PROFESSIONAL SUMMARY:

• Detail - oriented Financial Specialist, Healthcare Economics Consultant, Budget / Accounting and Contract Manager, and Systems Administrator dedicated and progressively promoted, and experienced in coordinating and taking lead in projects and performing advanced financial analysis and reporting in support of company initiatives, cost/trend analysis, and revenue/cash flow maximization.
• Diverse background specializing in National and Michigan Medicare and Medicaid managed care and long-term care financial analysis and competitive landscape, market expansion and network devel pment, cost trend analysis, healthcare reform, health system & hospital, ancillary, and physician contracting & pricing/ reimbursement analysis and charge master, physician and medical management cost analysis and reporting, HEDIS/quality & industry standards, financial analysis and system implementation, LEAN, working cross-matrix, cost accounting, budget coordination and analysis, fund & general accounting and financial statements, audit coordination, twenty years working knowledge of GAAP & auditing standards.
• High proficiency in MS Office (20+ yrs.) - Advanced Excel 2010/2013, MS Access, Data Warehouse, PowerPoint, Adobe Standard, Contract Management System Administration, Business Objects, Hyperion, Micro-strategies SMART & financial systems / Crystal Reports, MS - SQL and Excel/VBA trained, AS400, Sage Accounting, & Confidential at Confidential, Confidential, Confidential, Confidential, and Confidential .
• Team-oriented and customer-focused with Supervision and Technical Mentoring Experience in unionized customer service call center, managed care & finance, accounts payable & billing. Sales, banking, and operating room warehouse experience.

PROFESSIONAL EXPERIENCE:

Confidential, Livonia, MI

Payer Contract and Financial Analyst / Systems Administrator

Responsibilities:

• Primary role as the national contract management systems administrator and contracting/financial analyst in the Payer Strategy & Product Development (PS&PD) team for Confidential system, including managing contract renewal and approval workflows, bookmarking new and existing contracts and amendments with Adobe Standard implementing a new contract performance risk model, interpreting and evaluating contract terms and payer reimbursement, and updating contract records, reimbursement tables, and correspondence in the Mitratech TeamConnect Contract Management System. Supported process improvement, and the transfer and flow of contract documents to the new CLM contract management system during implementation, & maintained the health system’s contract files. Supported the PS&PD Manager during the TeamConnect system sunset and new CLM system implementation. Trained national regional leadership system users & Medical Economics interns.
• Supported the national Director of Payer Analytics & Central Operations and contracting managers, senior leadership, management and legal staff, and Medical Economics team with financial analyses, recommendations, Business Objects contract performance and due diligence reports, and ad-hoc reporting, and systems support.
• Further developed 20 years working knowledge and skills in advanced Excel and Db, including pivot tables, charts, graphs, and macros; uploading and downloading large data from multiple sources and .csv files between ACCESS and Db systems and Excel, and PowerPoint; stream-lining & improving & automating reports/analyses using advanced Excel formulas, formatting, printing, and modeling techniques, including: nested if / vlookup / sumif & countif / sumproduct / iserror & isna commands, merge cells and concatenate/split text, range-value formulas/ round/ date/ isnumber/ absolute value; data filtering and sort, sub-totaling, & data-fill, and other functions and short-cuts; and, working with multiple and linked workbooks having multiple (about 100) large spreadsheets; utilizing split screen & multiple windows, and multiple pcs/laptops/monitor screens. Also, converted Adobe pdf files to editable text, and scanned and created pdf files.

Confidential, Detroit, MI

Budget & Contract Manager

Responsibilities:

• Primary responsibility for managing, reporting, budgeting, and analyzing for all Confidential federal and local grants and other funding sources for facilities and programs (emergency shelter, transitional and permanent housing, treatment, and camp), and working with Confidential directors for grant applications, outcomes, and fulfilling contracts and grants requirements and responsibilities. Streamlined and improved analytical and grant billing and reporting processes in Excel.
• Responsible for developing proactive corrective action plans for grant over/under spending; researching vendors and products that will assist programs in increasing outcomes and quality of services; and, working with the Director of Quality Assurance to handle monitoring and credentialing inspections. Coordinated HUD audit and maintained grant / billing files.
• Managed the Confidential Finance team (5.0 FTE’s) in GAAP accounting, accounts payable, and grant billing, electronically using Excel and the Sage G/L system. And, primary responsibility for the payroll system reconciliation & maintenance.

Confidential, Detroit, MI

Grants and Contracts Manager / Senior Program & Financial Analyst

Responsibilities:

• Managed the Confidential Contract Management Department (3.5 FTE’s) and an agency leadership team member, supporting the Director of Contract Management and Planning Departments. Primary responsibility for contracting, State reporting, and program performance and benchmark reporting for the agency’s traditional and nutritional grants & contracts to provide personal care, legal services, and deaf/blind and aging support and Detroit Meals on Wheels to seniors & disabled persons (clients). Researched government standards & guidelines and internal policies & procedures to provide excellent service to providers and clients.
• Participated in development and implementation of an industry leading new model for Community Support Coordination services for seniors in order to partially recover lost State funding through coordinating Outreach providers and Senior Centers in providing assessments, filling service gaps, and identifying & procuring value added/other resources. Also, developed the Confidential ’s monthly reporting.
• Streamlined and improved the congregate meals and program performance monthly reporting processes.
• Participated in NCQA accreditation audit. Supported the Manager of Purchased Services Contracts and Director and Manager of Finance with contracting needs and analysis. Maintained agency contacts and directories and contracting files. Primary responsibility for preparing, delivering, and tracking contracts and applications, document requests, and correspondence in person and for mailing using MS Word mail-merge.
• Supported the Confidential ’s President and Leadership, and Grant Review and Executive Committees and Board of Directors with analysis, performance and financial reports, and presentations (Excel and PowerPoint), and Confidential queries and reports. And, lead and chaired the Confidential All-staff Meeting Planning Committee.
• Conducted provider & congregate meal site assessments and site inspections for compliance to State, Regional, Local & agency guidelines. Liaison to the Confidential Community Services & Nutrition Leadership and staff, major food vendors, & congregate site directors & hosts. Presented at Congregate Site al Meetings.

