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Work Background
Unitarian Universalist AssociationInsurance Plans Director
Apr. 2020 - Dec. 2024Boston, Massachusetts, United StatesOffice of Congregational Staff Finances management with responsibilities over the UUA Health Plans ($20 million in premiums with over 1,400 participants) and our group insurance offerings ensuring the efficient operations of vendor relationships, database management, IBNR reserve risk analysis, annual IRS 5500 ERISA compliance audit requirements and filing. Comprehensive benefits guidance to congregations, informing and guiding congregational senior leaders as they create legal health and welfare policies. Strategically implementing progressive health benefits ensuring equitable access to all populations.
Aetna, a CVS Health CompanyProvider Relations Delegation Oversight Manager
Oct. 2018 - Jan. 2020San Diego, CAAccount management for high profile providers or groups (i.e. local, individual providers, large groups/systems) to oversee and maintain positive relationships by assisting with or responding to complex issues regarding contractual policies and procedures (i.e. CMS, NCQA, HEDIS) related but not limited to plan design adherence, contract language disputes, claim risk management, annual credentialing, and education. Internal/External liaison facilitating communications between key stakeholders (operations, legal, quality, and special investigations unit). Lead initiatives to streamline and enhance oversight levering data analytics ensuring regulatory alignment with organizations goals.
Aetna, a CVS Health CompanySr. Program Manager
Oct. 2014 - Oct. 2018Phoenix, Arizona AreaSenior Program Manager at Mercy Maricopa Integrative Care the Regional Behavioral Health Authority for Maricopa County, Arizona. He oversees the business operations for State encountering, financial reconciliations including new policy implementations, data platform design/configuration to comply with Arizona Health Care Cost Containment (AHCCCS) and Department of Behavioral Health Services (DBHS) guidelines. He specializes in root cause analytics, performance improvement planning, and data interpretation utilizing IT products (i.e. QuickBase, Access, WSS, SharePoint Designer, SQL, and SSRS) to support business strategies and executive decision making. His future goal is to influence policy to fund risk management initiatives as a mechanism for funding case management programs and sustainable economic development in urban/rural communities and developing nations. His objective in life is continuous learning in the body of knowledge. His special interests are community relations, health education, and cost-efficient data analytics for business decisions under a $5 million-dollar threshold.
Aetna, a CVS Health CompanyHealth Plan Operations Manager
Mar. 2011 - Oct. 2014Orange County, California AreaThis position supports the Medi-Cal, Healthy Families, California Kids, and California Children’s Services lines of business including new product implementations, system configurations/maintenance in accordance to State and Cal-Optima guidelines. Root cause analytics and keen understanding of operational crosswalks to create cross functional processes; working with application development and architectural staff to ensure those requirements are met. Operational project management of new business venture implementation and related individual/group training. DMAIC methodology driven by claim data (SQL), trends and benchmarks to develop IT products (i.e. QuickBase/Access/WSS SharePoint Designer) to support business strategies and operational planning.
Aetna, a CVS Health CompanyClaims Reporting & Special Projects Manager
Feb. 2010 - Mar. 2011Orange County, California AreaThis position supports the Medi-Cal, Healthy Families, California Kids, and California Children’s Services (CCS) with functional responsibilities consisting of but not limited to application and system configurations/maintenance in accordance to State and Cal-Optima guidelines. Root cause analytics and keen understanding of operational crosswalks to create cross functional processes; working with Application Development (MAS) staff to ensure those requirements are met. Operational project management of new product implementation, individual/group training, DMAIC methodology driven by claim data request (SQL), identifying trends and benchmarks for strategic planning and developing products (i.e. QuickBase/Access/HUB-SharePoint Designer) to support business processes and operational planning.
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