Operations / IT / Finance / Client Services leader with comprehensive healthcare experience with Medicare health plans, PBMs, integrated delivery systems, and medical management organizations. Subject Matter Expert for Medicare Advantage, Medicare Part D, Medicare-Medicaid Plan (MMP), and D-SNP health plan regulations and operations; and CMS Risk Adjustment. Compliance focused and able to efficiently and effectively interpret
Operations / IT / Finance / Client Services leader with comprehensive healthcare experience with Medicare health plans, PBMs, integrated delivery systems, and medical management organizations. Subject Matter Expert for Medicare Advantage, Medicare Part D, Medicare-Medicaid Plan (MMP), and D-SNP health plan regulations and operations; and CMS Risk Adjustment. Compliance focused and able to efficiently and effectively interpret CMS guidance to build operational and IT solutions. Cross-functional leader focused on superior outcomes with internal stakeholders, clients, and health plan members. Lean Six Sigma Green Belt certified.
Director of Product Operations & Technology @ Responsible for leading the Product Operations, Risk Adjustment Analytics, and Vendor Management functions. From September 2014 to Present (1 year 4 months) Director, Service Operations, Aetna Strategic Business Unit @ As the Aetna Medicare Migration Service Operations Work Stream Lead, I am responsible for the successful operational migration for the Customer Care, Coverage Determinations, Complaints/Grievances/Appeals, Post Enrollment Member Website, Paper Claims and Beneficiary Recoupment functional areas. From January 2014 to September 2014 (9 months) Director, Membership Operations (MCO) @ Directs the efficient operation of the MCO-Finance/Reporting and the MCO-Data Operations functions, ensuring all operational and strategic programs are executed in alignment with financial and production goals. From August 2013 to January 2014 (6 months) Director, Medicare Operations @ Lead for the development for Magellan Complete Care of Arizona Medicare Operations to build the operational infrastructure for a MMP/D-SNP plan, including CMS Application submission, Enrollment, Sales & Marketing, Bid, Marketing Materials, and Risk Adjustment. From August 2012 to August 2013 (1 year 1 month) Phoenix, Arizona AreaDirector, Product Analytics @ Responsible for the development and production of client / product operational metrics, ROI, and risk adjustment analytics. From October 2011 to August 2012 (11 months) Director, Client Services @ Lead and managed health plan / medical group client program implementations and provided ongoing account management. Proactively identified operational issues and obstacles, ensuring client assessment production and financial goals were met. From June 2010 to October 2011 (1 year 5 months) Medicare Revenue Manager @ Provided leadership and oversight of the Medicare Risk Adjustment initiatives for the health plan and medical group. From September 2008 to June 2010 (1 year 10 months) Medicare Operations Manager @ Responsible for health plan CMS Medicare program operational compliance. From August 2007 to September 2008 (1 year 2 months) I/S Medicare Service Manager @ IT liaison for all Medicare-related issues between IT and cross-functional departments: Medicare Administration, Pharmacy, Finance and Medicare Enrollment. From September 2005 to August 2007 (2 years) Manager, Financial Planning @ Also held position April 1999 - December 2002. System administrator for the Eclipsys Sunrise Decision Support Manager System (TSI), facilitated annual capital allocation, and coordinated five-year capital / financial plans for eight hospitals, health plan and medical group using Kaufman Hall ENUFF software. From February 2004 to September 2005 (1 year 8 months) Manager, Financial Systems and Quality Control @ System conversion manager for Lawson General Ledger and Fixed Assets systems. From December 2002 to February 2004 (1 year 3 months)
Bachelors Degree, Finance @ Arizona State University From 1985 to 1991 Jennifer Lewis is skilled in: Medicare, Compliance, Cross-functional Team Leadership, Account Management, Process Improvement, Risk Adjustment, Program Implementation, Medicare Part D, Six Sigma, Business Strategy, Pharmacy Benefit Management, Change Management, Management, Medicare Advantage, Leadership
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