Profile: Executive leader with extensive experience and background in healthcare, policy development, program implementation and continuous process improvement, negotiation, consultation, and coaching. * * Employment History * * Chief of Operations, Oregon Educators Benefit Board OHA, Health Policy Analytics, Salem, OR July 2007 - August 2017 * Administered medical, dental, vision and numerous other benefit offerings to more than 148,000 members. This includes communications, contracts, customer service, finance and various interrelated systems and processes. * Developed and managed $1.5 billion biennial budget, long and short range goals and plans, system priorities and improvements, program evaluation, program rules and policies. * Developed, implemented and administered the Health and Wellness Programs and activities. * Partner with national healthcare data experts at MIT and Truven to perform a long-term independent research study and complex data analysis, comparing historical claims costs and utilization residing in the OEBB claims data warehouse to members' plan selection decisions which using different plan comparison tools. * Developed and managed the reporting requirements and performance guarantees to ensure contractors are meeting or exceeding the requirements and guarantees. * Collaborated with Board members, legislators, the Governor's office, and key stakeholders, including data and analytical experts to gather and interpret utilization and quality data to develop strategies that promote a healthy, medically competent population while eliminating barriers to care and reducing or stabilizing health care and administrative costs. * Managed and continuously developed staff and improving processes, many of which are interdependent on external or other systems or processes. * Community Care Organization (CCO) Request for Application (RFA) Subject Matter Expert Team Lead responsible for reviewing applicants' organizational and governance structure. Evaluation and Negotiation Team Lead and key OHA contact person responsible for identifying and recommending information needed or areas to be developed that were short range (prior to receiving CCO certification), or longer range goals needing to be accomplished. * Acting Chief Audit Executive DHS, Directors Office, Salem, OR September 2006 - July 2007, * Responsibilities include development of program rules and policies, development of long and short range goals and plans, program evaluation, budget preparation. * Provided ongoing education and training of organizations staff and management about the purpose of the internal audit function, and build internal relationships and employee trust. * Developed the annual audit plan through determining and prioritizing risks agency - wide. * Managed all aspects of the internal audit functions, including audit development, data review and analysis, and partnering with program staff to develop recommendations based on the findings and legal or contractual requirements. * Responsible for monitoring and responding to all federal and state (i.e. CMS, OIG, and SOS) audits, including follow up and resolution of findings. * Served as the President, President-elect, and Vice President of the Salem Chapter Institute of Internal Auditors. * Senior Policy Analyst, Internal Auditor, Medicaid Auditor, Research Analyst DHS, Directors Office and DMAP, Salem, Oregon November 2000 - August 2006 * Researched federal regulations, state statutes, administrative rules, contracts, agreements and data to identify risks, opportunities for improvement, or ways to achieve savings or desired outcomes related to Medicaid and many other DHS programs and funding sources. * Identified and collected over $1m of inappropriately billed Medicaid CAWEM program claims and collaboratively developed system logic that was integrated into the MMIS to significantly reduce unsupported payments from being issued. * Performed several internal and external audits including but not limited to the Medicaid program, IT security, and internal controls related to negotiable instruments, receipting processes, and medication dispensing. * Manager for Medicaid Managed Care Organization (MCO) FamilyCare Health Plans, Portland, OR February 1994 - August 2000 * Responsibilities included development of program rules and policies, development of long and short range goals and plans, program evaluation, and budget preparation. * Managed several departments and functions including customer service, eligibility, claims, referrals, prior authorizations, complaints and hearings, and capitated and fee-for-service payments. * Developed and automated customer service and the complaints and hearings processes. Created member surveys. Served on several committees and workgroups related to member education, access to care and contract improvements. Worked at various commercial insurance and managed care organizations and with claims systems. Worked with contracted dental care organizations pharmacy benefit managers subcontractors contracted providers and other organizations.

Highlights:

• Audit
• Budget Preparation
• Budgeting
• Cms
• Coaching
• Complaints
• Data Analysis
• Data Warehouse
• Health Care Industry
• Insurance