Managing Partner/Consultant - Strategic Health Consulting
• Provide consulting services to clients ranging from start-up business to NASDAQ 100 companies.
• Developing predictive analysis, provider profiling, patient stratification, and disease management system based on ACG, CDPS, ETG and DCG/HCC methodologies.
• Developing software solutions for HEDIS, Medicare STARS, and Medicare Revenue Analysis/Maximization (HCC).
• Assisted clients in identification and segmentation of markets and customers enabling them to evaluate opportunities and speed time to market.
• Served as intermediary between clients, investors and providers, including negotiated contracts with suppliers and health plans included Merger and Acquisition and Joint Venture Analysis.
• Developed business plans including financial and marketing plans for start-up and established businesses.
• Aided clients by serving in roles of Chief Financial Officer (CFO), Chief Operations Officer (COO), Controller, and Vice President of Sales on an interim basis.
• Developed and documented data collection processes and systems enabling client to receive an additional $12 million in premium revenue.

Selected Client Engagements Include:
• Seattle’s Largest Independent Physician’s Association – Developing provider profiling, patient stratification, and disease management system based on ETG and DCG methodologies. Working with payor on gaining additional Medicare reimbursement for both the medical group and plan on missing and under coded HCC. Converting all MS Access databases into a SQL Server environment. Audited all shared risk arrangement settlements.
• Leading Internet Media Company – Served as Vice President of Sales for the Northwestern United States (WA, OR, Northern CA) adding additional clients and agencies to the business network. Created company’s business and financial plan that was successfully used in the company obtaining offers of financing.

Vice President Solutions Management/Client Services - Chart Review and Medicare Risk Organization - 2010-2011
• Manage National Account Management Organization restructuring team from a project management focus to a consulting focus to support client initiatives.
• Manage National Sales Team refocusing sales efforts from hard sales approach to more consultative approach. Redesigned corporate pricing structure to support more efficient pricing for larger clients.
• Develop company’s offering in the Risk Adjustment/Payment Integrity Space including creation of the company’s Medicare Health Plan Quality and Performance Ratings Program Consulting Solution (STARS) and Risk Adjustment Software offerings while redefining the company’s core care gap identification logic.
• Presented at industry conferences on Medicare Health Plan Quality and Performance Ratings Program (STARS), Risk Adjustment Data Validation Audits (RADV), and the Integration of Medical Management and Revenue Management
• Presented on Accounting Industry Healthcare Panel on Healthcare Reform.
National Vice President, Medicare Finance, Enrollment and Reconciliation - National Health Plan - 2006-2009
• Functioned as Chief Financial Officer for the company’s Medicare line of business managing the Medical and SG&A budgets and forecasts and provided analytical oversight for thirty-four (34) Medicare Advantage plans in 7 states.
• Developed, implemented and managed the enrollment and premium reconciliations operations needed to support Medicare Advantage plans.
• Managed the Medicare market feasibility analysis and bid process including competitor and reimbursement analysis.
• Implemented operational processes to ensure maximization of Medicare Advantage and Part D premium revenue methodology, including effective member and premium reconciliation and timely transaction processing.
• Implemented Enrollment, Reconciliation, and Risk Adjustment system to maximize revenue and streamline operations.
• Implemented SOX controls across the Enrollment and Reconciliation Departments.
• Developed processes for the submission and reconciliation of the Medicare Part C (RAPS/Risk Adjustment Payment System) and Part D (PDE/Prescription Drug Event) encounters.
• Realized increased premium revenue of 5-10% per year of premium via HCC suspect/missing diagnosis identification and risk adjustment/revenue maximization initiatives in 2007-2009.
• Manage staff of 15 including AVP, Directors, Managers and Analysts.
• Provide analysis on Merger and Acquisition targets related to Medicare plans.

Masters in Business Administration (MBA), Seattle University, Seattle, WA. Member Beta Gamma Sigma Honor Society.
B.Sc., Accounting and B.Sc., Business Finance Central Washington University, Ellensburg, WA. Graduated with Highest Honors – Outstanding Business Graduate.
Certified in Financial Management (CFM), Institute of Certified Management Accountants, July 1997.
Certified Management Accountant (CMA), Institute of Certified Management Accountants, July 1996.
Certified Public Accountant (CPA) (certificate), Washington Board of Accountancy, AICPA, July 1996.

RISE Member - Medicare Risk Adjustment Society
Institute of Management Accountants, Member
American College of Healthcare Executives, Member
Gulf Coast Area TE/GE (Tax Exempt/Government Entity) Council, Member/Speaker
Juvenile Diabetes Research Foundation (JDRF), Hampton Roads Chapter Board Member

Established speaker on Medicare Advantage and the effects of Healthcare Reform.
Presentations given
2012
January 16-18 - Breakthrough Strategies to Raise HEDIS Scores and Quality Management and Revenue Management - Words to Live By: More Members Equals More Revenue
April 29 - May 2 - 16th Annual Compliance Institute - Preparing For and Managing a RADV Audit

2011
January 24-26 - Medicare Advantage Congress - RADV Audit Boot Camp! – Everything you need to Prepare for and Survive RADV Audits Workshop

2010
October 20-21 - Healthcare Education Associates’ Critical Strategies to Achieve CMS’ 5-Star Rating – Orlando, FL - Integrating Medical and Revenue Management
July 20 - Webinar - Medicare Health Plan Quality & Performance Ratings Program
June 24 - Gulf Coast Area Tax Exempt/Government Entities (TE/GE) Council’s Quarterly Meeting - Health Care and the Impact on Organizations

2009
May 24 - World Research Group - Medicare Revenue Management Conference - The Changing Landscape of Managed Care