SUMMARY

• An accomplished Healthcare Senior Leader with extensive experience in Contract and Program Management. Recognized accomplishments in contract negotiations, regulatory review and auditing, process improvement, revenue cycle management, provider enrollment, global IT vendor and outsourcing management, client services, contracting, acquisitions, financial analysis, budgeting, and forecasting.
• Effective in driving for success through collaborative efforts with internal and external business partners.
• Exceptional record of contract execution and expansion to increase business, maintain compliance and develop road maps to meet and exceed CMS requirements, reduce operating costs, and provide sound decision - making for all business decisions.

TECHNICAL SKILLS

• Contract Negotiation
• Project Management
• Strategic Planning
• Program Management
• Global Vendor Management
• Health Care Admin
• Government / Regulatory Compliance
• Contract Execution and Management
• HIPAA
• Process Improvement

PROFESSIONAL EXPERIENCE

Confidential

Sr. Program Manager

Responsibilities:

• Responsible for all Program Management activities of seven Program/Client Services Managers and their twenty customer contracts valuing over 20 million dollars.
• Manages all aspects of outsourcing of vendors for large offshore contracts.
• Represents operations business needs and prepares requirements for IT.
• Reviews all NDAs, MSAs and SOWs for compliance with WWTS’s protocols.
• Develops and presents new product and services proposals and SOWs for customers based on company capabilities, strategic direction, and financial viability.
• Negotiates customer and partner pricing and requirements to ensure that the result will provide a compliant and financially sound solution.
• Develops budgets and forecasts based on customer contracts, outsourcing margins and new projects or additions to current contracts. Provides P&L information to Senior Management.
• Developed and implemented quarterly business reviews with partners to ensure all contractual requirements are met.

Confidential

Sr. Global Vendor Manager

Responsibilities:

• Developed vendor management program including contract negotiations, RFP responses, deal review, pricing, and partner vetting to ensure all customer requirements were addressed.
• In conjunction with IT, developed and implemented an internal reverse logistics process.
• In conjunction with IT and operations developed business requirements to support the quote to cash process.
• In conjunction with Sales, developed and presented service options such as blended or a la cart that met and exceeded the customer’s requirements.
• Sourced IT systems, Third-Party Maintenance, and Profession Services providers to provide the highest quality systems and support at a reduced cost to Zensar.
• Instituted quarterly business review in ensure partners were meeting SLAs and other contractual requirements. Developed and implemented Performance Improvement Plans including closed loop corrective action plans and breach of contract notifications.
• Instituted HIPAA training program as required for all Health Care contracts.
• Collaborated closely with Sales, Legal, Finance and customers to provide superior subcontracting support based on contractual requirements, cost, and margin.
• Developed and implemented new global RFP to ensure consistent qualifications and reduce vendor costs by 20%.
• Developed and implemented service level agreement dashboard identifying and resolving scoring deficiencies.
• Developed and presented status reports, process improvement initiatives and cost savings reports to senior management.

Confidential

Program Manager

Responsibilities:

• As part of the Leadership Team, reviewed and revised Medical Billing process from provider encounter to payment including scheduling, EDI Claims EOB, edit flags and payments.
• Reduced division focus on projects from 120 to 64 by aligning strategic goals and reducing the number in the pipeline.
• Implemented: Portfolio Management using MS Project Master, ROI analysis, risk management program, project approval process, success measure review process, policy, and procedure development, tracking and review.
• Led provider acquisition project between two major hospitals successfully transitioning the providers with no gaps in scheduling or service.
• Managed Provider Enrollment and reduced operating costs by $50K per year.
• On-boarded a new provider enrollment business including Medicare and Medicaid with no negative impact of revenue by managing all third-party payer enrollments including fee schedule negotiations, contract assignments.
• Directed work flows for all credentialing staff.
• Managed Dual eligibility process for enrolling and billing.
• Aligned leadership’s focus on strategic goals through creation and presentation of monthly dashboard reports.
• Led development of Quality Assurance process which ensured consistent reviewing, auditing, and reporting for all customers based on specific regulatory and contractual requirements.
• Reduced operating expenses by $100K by effectively managing vendor relations, and negotiating contracts for domestic and international vendors which also ensured regulatory compliance.
• Managed all Revenue Cycle Operations projects for business partners and customers using PMI and SDLC methodologies which resulted in reduced payment time periods and in turn eliminated need to increase staff.

Confidential

Business Contracts Manager

Responsibilities:

• Developed and maintained relationships with all providers including State Directors, Commercial Network Managers, and Case Managers to participate in new policy and regulation generation and to revise existing policies.
• Successfully lobbied Medicaid to permit document storage in a management system for audit purposes which reduced leasing and staff costs.
• Developed and presented SLA reports including service reviews and corrective actions.
• Managed the selection process to purchase a new remote monitoring and billing system to support Homebased remote monitoring and the subsequent billing/claims requirements.
• Managed large acquisition integrations across internal and external customers.
• Worked closely with social service organizations to ensure proper credentialing was obtained.
• Developed and implemented company-wide policies and procedures based on contractual and regulatory requirements which reduced external audits and eliminated citations.
• Managed all vendor relations and contracts for Govt. Services including On Base Solutions, Iron Mountain, On Process and all field support vendors.
• Developed, implemented, and managed the upgrade to a CRM management system which provided contract management tools for audits, contract terms, pricing, and compliance requirements.
• Worked in conjunction with Sales and Operations to provide competitive pricing models and service level agreements to execute competitive contracts with customers.
• Developed monthly reporting to payers based on contractual metrics which replaced many formal site audits.
• Developed proposal model used across Government Services which reduced submittal time and ensured consistency across customers.
• Managed all aspects of State and Agency audits which included Infrastructure, Provider Service, Billing, Disaster Recovery, and Federal and State Regulations.
• Developed internal audit process which resulted in an increase in external audit scores across customers.

Confidential

Manager

Responsibilities:

• Developed, Implemented, and managed FCHP’s project portfolio, ROI analysis, budget review and forecasting process, risk management program, project approval process, success measure review process, policy, and procedure development, tracking and review.
• Developed and led project management methodology and workflow processes designed to enable project managers to consistently implement quality solutions, on-time and within budget.
• Developed and implemented contracting process including review, regulatory review, negotiating and ongoing tracking.
• Managed NCQA initiatives such as implementing a Nurse Call Line, implementing a new Case Management program, and led the project to elevate FCHP to a Center of Excellence.
• Managed transition of Medicare Part D within IDX (Centricity) systems.
• Lead Affordable Health Care Proposal initiative including Pharmacy tiering.
• Developed company-wide Key Performance Indicator reporting tools and processes for improvement which were collected, reviewed, mitigated, and implemented by all departments.