Description
KEY QUALIFICATIONS - OVER 21 YEARS EXPERIENCE IN MEDICARE, MEDICAID, AND MEDICARE-MEDICAID PLANS (MMP) Profit & Loss Accountability * Product Implementation / Mgt * Marketing & Communication Strategy * Product Strategy & Development * Business Development * Collateral / Campaign Development SUMMARY OF PROFESSIONAL EXPERIENCE CAPTIAL BLUECROSS HARRISBURG, PA 17050 SEPTEMBER 2015 - PRESENT DIRECTOR OF MEDICARE PRODUCT DEVELOPMENT, MANAGEMENT AND MARKETING Business owner and decision maker for the Medicare product portfolio which consists of four Medicare Advantage Plans and five Medicare Supplement plans, and each plan's respective staff, overseeing daily operations, Risk Management, STARs, Marketing, and Medicare Product (HMO, SNP, PPO, PDP). Responsible for combined annual budget of $32M, which includes personnel, operational functions, marketing, and vendor costs. Collaborate with Medicare Sales, Actuarial, Finance, Compliance, Clinical and Pharmacy Operations to set strategic direction including enrollment and growth targets driven by financial performance, and competitive analysis. Developed five year strategic road map and strategy plan for growth and future plan / provider partnerships to expand government program. * Drive efforts to create and maintain product strategy & roadmap, product innovation pipeline management, product concept development, strategic initiative planning and coordination, and go to market strategy closely collaborating with sales senior leadership to define sales plan and strategy. Ensures product activities are in alignment with product vision and corporate strategy. * Directs, coordinates, and manages multiple programs, multiple cross-functional teams, products and initiatives as it relates to performance from a financial, operational, procedural, and market delivery perspective resulting in product/program/ initiative value realization. * Develop high impact, results-driven integrated strategic marketing and communication plan that powerfully execute brand strategy, achieve marketing and sales objectives, and accomplish organizational goals. Total Marketing budget of $6.3M. * Oversee Medicare Risk Adjustment department in the accurate and timely submission of RAPS and EDS data. Increased Risk Revenue from $3.5M annually to $9.6M in 9 months through identification of high-risk population and prioritized chase lists while implementing Gaps in Care quality measures. Key Achievements: * Increased Medicare Advantage group business by 105% over 1 year period enhanced product portfolio improving value proposition and customer retention across individual and group products. * Successfully increased Risk Adjustment Revenue by 6.5M in first nine months of employment through analytics, implementation of aggressive gap closure campaigns, and targeted marketing initiatives. * Successfully generated 20,810 leads for 2016 AEP out of 350,000 prospects. Lead marketing activities providing high-impact, results-driven marketing strategies and design solutions. Responsible for the development and management of CRM & Demand Generation marketing programs, including strategic planning, KPI goals, budget management, execution, and ROI tracking. Manage a small team of marketing professionals focused on executing campaigns including (but, not limited to) email, direct mail, database marketing, TV, radio, community, and digital marketing. * Collaborated with Network Team to design Network strategy for provider partnerships and future product expansions into multiple counties and states. Successfully managed cross-functional teams to deliver roadmap expectations. 2018 Application approved by CMS for contract expansion for HMO products. * Successfully developed pricing and benefit design for the 2016, 2017, and 2018 Bid submissions for four Medicare Advantage contracts. Bid submission was successful with no benefit changes during desk review and minimal questions from CMS Office of Actuary. * Collaborated with Sr. Vice President of Government Programs to identify acquisition opportunities, resulting in the purchase of Vibra Health Plan. A new Medicare Advantage Plan in Central Pennsylvania focused specifically on Medicare Advantage Products. Worked with Legal on due diligence review of all health plan information including state licensing, estimated valuation, vendor, broker, and provider contracts, marketing information, bid and pricing information, strategic information, and other various documents to evaluate plan assets, liabilities, and determine market potential. HEALTHCARE MAVERICKS - OWNER AND CHIEF EXECUTIVE OFFICER (2011 - PRESENT) Consulting firm established to support organizations with achieving performance objectives, translating strategic plans into tactical initiatives. Provides solutions to optimize operational performance across a broad range of areas including executive leadership, strategic, operations, project management, and implementation services. Clients include Harvard Pilgrim Healthcare, Beacon Health Solutions, Universal Health Services, Centene Corporation, and CrestPoint Health Plan. CRESTPOINT HEALTH PLAN JOHNSON CITY TN PRINCIPAL CONSULTANT AND STRATEGIC LEAD JANUARY 2015 - JUNE 2015 * Successful managed Medicare Advantage Application and Service Area Expansion, Product Development, benefit configuration, and Bid Submission, Sales Strategy, marketing activities, and operations process improvements. * Provided strategy and recommendations to business units in regards to Stars, Risk Adjustment, and network strategy. * Evaluated organization for process improvement and business re-engineering in an effort to build efficiency and identify areas to lower administrative costs. Lowered administrative costs by $5M. * Identified opportunities to increase review by $2M through analytics, chart chase activities, and aggressive gap closure.
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