Trinity International University

Certified Pharmacy Techs - CPhT

Luther South

Olive Harvey College, Illinois 2003

St. Thomas College, MN 

Trinity College and University, Illinois 2003

US Army

University of St. Thomas - Opus College of Business

Director Client Sucess at Simplify Healthcare

Responsible for growth, health and rapid business expansions. Managed account relationships with key stakeholders throughout the implementation and warranty periods. Managed and mentored client delivery and engagement teams. Provided oversight of their day-to-day activities, overarching recruitment, onboarding, development and client satisfaction. Accountable for production clients and administered invoicing, contract renewals and annual licensing.

Simplify Healthcare

Director Client Sucess

Responsible for the execution of optimization efforts, initiatives and activities as well as ongoing competency evaluation and development of FACETS claims projects. Providing ongoing feedback to internal product and client teams to ensure deliverables are met within the project timeline.  Accountable for providing resolution to strategic product issues, SLAs, SOW’s and client product related escalations. Managed delivery capabilities for clients, their contractors and vendors when applicable. On-site visibility at client location (s) including the building and maintaining of relationships with key stakeholders, understanding cross-company policies and business practices.  Lead software development and multi-channel implementations. Managed transformation initiatives, project cost, resources allocation, timeline and scope. Responsible for team coaching, customer engagement and customer/client satisfaction.

Cognizant Digital Services

Assoicate Director- HealthCare Consultant

Manage and develop ASP relationship. Provide pre-sale and marketing expertise in the development of the proposal for ASP clients. Provide direction and leadership to internal management and staff regarding client's needs and objectives, focusing on service, efficiency, and implementation of sale.

Oversees client interactions focusing on business implementation plan that will be implemented by project delivery team. Works with the project delivery team to develop business migration strategies and program plans, performance metrics and risk/benefit analyses, financial projections and related communications for ASP clients.

Cultivate and manage strong professional relationships with ASP clients and staff to gain trust and focus on future deliverables and value generation. Provide primary point of communication to client in regard to scope change, organizational issues, and project delivery concerns, new intake of work.

Provides information of broad set of Company’s capabilities to external audiences for clients, their contractors and vendors when applicable. On-site visibility at client location (s) including the building and maintaining of relationships with key stakeholders, understanding cross-company policies and business practices.

Highmark Health

Strategic Solutions /  Client Implementation Consultant, Medicaid Platform

Providing leadership and guidance for application conversions, product development, requirements gathering and project management. Managed software development efforts and application scalability. Lead configuration efforts, operational processes, and system integration procedures across multiple integrated platforms and product lines.

Managed consulting practice delivering system implementations and client upgrades. Lead development strategies and managed several implementations across multiple integrated platforms and products for Medicare, Medicaid and Commercial lines of business. Provided direction and leadership for testing, training, operational readiness and call center management.  

Managed successful claim re-pricing platform conversion projects for top five EDI clients with annual revenue in excess of 6 million dollars. Work closely with ikaMedicareGateway and ikaClaims systems, contributing to pre-sales activities, product demos and RFP responses. Manage relations with third-party software vendors such as, Ingenix, Milliman, Emdeon and others. Served as single point of contact for client, stakeholders, executive teams reporting, escalations and product delivery.

Emergent Holdings

Sr. Soultions Delivery Director

Provided configuration and migration support to achieve a model office for FACETS 4.5 
all office domains. Developed best practice operational procedures and technical solutions for JAD sessions. Built product designs based on business requirements and created supporting detail design documents.

Blue Cross Blue Shield of Rhode Island

FACETS IT Configuration Manager

Focused on providing configuration and migration support to achieve Model Office  for Facets 4.5 release across all Office domains.
Worked with all levels of management to develop best practice operational procedures and technical solutions for JAD sessions.
Built product designs based on business requirements and created detail design documents.
Demonstrated strong communications skills to facilitate effective coordination between delivery managers, project coordinators and team members.

CareFirst BlueCross BlueShield

Senior Project Manager  / FACETS Business Analyst

Worked with specialists, managers, directors, and VP to identify areas for improvement and deploy project initiatives to enhance efficiency capabilities and develop practice-specific resolution plans.
Managed the development of reimbursement policies / procedures and support of benefit builds as per Rider filings and / or new products/components.
Participated, as needed, in process and technology enhancement activities and coordination with multiple units (benefits, marketing, products/operational build areas, sales).
Developed and managed costumed QLL, QD, and Step Therapy Programs.

MedImpact Healthcare Systems, Inc.

Manager Business Development / Senior Project Manager Pharmacy Health Services

Facilitated cross-functional work teams to develop the enhancements of the Houston application to support Product Management's routine service request.  Ensured compliance with CMS regulations and deadlines for Part D activities.

Assisted with directing the accurate, effective and efficient configuration, support and maintenance of assigned components of the company’s core and integrated systems.

Managed special projects, including developing, implementing and designing operational procedures.

Determined necessary resources and project timeline, created plan designs and policy and procedures for new corporate initiatives.

Worked with clinical, account managers and IT to develop process improvements for Disease Management programs and to assure CMS compliance utilizing both TriZetto Facets 4.3 and Shareware

Express Scripts

Senior Product Manager Pharmacy Health Services ( Consultant)

Focused on Medicare and Medicaid management environment, worked heavily with researching regulatory guidelines as they related to Employer Group Work Plans.

Worked with all levels of management to develop best practice operational procedures and marketing solutions for MA-PDs, PDPs and EGWPs.

