Consultant:
2004 to present
A
consulting practice to physicians, hospitals and
health plans
Santa Barbara, CA
- Business consultant to the Sansum/Santa Barbara
Medical Foundation
- Provider contractor for Blue Shield of CA/Tricare
Division
Patient
Choice Healthcare, Inc.
A Preferred Provider Organization, St. Louis Park
MN
(remote job based in Portland OR)
Director
Care System Development: 2001-2003
- Contracted with 12 care systems and 28 hospitals
for Oregon/Southwest Washington region
- Recruited first payer for the network, PacificSource
Health Plans
- Led successful provider contract renewal retaining
100% of contracts
Managed
HealthCare Northwest, Inc.
A Preferred Provider Organization in Oregon
Portland, OR
Finance
Director: 1996-2001
- Stayed on budget every year for a $3 million revenues/year
company
- Reorganized claims department by hiring/coaching
new manager, using temp-to- hire staffing and went
from 100% to 0% turnover in one year
- Moved corporate office saving $70,000 a year in
rent by finding lower cost space and reducing square
footage by one third
- Saved physicians and hospitals over $1 million
in health plan risk sharing plan settlements by
finding errors and omissions in comparing contract
terms to financial schedules
Managed 8 FTE claims/administration/information
services departments
Development
Specialist: 1990-1996
- Advocated for doctors and hospitals in a $20 million
a year settlement with Regence HMO Oregon
- Explained financial terms and risks sharing plan
to doctors and hospitals and organized risk sharing
groups resulting in over 20 primary provider teams
taking care of 150,000 members for Regence HMO Oregon
- Developed a unique provider contracting model
“BlueCap” giving provider groups the
benefits of capitation without the cash handling
challenges
- Led the benefits/service operations of an Exclusive
Provider Organization, Legacy Precision Plus providing
Precision Cast Parts member’s first class
service for a 3-year contract period
Managed Care Solutions
A consulting practice to physicians, hospitals and
health plans
Portland OR
Owner
1989-1992
- Trained staff of health plans on risk management
principles by developing and modeling or demonstrating
via PowerPoint presentations to customer service
and sales staff
- Audited end of the year settlements for PacifiCare
participating medical groups
PacifiCare
of Oregon
A 40,000-member health plan with commercial and
Medicare product lines
Lake Oswego, OR
Director of Operations 1987-1989
- Improved relations between health plan and participating
medical groups by problem solving administrative
issues and regular service visits
- Managed a staff of 12 FTE in customer service,
claims processing, medical management, and provider
relations departments through implementation of
a new health plan information system transition
PacifiCare Health System
A 120,000-member multistate health plan system with
commercial and Medicare product lines
Cypress, CA
Vice
President Benefits Administration: 1986-1987
- Developed first claims operations metrics benchmarks
and reporting system
- Overhauled claims system decreasing turnaround
time and reducing inventory
- Third party and coordination of benefit activities
increased total savings to 35% off billed charges
- Responsible for benefit interpretation, subscriber
contracts, legal services utilization review and
risk management functions for all PacifiCare health
plans
- Managed claims, member service, enrollment services,
and corporate service departments, with 81 FTEs
PacifiCare,
Inc.
An 80,000-member California health plan
Cypress, CA
Health
Plan Director: 1984-1986
- Managed member service, medical service, grievance
and appeals departments with 23 FTEs
- Responsible for benefit interpretation, subscriber
contracts and risk management for PacifiCare of
California and Secure Horizons
- Participated in the original Secure Horizons task
force for implementation of a Medicare Risk Contract
CIGNA
Healthplans of Southern California
A 350,000-member California health plan
Glendale, CA
QA/RM
Coordinator 1980-1984
- Managed innovative QA Dept “Health Accounting”
with 5 FTE
- Developed first Risk Management program for the
health plan
Ross-Loos Medical Group
A 350,000 member staff model California health plan
Los Angeles, CA
Assistant to the Clinic Administrator 1978-1980
- Developed and implemented QA program improving
corporate compliance
- Implemented appointment systems, built chart files
and otherwise assisted the 24 clinic offices of
the Medical Group
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