Confidential, Sunrise, FL

Healthcare Economics Consultant

Responsibilities:

• Primary responsibility for Confidential ’s National Medicaid and Medicare cost trend, and financial and budget initiative analysis and reporting, and ad-hoc analysis and Long-term Care/Dual SNP reporting. Performed national market expansion analysis, hospital/ ancillary/ physician utilization and unit cost trend reporting and analysis, and pricing and settlements analysis.
• Sole responsibility for national hospital utilization and unit cost reporting and variance drill-down, budget analysis and project initiatives and cost-trend analysis and reporting supporting Confidential ’s corporate financial planning and analysis team in forecast and budget preparation and analysis.
• Analysis supported Medicaid and Dual SNP expansion and entry into several States in the U.S., and national ancillary service vendor contracts. Compared and analyzed provider contracts.
• Developed Dual SNP Spend Reports for health plan administrators for contract remediation.
• Presented Long-term Care 101 and The Unit Cost Reporting Process for employee development.
• Developed Policies and Procedures for National and Michigan Medical Economics.
• High proficiency in MS Office - Advanced Excel / ACCESS, and SMART, and financial & claims systems.

Confidential, Southfield, MI

Contracting/Financial Analyst

Responsibilities:

• Worked with Contracting Manager to support timely contract renewals, supporting Vice President of Operations and President. Modified and compared/analyzed provider contracts.
• Primary Responsibility for contracting and initiatives cost impact analyses to support the Confidential Financial Planning and Analysis team in preparing the national and Michigan division three year forecast and annual budget. Performed budget variance and cost-trend analyses.

Confidential

Contracting/Financial Analyst (Continued)

Responsibilities:

• Sole responsibility for physician reporting, reconciliations, and compensation projections, provider relations support and cost analysis and ad-hoc reporting (MI, NE, and WI Medicaid), health system & hospital/ ancillary/ specialists rate proposals and competitive assessments to support growth, provider network expansion, market development and the enhancement of existing contractual relationships.
• Developed Confidential Medicaid Out Confidential t OPPS/APCs and In Confidential t DRG/Per Diem pricing model.
• Implemented Confidential ’s Michigan Division Medicaid Unit Cost Reporting Template and analysis.
• Saved millions of dollars annually and provided quality healthcare to members, through:
• Transferring percent of charge reimbursed hospitals to DRG based reimbursement contractsPhysician compensation analysis and reports to convert 500+ capitated and fee-for-service PCP Groups to a Pay for Performance contract, and ongoing for over 1,500 more PCPs.
• Developed reporting for high-cost members, identifying approx. 500 members totaling nearly $30 million in annual cost, in order to identify such members proactively and intervene to manage care and cost.
• Primary responsibility for Emergency Room Physicians cost/utilization and Medical Management Program reporting, related re-admissions analysis, in Confidential t outlier analysis, physician capacity analysis, and reinsurance analysis and filings. Solely responsible for external IP and OP outlier/claims audits, and high dollar claim auths.
• Sole responsibility for IBNR/lag, one-day stay, related re-admissions, & co-morbidity reports for MI & NE.

Confidential, Southfield, MI

Claims/Customer Service Supervisor

Responsibilities:

• Supervised, coached, and motivated staff of unionized call center claims customer service representatives.

Confidential, Dearborn, MI

Financial Analyst - Contractor

Responsibilities:

• Performed health care benefits cost analysis.
• Assisted in preparation of the business plan/budget and forecasts.
• Coordinated billings on Peoplesoft: international service employees' and salaried retirees' health care benefits.

Confidential, Detroit, MI

Financial Specialist

Responsibilities:

• Promoted to Financial Specialist and coordinated Confidential 's Managed Care Finance activities and supervised three employees. Sole responsibility for developing written policies & procedures and flow charting in Visio Graphics.
• Assisted with evaluating and negotiating new HMO/PPO/POS/TPA contracts and existing program changes.
• Prepared financial statements, forecasts, cost and budget/variance analyses. Sole responsibility for hospital and HMO reinsurance analysis and several million dollars in filings annually.

Confidential

Senior Budget/Financial Analyst

Responsibilities:

• Performed accounting & financial/budget/accounting/profitability/ cost analyses, making recommendations to executives and management for new and current hospital programs, and Geriatrics Strategic Planning.
• Coordinated and prepared the RIM hospital operating, capital, and grant budgets, and Board of Directors’ financial statements, rolling and three year forecasts, trend analyses, and fluctuations/variance analysis.
• Implemented and maintained RIM’s TSI Cost Accounting System.
• Sole responsibility for grant and fund accounting with GAAP working knowledge, RIM & Grace charge masters and bill coding, pricing and reimbursement analysis, Medicaid peer claims review and complex third-party insurance claims resolution, Operating Room warehouse, corporate accounts payable, and policies & procedures.