Supported Medicare, Medicaid and Commercial claims CMS mock audits, provided clients with detailed error reports and strategies to prevent continued errors.

Demonstrated strong communications skills to facilitate effective coordination between delivery managers, project coordinators and team members.

PwC Consulting

Senior Associate

Managed day-to-day operations, promote the overall vision, goals, performance and strategies conducted numerous risk assessments based on member utilizations and population cost.

Experienced with planning, budget and overall supervision of business units of various size and scopes.

Analyzing contracting, clinical and data management to determine if client’s expectations are meet.

Contributed to the growth of the implementation and benefit design infrastructure made decisions that offered creative solutions to lessen impacts to the operational areas.

Developed project proposals and determines time frames for product and plan implementations.

Contract Manager, Medicare Part D

Managing concurrent vendor activities and performances for Medicare D interrelated products.

Responsible for configuration, migration and developing of crosswalks between RX claims, MARX’s, PCAT and Trizetto’s Facets application.

Developing and managing departmental budgets, staff goals and objectives, project plans and resources. Lead technical projects from concept to implementation. Translated complex functional and technical requirements into detailed project plans.

Established and maintained quality procedures utilized by benefit design staff and the quality assurance department to ensure claim adjudication, COB coordination, Plan to Plan reconciliation and PDE submission.

Prime Therapeutics

Senior Project Manager Part D Operations

Managed installations and served as primary contact for inter-departments, external and offshore customers, performed UAT testing and obtained business unit approval in order to migrate to Trizetto’s Facets application.

Directed and validated the maintenance of documentation to support appropriate recordkeeping and change control.

Developed test plans, executed testing, coordinating tasks and supporting customers during system implementation and modifications upgrades for several independent projects related to Medicare Part D.

Translated business requirements into technical requirements used for driving improvements, enhancements, for creation of new applications or processes.

Coordinated the production reports and security levels utilizing Crystal 7 reporting tool. Familiar with SQL and Oracle.

Ovations

Senior Project Manager / Business Analyst (Consultant)

Managed employees, vendors and virtual resourced teams and communicated to leadership financial acumen.

Coordinated change control request, using project management, and spreadsheets to analyze data and produce reports. Developed programs to enhance and increase formulary compliance in addition to cost savings for managed care organizations.

Effectively managed cost, schedule, scope, quality, risk, and project resources over duration of assignment following the appropriate methodology.

ICORE Healthcare

Product Manager for Specialty Pharmacy

Provided technical and facilitation expertise in support of several IT projects. Participated in all aspects of the product development life cycle, from defining the platform strategy, and architecture through product deployment and support with FACETs'.
Provided detail management to assure maximum performance for implementation and customer deliverables.
Collaborated with New Business development, Operations, Finance, Distributions, Trade Relations, Managed care sales, and Marketing to acquire pipeline requirements.

United Helth Group

Project Manager Specialty Pharmacy Contracts / Account Executive

Provided technical and facilitation expertise in support of several IT projects. Participated in all aspects of the product development life cycle, from defining the platform strategy, and architecture through product deployment and support with FACETs’.

Provided detail management to assure maximum performance for implementation and customer deliverables.
Collaborated with New Business development, Operations, Finance, Distributions, Trade Relations, Managed care sales, and Marketing to acquire pipeline requirements.

Monitored business plan initiatives that related to system enhancements, interrelated projects and cross-functional teams.

CVS/Caremark

Account Execuctive Specailty Pharmacy

Manufactured new hire job specific training manuals using innovative methods that increase productivity. Developed business requirements related to product development.

Develop Healthcare program business opportunities within client community for facilities. Identify/qualify leads, working with principals and technical staff to develop marketing strategies to bring targets to closure.

Created detailed business requirements and day-to-day production sheets.

Gathered business requirements regarding data needs from internal customers, communicated user requirements to create strategic initiatives and data mapping for TOPS, UNET, Diamond and COSMOS.

UnitedHealth Group

Project Manager /National Trainer

Coordinated negotiation of multi-product provider contracts for various books of business. Maintained effective business relationship with physicians, hospitals and ancillary providers.
Increase awareness of Healthcare practice among individuals within region's potential clients, network of contractors, consultants, and potential associate firms.
Identified needed resources, assisted in cost/benefit analysis; established overall project plans for business process improvements.
Monitored contract rates and fee schedules for Physicians, Ancillary and Hospital with TOPS, UNET, VAXs and COSMOS and Diamond.

Project Manager for Provider Relations

Coordinated negotiation of multi-product provider contracts for various books of business. Maintained effective business relationship with physicians, hospitals and ancillary providers.

Increase awareness of Healthcare practice among individuals within region’s potential clients, network of contractors, consultants, and potential associate firms.
.	Identified needed resources, assisted in cost/benefit analysis; established overall project plans for business process improvements.

Monitored contract rates and fee schedules for Physicians, Ancillary and Hospital with TOPS, UNET, VAXs and COSMOS and Diamond.

Project Manager / Contract Business Analyst

Responsible for program development, reporting and systems implementation, as well as knowledge of ICD9, CPT and HCPC codes.
Coordinated claims processing including Front End functions (i.e. Electronic Data Interchange interface, paper claims intake, document control, provider direct data.
Identified needed resources, assisted in cost/benefit analysis; established overall project plans for business process improvements. Analyzed operational workflow to ensure quality, quantity, required timeframes, and efficiency standards are satisfactorily met.
Prepared Business rules and requirements for system migrations to EASYCAP application.

Toya Creed