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Work Background
Cleveland ClinicSenior Project Manager
Apr. 2024Cleveland, Ohio, United StatesDriving enterprise-level financial and operational excellence at one of the nation's top health systems. In my current role, I lead high-impact, cross-functional initiatives focused on maximizing reimbursement accuracy, strengthening audit preparedness, and improving strategic alignment across service lines. Spearheaded multi-specialty operational improvement efforts, identifying $25M+ in net patient revenue growth opportunities.
Led contract and claims data analysis to support CMS audit readiness, payer compliance, and internal revenue integrity.
Partnered with executive leadership to align reimbursement metrics with enterprise financial performance goals.
Built and optimized financial forecasting models using Strata and Excel to support strategic planning and decision-making.
Evernorth Health ServicesMEDICAL ECONOMICS ANALYST
Aug. 2020 - Apr. 2024Plano, Texas, United StatesLed high-visibility analytics efforts supporting value-based care, payer contract performance, and provider group (PG) strategy. Partnered cross-functionally across clinical, actuarial, and finance teams to optimize reimbursement models and deliver actionable insights. Designed and implemented payer-specific risk adjustment models and shared savings analytics for value-based contracts.
Developed executive dashboards and PG performance tools that drove strategic decision-making and transparency.
Collaborated with leadership to align financial metrics with LOAs, contract terms, and enterprise goals.
Mentored junior analysts and ensured data integrity across recurring and ad hoc reporting deliverables.
Aetna, a CVS Health CompanySenior Negotiator
Jan. 2015 - Aug. 2020Pittsburgh, PADrove high-impact contract strategy and provider performance oversight across $500M+ in Medicare and Medicaid agreements. Successfully aligned operational execution with complex payer and provider requirements through cross-functional collaboration and risk mitigation. Managed performance guarantees (PGs) and value-based contract terms, ensuring measurable results and compliance.
Led gap analyses and implemented liability-reduction strategies to improve provider outcomes and audit readiness.
Played a key role in RFP development, contract negotiations, and operational modeling for new and existing provider groups.
Acted as a strategic liaison across legal, finance, and operations to optimize contract execution and reporting efficiency.
Coventry Health Care, an Aetna CompanyAccounts Receivable Manager
Sep. 2011 - Jan. 2015Coraopolis, Pennsylvania, United StatesLed financial operations and provider performance tracking across multi-state Medicaid and Medicare lines of business, focusing on contract accountability, audit compliance, and data-driven performance improvement. Directed adherence to provider guarantees (PGs), overseeing internal audits that significantly reduced risk exposure.
Designed and implemented PG tracking systems, boosting reporting accuracy and visibility by 30%.
Partnered with client and operational teams to resolve contract performance issues, strengthening payer-provider relationships and enhancing financial transparency.
McKessonReimbursement Manager
Nov. 2007 - Sep. 2011Green Tree, Pennsylvania, United StatesLed specialty drug billing operations and supported multiple West Coast anesthesiology provider offices, driving improvements in revenue cycle performance and provider guarantee (PG) compliance. Directed a high-performing team responsible for end-to-end claims processing and reimbursement accuracy across specialty pharmacy and outpatient practices.
Designed and implemented real-time dashboards to monitor clean claim rates, DSO, and PG metrics, enhancing operational visibility and decision-making.
Spearheaded root cause analysis of underperforming KPIs, resulting in a 20% reduction in PG penalties and improved audit readiness across key service lines.
HCA HealthcareFinance Operations Manager
Sep. 2004 - Nov. 2007Coppell, Texas, United StatesLed multi-state revenue cycle operations and developed scalable financial frameworks to support provider performance guarantees (PGs) and regulatory compliance across Texas, Arkansas, Oklahoma, and New Mexico.
Oversaw financial operations for $180M+ in annual revenue, driving improvements in reimbursement accuracy and contract compliance.
Designed and implemented PG structures aligned with CMS requirements and enterprise KPIs, enhancing accountability across physician groups.
Partnered with capital planning, compliance, and revenue integrity teams to improve forecasting, budget alignment, and operational performance.
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