Business Process Manager, Commonwealth Care Alliance – Boston,
Led the planning and achievement of goals and objectives consistent with the agency mission and philosophy.
Led cross functional team responsible for implementation of claims processing for CCA's new One Care demonstration product including benefits matrix, prior authorization rules, standard and vendor specific reimbursement rules to enhance auto adjudication of claims. Coordinated claims processing responses and participated in systems testing for One Care readiness review required by CMS.
Oversaw investigation and resolution of state and federal regulatory changes impacting claims processing.
Identified and implemented process improvements in the day-to-day functioning of the clinical operations department.
Built and managed team of clinical operations support staff responsible for reviewing field nurse MDS assessments prior to submission to MassHealth reducing the need for a second clinical review by >50%.
Developed and implemented metrics and reporting to improve clinical operations MDS processes and identify areas of improvement allowing feedback from MassHealth regulators. Reduced MDS rejections from 15-20 to 1-2 per month.
Developed use cases and performed user acceptance testing during implementation of CCA's new enrollment application supporting both the enrollment and member services departments. Also tested feeds into CCA's case management application during implementation and upgrades.
VP, Business Support Manager, Columbia Management Advisors, subsidiary of Bank of America – Boston,
MA • Managed transition (relationships, technology, products, and processes) of the US Trust equity trading desk in NYC to Columbia's equity trading desks in Boston and Portland OR during acquisition of US Trust by Bank of America. • Led Six Sigma Lean project team to identify root causes and recommend solutions to reduce trader errors. Identified and implemented data and process improvements that eliminated paper trade orders and fully automated the process. • Business unit leader of strategic technology projects for the Office of the CIO including development of a central holdings database. Participated in requirements gathering, risk assessment, design, and user acceptance testing. • Performed trading oversight activities including presentation of issues identified to the Trading Oversight Committee and its Best Execution subcommittee. • Managed business continuity/disaster recovery plans for equity trading desks. Executed testing of same.
Buyer II, Strategic Procurement, CVS Pharmacy – Woonsocket,
RI · Managed relationships with CVS distribution center (DC) management staff and DC vendors. Analyzed DC spending data and met with DC staff at multiple US locations to determine purchasing patterns and needs. Presented my assessment and plan to management. · Managed project to roll out online purchasing with a large DC vendor, Grainger. This fully automated order entry and invoice processing. · Rolled out new purchasing vehicle, the AMEX Pcard, to cover DC local purchases. · Negotiated purchase of furniture, startup equipment, and supplies for new DC under construction in Vero Beach FL. · Redesigned CVS intranet procurement site.