Responsible for leading and developing strategic premarket provider, payer and employer relationships to bring a new technology of liquid biopsy multi-cancer detection to market.

• Securing multiple national and regional key opinion leader relationships as pilot partners to assist in the development of real-world evidence to support FDA and CMS approval
• Development of market access approval pathways for CPT, CMS and HEDIS
• Obtaining laboratory-developed test (LDT) innovation partnerships to gain learnings of health system workflow redesign
• Creation of pilot partner contract templates

Served as the executive in charge of developing provider relationship strategies, provider network sufficiency and network operations, during a period of significant organizational growth and turnaround. The product lines supported by this role included behavioral and specialty carve outs, Medicare and Medicaid.

• Creating and implementing value-based strategies to promote overall provider engagement and meet commercial and government customers requirements
• Driving efficiencies and redesign efforts to reduce the Provider Strategies and Solutions’ operational costs by 10%
• Developing and implementing a structure to drive improvements in the cost of care
• Executing on efforts to outsource non-value add functions including credentialing and centralized printing services
• Executing significant network builds for new products and customers

Accountable for helping the organization manage overall hospital and physician spend through developing contracting strategies, providing educational guidance to the markets, overseeing network adequacy and provider communications.

• Oversaw the implementation contract approval forum
  Created and led an enterprise team to improve the integrity of provider data
• Supervised the creation of a return on investment-based provider communications hub
• Significantly realigned resources to redirect management resources into front-line associates to provide greater assistance to market-based teams
• Initiated the implementation of a new contract management system
• Led teams to develop adequate networks for Medicaid RFP responses
• Oversaw the assessment of network adequacy for all product lines

Responsible for all provider development activities to support commercial, Medicare, Medicaid, and exchange-based products for 850,000 members.

• Led the contracting team through significant expansion of path-to-value agreements including full risk, partial risk, value-based arrangements
• Locally negotiated contracts with national providers have become the Humana template for these national chains
• Built a comprehensive Medicaid network in seven months which was accessed by more than 120,000 members
• Coached staff through development of business plans yielding $70M in cost of care savings
• Leadership of national reimbursement templates and contract process improvement strategies leading to enterprise changes in Provider Development

Responsible in leading the national Accountable Care Organization provider strategy over 14 states

• Worked across multiple departments to develop contractual templates and contracting playbook
• Trained field-based provider contracting divisions in negotiating techniques and strategies

Accountable for development and leadership of the entire finance function as well as China-based provider network. Recruited, developed, and managed team of finance and contracting professionals, managers, and support staff.

• Instrumental in international joint venture development
• Designed financial board packets to drive a thorough understanding of performance improvements
• Led the implementation of alternative financing for silent US partner investment in the foreign operations
• Enhanced accounting controls to ensure compliance with WellPoint policies, accounting guidelines and the Foreign Corrupt Practices Act
• Led the monthly closing and related analysis with cost center managers
• Negotiated and implemented an international network contract

Responsible for all hospital and ancillary provider relationships and contracts in Indiana. These responsibilities included physician contracting of fee-for-service, capitation and risk sharing arrangements for more than 2 million members.

• Supervised the contractual relationships of $3.0 billion of annual hospital and ancillary expenditures which assist Anthem’s growth in commercial market share from 35 to ~60%
• First in the nation to base hospital reimbursements on quality outcomes. Over 75% of the Indiana hospital contracts were converted to include pay-for-performance
• Periodically testified before the Indiana legislative subcommittees to promote cost-effective healthcare legislation
• Central Region lead for the integration team assigned to optimize and leverage enterprise strengths in contracting hospitals.
• Significant role in acquiring a statewide HMO
• Aligned with Anthem’s PBM to ensure provider agreements were aligned for overall cost-effectiveness
• Instrumental in the development and presentation of the Request for Proposal response for Healthy Indiana
• Indiana’s subject matter expert for provider network impacts to local and national employers.

Significant responsibility for all financial functions of a company that grew from a $5 million to a $100 million operation, including a 65,000-member HMO and a third-party government contract administration company. Implemented accounting, internal control and reporting systems to support rapid growth, employee turnover, and efficiencies. This staff of 32 was also responsible for all tax filings, treasury interactions, and establishing adequate and mandatory reserves.

• Managed the financial aspects of merging three diverse businesses into a new managed care organization with $100 million in revenues
• Supervised various analyses that identified major clients, which were generating large underwriting losses. Earnings improved by $2 million
• Developed product-pricing models, which contributed to the award of six major government contracts with a value of $7 million in annual revenue
• Implemented a new accounting system and procedures 

Served in the highest financial position of this $2 million downstream marketing and research firm. The Controller was also responsible for the human resources of 65 employees, tax filings and banking relationships.

• Installed and implemented a time and billing system including the creation of all necessary written accounting policies and procedures related to the new system
• Led the acquisition of a direct marketing ad agency and a marketing research firm
• Developed pricing models for account executives

Progressed through various auditing roles of increasing responsibility for the Indiana Medicare Intermediary.

• Directed Medicare cost report compliance audits of hospitals, skilled nursing facilities and rehabilitation centers
• Established the Indiana Medicaid Disproportionate Share payments
• Developed a computerized auditing system, which was awarded HCFA funding