COVER LETTER FOR:

Account Director

I have been an Operations and Account Director for over 25 years. My real expertise is in revitalizing existing operations, integration of diverse operations or starting new business opportunities. You will find that I am a results oriented manager and a consensus builder internally and externally. A creative executive, I am highly adaptable to situations that require judgment of organizational needs and decisive managerial action. As a leader, I provide strategic planning and program development. I am able to effectively communicate and transform an organization to the corporate vision and plan. A motivated team leader, I can operate independently and with a minimum of supervision.

Below are some specific skill sets and career highlights that demonstrate my expertise operational and managerial areas:

General Operations
1. Broad-based general management skills in human resource affairs, training, facilities and materials management, budgeting, manpower planning, and other senior level management functions.
2. Health insurance experience with Medicaid fee for service, Commercial Administrative Service Organizations (ASO) or Third party Administrators (TPA) and Military TriCare Plans.
3. Progressive operations and administrative experience backed by in-depth knowledge of the managed care industry.
4. Operational experience in managing a claims and customer service operation for a 131,000 member accounts for the State Employees of Illinois.
5. Current operational experience in managing a Medicaid MMIS Fiscal Agent office including Claims, Customer Service, Provider Enrollment, Mailroom, Data Entry, QA and financial functions. Including all Pharmacy Benefit Management and rebates.
6. Health Care Management operations including Level of Care, Prospective and Retrospective reviews and Prior Authorizations also fell under my operational responsibility.
7. Staff management experience of 30 to 200 staff, I have managed over 200 staff in multiple geographical locations.
8. Significant experience in compliance with State and Federal regulations and contract compliance.
P&L and Financial responsibilities
1. Experienced in developing, implementing budgets for start-up operations, turn-around and cost reduction budgeting for operations exceeding 25 million.
2. Successful in bringing new projects on line on time and on budget. Have historically improved operating margins year over year through contract enhancements, process improvements or staffing reductions.
3. Profitable financial management of multi-site facilities and successful administration of full risk multi-million dollar budgets.
4. Profitable financial management of multi-site direct care medical facilities and successful administration of multi-million dollar budgets.
5. Bid, purchase and installation of all types of medical equipment.
6. Budget, build and equip freestanding medical center x-ray, lab and dental operations.
RFP & Proposal Experience
1. Proven expertise in proposal development including, operational planning, start-up, financial and staff modeling, with over 100 RFP responses and in excess of 40 startup operations in my career.
2. Expertise in provider network development, vender relations, vendor contracting, negotiation and compliance.
3. Identification of new business opportunities or expansion of existing operations, program, proposal development and presentation, relationship building with potential clients, and retention or turn around of existing accounts.
4. Experience in Private, County, State and Federal contracting.
5. Independent Contracting with Physicians for Emergency Rooms and other Direct Care Settings. Experience with independent contracting for all types of Medical Professional services.
Account Management
1. Over twenty years of direct daily responsibility for client relations and account management including contract negotiation and compliance, contract renewal and renegotiation.
2. Virtually 100% account retention where I had primary leadership responsibility in renewal process and relationship.
Provider Network Development
Developed and provided services to individual facilities established and operated a comprehensive provider network for a statewide system covering 18,000 lives.
Process improvement
1. Developed and implemented an operational improvement program that resulted in the State of Illinois client forgiving over $1 million in performance penalties.
2. Improved the customer service training and hiring program that elevated the performance and quality of the customer service representatives, thus reducing the response time by 50%, and saving over $100,000 in quarterly performance penalties.
3. Experienced in the operational turnaround and management of two large claim and call centers.
4. Streamlined the departmental operations by cross training all employees thus reducing the need for mandatory overtime, improving claims production and saving over $400,000 in annual operating expenses.
5. Extensive experience in process improvement, metric setting and policy and procedure development.
IT and Systems experience
1. Created and facilitated the implementation of an Intranet worksite that captured the plan and policy documents and all updates on a daily bases, thus assuring that all claims are being processed utilizing the most current guidelines.
2. Functional proficiency and understanding of technical aspects of claims and customer service IT issues.
3. Experience with call center technology and voice over internet call centers.
4. General management skills in MIS technology, human resource affairs, training, facilities and materials management, budgeting, manpower planning, and other senior level management functions.
5. Recent experience in operational input for Business Process Management workflow project
6. Experienced in current imaging technology and proper utilization in a Business Process Management workflow
Staff Recruitment, Selection and Retention
1. Experience in recruiting physicians and specialists personally from scratch for emergency rooms, clinics, hospitals.
2. Recruited all other types of health care providers for direct services or as part of network operations.
3. Recruitment and selection of physicians, administrators, medical directors and support staff for corporate positions and for client accounts.
4. Multiple successes in reducing turnover from 30-40% annually to 10-15%
5. Aggressive cross training of staff where applicable have resulted in higher retention and staff reduction through attrition.


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