and strategic partnerships.
Responsibilities:
• Engaged providers to promote the concept and understanding of Commercial and Medicare Value Based Program models.
• Evaluated providers and proposed appropriate payment methodology such as gain sharing and partial or global risk, based on each group’s readiness.
• Negotiated the contractual terms and conditions with provider groups for Accountable Care and Bundled Payment arrangements.
• Coordinated program implementation plans based on individual provider goals and structure; translating their business needs into practical applications and innovative solutions and designated responsibilities as determined by area of expertise.
• Designed complex financial analytic reports to provide high-level information to internal and external stakeholders.
• Analyzed the financial performance of participating providers and provided solutions to drive measurable results.
• Managed payer/partner relationships and ensured deliverables were met.
• Developed presentations for and facilitated effective Joint Operating Committee (JOC) meetings with Executive Leadership of provider groups.
• Supported program quality success metrics through education and support to health care organizations enrolled in an Accountable Care or any other Value-Based Payment Program.
• Ensured program integration across the business enterprise to guarantee alignment with corporate strategies and leverage potential opportunities.

Florida Blue

Program Manager, Value Based Payments

Used professional and institutional knowledge, including theories, practices, and techniques, to successfully implement corporate strategic initiatives and departmental activities.
Responsibilities:
•	Directed the planning, design, production, and management of Alternative Payment Arrangements that included Capitation and Bundled Payments, Analytics, Medical Operations Capabilities and Medicare projects.
•	Led cross-functional project teams that included Actuarial, Audit, Delivery Systems, Finance, Informatics, Information Technology, Marketing, Product Management, Sales, Service, and other enterprise areas. Guided the work of technical teams by articulating project goals and scope, translating business needs into technical terms, preparing detailed work breakdown structures (WBS)/project timelines, and instilling shared accountability for achieving project milestones.
•	Organized and facilitated regular cross-functional work group meetings to monitor and evaluate processes, discuss policy issues, and recommend improvements and adjustments.
•	Ensured the timely completion of assigned projects including addressing staffing shortages, tactical matters, uncontrolled changes in a project scope, and divergent business and user needs.
•	Developed cost-benefit analyses and ROI assessments to facilitate management decisions.
•	Subject matter expertise on various Medical Cost Management workgroups and projects for the development of strategic cost savings programs.
•	Developed and submitted scheduled reports, documentation, and presentations to provide status updates and outcomes to Senior and Executive Leadership.

Business Project Manager

Managed the daily activities of the 10 employee operations unit, consisting of Personnel Recruiters, Scheduling Coordinators, Team Assistants, and Receptionist, and administratively supervise 400 field employees for flagship branch of Care Management Company.
Responsibilities:
• Developed and implemented strategic initiatives aimed at revenue growth, and client/referrer satisfaction.
• Prepared annual financial budgets, forecasting revenue and expenditure targets for the fiscal year.
• Created, executed and maintained budgetary controls to guarantee expenditures were kept within budgeted limits.
• Involved with vendor negotiations, ensuring the company received the best possible pricing and terms.
• Maintained vendor relationships in support of company objectives.
• Monitored and approved financial transactions, including client billing, payroll, vendor payment and petty cash.
• Reviewed monthly P/L, weekly productivity, compliance and other reports for accuracy and to ensure set targets were met. Developed ad hoc reports as needed.
• Ensured NYS Department of Health and CHAP compliances were maintained by conducting quarterly audits of files and computer systems.
• Recruited, interviewed, hired and did separations of office and field staff as necessary.
• Conducted annual performance evaluations, and organized the training and development of office and field staff.
• Organized community outreach initiatives to establish and maintain referral sources.
• Addressed client concerns promptly to ensure continued client satisfaction.
• Maintained existing policies and procedures, making operational improvements if necessary. Developed new policies and procedures to address regulatory changes, new business initiatives, etc.

SeniorBridge

Operations Manager

Managed the 34 employee, multi-facility Operations Unit, consisting of Office Managers, Department Coordinators, Patient Service Coordinators, Paraprofessional Schedulers, HRA/OASIS Liaisons, File Room Clerks, Receptionists, and V.A.N. Drivers for the Long Term Home Health Care and Care At Home Programs of a leading pediatric health care organization.
Responsibilities:
• Developed the annual revenue and expense budgets for both the Long-Term Care and Care At Home Programs.
• Reviewed monthly P/L and other reports for accuracy and reconciled differences.
• Negotiated with vendors and managed vendor contracts, ensuring the company received the best possible terms.
• Developed ad hoc reports to project need for change and move resources to help improve areas where need was greatest.
• Coordinated Medicare and Medicaid billing of all client accounts in conjunction with the Finance Department.
• Developed and implemented strategic objectives, and identified operational metrics to measure the success of objectives.
• Attended Home Care Association, Greater New York Hospital Association, and Cerner NY User Group meetings to stay aware of industry and regulatory changes.
• Reviewed vendor invoices for accuracy and approved payments accordingly.
• Primary project manager for the implementation of new electronic medical records system—Cerner HomeWorks & RoadNotes.
• Recruited, interviewed, hired and did separations of operations staff as necessary.
• Reviewed and approved personnel and payroll transactions, and conducted annual performance evaluations for all operations staff.

St. Mary's Healthcare System For Children

Business Operations Manager

Managed the department activities, handled administrative matters, and performed data analysis and facilities planning across the Queens, Manhattan, Bronx and Brooklyn locations of the Long Term Home Health Care Program (LTHHCP).
• Prepared annual financial budgets and assisted in the development of strategic initiatives.
• Tracked the Department’s performance against its strategic objectives, and monitored reports to ensure Department was in line with set metrics. Alerted Senior Management about underperforming areas.
• Reviewed and approved staff reimbursement requests and invoice payments to vendors.
• Collected data and prepared related reports, presentations and documentation, including the Department’s Annual Report, Program Review, and Board Quality Review for presentation to company’s Executive Management.
• Prepared project plans, coordinated implementation of projects, and followed up with managers and staff to ensure success of projects.
• Supervised the administrative staff, interns and volunteers within the Department. • Oversaw the planning and execution of patient luncheons across all four office sites.

Visiting Nurse Service of New York

Department Coordinator

Coordinated all administrative and personnel functions for the Faculty Practice of the Department of Surgery (November 4, 2002 - June 18, 2004)/Division of Medical Oncology, Department of Medicine (September 4, 1999 – November 1, 2002)
• Handled Practice personnel transactions, and responsible for payroll and related issues.
• Implemented policies and procedures in accordance with facility and industry standards for smooth operations.
• Developed inventory control mechanisms to eliminate waste and cut cost.
• Assisted in negotiating with vendors, including after hours answering service, to get the best possible rate.
• Ensured vendor invoices were accurate and processed timely to avoid application of late fees.
• Processed requests for medical information from law firms, other physician offices and patient.

Rae Richards