Consultant resume example with 4+ years of experience
- www.versanconsulting.com
Board Member of Catalyst for Payment Reform; Advisory Committee Member for Goldfinch Health; Advisory Committee Member of the Validation Institute; Former Member of NJ State Bar Association; Former Member of Pennsylvania State Bar Association; Former Member of Delaware Bar Association; Rutgers Law School Alumni Association
Experienced consultant for large self-funded healthcare plans, primarily for Taft-Hartley and Public Sector Government Qualified Health Plans, engaging in procurement strategy and methodology, claims administration oversight, and financial and payment integrity over trust assets of the respective health plan.
Organized Health Plan Administrator with outstanding record of financial stewardship and fiduciary commitment to public sector entities; highly skilled at communicating with members of labor and management, as well as staff to provide administrative needs and requirements. Conducted meetings with staff concerning budgets, program management and compliance. Significant achievements include architected and executed on multi-billion dollar procurements that resulted in billions of dollars in savings for the State of NJ over the life of the contracts - including Third Party Administrator requests for proposals, Pharmaceutical Benefit Manager RFP, and Third Party Claim Pre and Post Claim Audit Services.
Former Deputy Attorney General and Special Assistant Counsel to Governor's Office; responsible for overseeing Department of Treasury and agencies within Treasury including Division of Purchase and Property as well as Division of Pensions and Benefits. Significant achievements include overseeing deposit of NJ Lottery into the NJ Pensions System as a commercial asset worth over $3B in revenue annually; Appellate wins for Division of Purchase and Property on Open Public Records Act cases and Procurement issues; Overisght of transition of 360,000 retirees from Medicare Supplement to Medicare Advantage Program.
Federal Bankruptcy Law Clerk and Private Practice Attorney in Corporate Restructuring.
|
|
- Review Plan Documents, SPDs, Contracts (TPA, PBM, Third Party Point Solutions, Direct Contracts, etc.) for strategic and financial input to ensure client is fully in compliance with governing fiduciary principles.
- Claims data analysis to optimize health plan spending and manage costs;
- Claims data review for financial and payment integrity; reconciliation of claims file to invoices and ledgers related to claims files;
- Direct client engagement with large self-funded health plans in order to counsel on healthcare cost savings strategy, hospital price containment strategies, etc.
- Business and Product Development for Payment Integrity Digital Health Company with focus on self-funded clients to optimize and recover, where appropriate, overpayments or payments made in error.
- Responsible for strategic growth in public and government sector engaged in government plan sponsor fiduciary oversight.
- Engagement strategy with TPAs to collect high quality claims data for review; execution on engagement strategy with clients and TPAs.
- Responsible for management of all aspects of State and School Employee Health Benefit Programs ($7B total spend 2019)
- State Contract Manager for TPA contract with Horizon BCBS and Aetna as MA administrator, State Contract Manager for PBM contract with Optum, ESI., State Contract Manager for Actuarial and Health Benefits Consultants contract with Aon; etc.
- Responsible for architecting, designing, and executing on all major procurements including TPA contract (conducted in 2019 for PY 2020 effective date - overhaul of prior procurement and evaluation methodology); PBM contract (reverse auctions conducted in 2019 for effective date of PY 2020).
- Engaged in procurement and retention of Third Party Claims Review entity (HMS) to review all claims processed on a pre-pay and post-pay basis; to date implementation of solution for 14 months has led to over $128M in booked savings for SHBP/SEHBP.
- Responsible for oversight of Department of Treasury - including Division of Purchase and Property, Division of Pensions and Benefits, Economic Development Authority, Department of Taxation, and all document custodians related to said agencies.
- Responsible for oversight of Department of Banking and Insurance; including oversight of all carriers regulated within State and business practices; fought reorganization of Horizon BCBS from state charitable institution to Non-Profit Mutual Holding Company
- Liaise between all portfolio agencies listed above and Governor's Chief of Staff and Chief Counsel, lobbying organizations, and internal leadership.
- Substantial and ongoing work with Employer and Purchaser Coalitions on healthcare purchasing strategy, litigation strategy to enforce fiduciary rights, etc.
- Frequent speaker at National Forums and Venues on current state of Health Plan fiduciary litigation, as well as the Consolidated Appropriations Act, Hospital Price Transparency Rule, Transparency in Coverage Rule, and other recent federal and state regulatory areas of interest to ERISA and Government Sponsored health plan administrators.
By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy
Your data is safe with us
Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.
Resume Overview
School Attended
- Rutgers University School of Law
- George Washington University, The
Job Titles Held:
- Consultant
- Executive Vice President
- Director of State & School Employee Hlth. Ben. Prg
- Special Assistant Counsel to Governor
Degrees
- J.D.
- Bachelor of Arts
By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy