Vice President of Network & Operations @ Molina Healthcare
Director of Medicaid Operations @ Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas
Molina Healthcare @
Illinois State University
Director of Program Management @ From August 2015 to Present (4 months) Greater Chicago AreaProgram Director of Healthcare Services @ From February 2015 to August 2015 (7 months) Greater Chicago AreaQuality Improvement Program Manager @ Responsible for ensuring Molina Healthcare plans comply with federal and state based quality operations across Medicare, Medicaid, Marketplace and Dual Eligible (MMP)
Director of Program Management @ From August 2015 to Present (4 months) Greater Chicago AreaProgram Director of Healthcare Services @ From February 2015 to August 2015 (7 months) Greater Chicago AreaQuality Improvement Program Manager @ Responsible for ensuring Molina Healthcare plans comply with federal and state based quality operations across Medicare, Medicaid, Marketplace and Dual Eligible (MMP) lines of business. Primary focus is to identify gaps in performance, develop quality improvement strategies, comply with federal and state reporting requirements, and ensure accurate and timely submission of quality data for the Dual Eligible Demonstration program in six states. From March 2014 to February 2015 (1 year) Greater Chicago AreaFacility Performance Manager @ Responsible for the successful program design, implementation, and presentation of the quality improvement initiative Achievements in Clinical Excellence with Optum Behavioral Health. Acted as the liaison between the hospital, network staff, and clinical operations within the organization with a focus on improving quality and efficiency.
- Presented the Achievements in Clinical Excellence program to C-Suite executives and Medical Directors at hospitals across the country
- Implemented methods for improving HEDIS 7 & 30 follow-up after hospitalization rates, decreasing 30 and 90 day readmission rates, and decreasing risk adjusted residual length of stay standards
- Resolved shortfalls with facility contracting and network composition From July 2013 to March 2014 (9 months) Greater Chicago AreaNetwork Implementation Manager @ Responsible for driving high-profile implementation projects, helping customers and stakeholders to meet their needs, and fostering continuous process improvement. Implemented three government behavioral health initiatives with objectives to enhance network adequacy at a cost reduction. Developed, implemented and assessed comprehensive performance improvement and re-design initiatives within the behavioral health system.
- Implementation manager for the TRICARE West program where I was assigned the task of developing recruitment strategies, conducting staff and provider education, identifying operation shortfalls, and onboarding of 30,000 providers in 21 states with various behavioral health backgrounds
- Lead implementation manager for two government contracted military behavioral health projects
Developed, maintained, and managed the individual project plan for each client implementation Provided a framework for the proactive and successful management of issues, risks and deliverable's
- Successfully developed recruitment strategies for three national programs, including recruiting over 500 psychologist to administer veterans disability exams, and 300 psychologist, psychiatrist, and neuropsychologist to conduct behavioral health consultations for individuals entering the military
- Conducted training for over 30 staff and developed external provider education programs for each implementation From November 2011 to September 2013 (1 year 11 months) Greater Chicago AreaSr. Recovery Resolutions Analyst @ Provided consulting services to five area hospitals on their revenue cycle management techniques. Responsible for the region’s growth, strategic planning and execution, operating income, service quality and delivery, personnel development, and enrich each provider relationship.
- Investigated, recovered and resolved all types of insurance claims at 5 Illinois providers as well as data mining assistance for health plans with commercial customers and government entities
- Processed recovery on claims in adherence to state and federal compliance policies, reimbursement policies and contract compliance for over 4,000 insurance payers nationwide
Recognized as the top analyst in the Mid-West in May 2009, based on daily claim average, percentage of invoiced budget, least number of exception claims, number of sales leads and average fee submitted
- Recognized nationally as someone who demonstrates strong relationship building techniques and for my ability to garner great lasting relationships with my providers
- Met or exceeded monthly invoice budgets 90% of the time and have exceeded quarterly budgets in every quarter From August 2008 to November 2011 (3 years 4 months)
Master of Public Health (MPH), Policy and Administration @ Northern Illinois University From 2013 to 2016 Master of Business Administration (MBA), Health Sector Management & Finance @ DePaul University From 2011 to 2013 BS, Finance @ Illinois State University From 2002 to 2006 Matt CPHQ is skilled in: Healthcare, Management, Managed Care, Strategic Planning, Health Policy, Medicare, Leadership, Training, Healthcare Management, Mental Health, Health Insurance, Analysis, Medicaid, Behavioral Health, Performance Improvement
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