Customer Service Manager
Resume:
Kenneth R. Kramer
Hudson, OH 44236
Home: 330-***-**** Work: 440-***-****
Cell: 216-***-****
Email: *.******@**********.***
Experience 2011 - Present CVS Health Solon, OH
Senior Director Business Support, Quality and Reporting
Lead the Audit Support, Business Support, Quality and Reporting teams for the Pharmacy Benefits Management (PBM) unit including over 200 direct and indirect employees
Manage the annual readiness activities for the Government Services Unit including Medicare, Medicaid and Exchanges
Lead the implementation of the new Medicare Card Program for the enterprise including ownership and accountability for the overall program and routine discussions with leaders at Center for Medicaid and Medicare Services (CMS) to influence regulatory guidance
Implement quality risk assessments to detect risks and prevent potential issues before they occur
Create reporting enhancements to drive operational performance improvements across the PBM
Senior Director Business Support
Managed audit support team responsible for producing and validating corrective action plans provided to PBM clients for over 20 program audits with CMS including successful validations of any audit conditions
Provided support and readiness activities to operational departments for CMS program audits including Formulary Administration and Coverage Determinations, Appeals and Grievances
Led the 2018 and 2017 readiness activities for the Government Services Unit including Medicare, Medicaid and Exchanges with record results
Managed and successfully integrated three acquisitions including United American/Torchmark in 2016 (150k members), Carefirst in 2014 (20k members) and HealthNet in 2012 (450k members)
Led the 2016 welcome season efforts for the Coverage Determinations and Appeals function
Led the successful exit of the Aetna Coverage Determination function which was moved to an in-house platform
Completed the consolidation of the SilverScript Choice Plan into the Basic Plan for 350k members
Vice President Operations
Appointed to the board of directors for Pennsylvania Life Insurance Company
Led sanction discussions with CMS during 2013 including member remediation activities
Led the rehost of the Facets enrollment and billing system platform from Computer Sciences Corporation to TriZetto
Led the upgrade of Facets system from version 4.31 to version 4.81
Integrated and led the consolidation of the enrollment, premium billing, financial reconciliation and systems support functions for 4.5 million members in the SilverScript Medicare Part D plans
2007 - 2011 Universal American (acquired by CVS Health) Solon, OH
Vice President Operations
Led the enrollment, premium billing, financial reconciliation, systems support and prescription drug event (PDE) data functions for Medicare Part D with up to 1.9 million members
Managed off-shore vendor for enrollment with over 200 FTEs
Implemented the Valencia reconciliation system for enrollment reconciliation
Converted the Universal American Prescriba plan consisting of 450k members into the Facets system for enrollment and billing including three years of history
Successfully completed a CMS program audit for enrollment and premium billing
2006 - 2007 MemberHealth, Inc. (acquired by Universal American) Solon, OH
Vice President Financial Operations
Led the premium billing, financial reconciliation and PDE data functions for Medicare Part D startup company with 1.1 million members
Managed the premium billing implementation from MMC 20/20 system to Facets
Worked closely with all functions and CMS to resolve over $200 million in claims rejects for the 2006 plan year at the start of Medicare Part D
Controller
Implemented key controls and managed all financial accounting functions including a conversion to the Great Plains accounting system
Coordinated outside actuary activities and results for the monthly financial close
Managed all activities for the financial statement audit process for both the Company financial statements and the 401(k) plan financial statements
Implemented and managed the outsourcing of the tax function
Managed the daily treasury activities with close coordination with the Chief Financial Officer
2005 - 2006 Edgepark Surgical, Inc. Twinsburg, OH
Controller
Managed all financial functions including accounting, accounts payable, budgeting, cash application, taxes, and treasury and risk management
Responsible for the annual financial statement audit, 401(k) plan financial statement audit and quarterly bank reporting
2004 - 2005 KPMG LLP Cleveland, OH
Senior Manager
Managed and coordinated audits and the rollout of Sarbanes Oxley for clients including Century Business Services, Degussa Construction Chemicals, Hilite International and IMG Worldwide, Inc.
Managed the recruiting process at Kent State University and assisted with other university recruiting efforts on a routine basis
1999 - 2004 Tranzonic Companies Highland Heights, OH
Vice President – Retail (2002 – 2004)
Managed all business functions including financial analysis, sales support, customer service, and all third party contractors
Reviewed and approved all key pricing decisions on large customers with focus on retaining profitability while driving sales growth
Worked with key customers on managing inventory levels and analyzing point of sale data including Advance Auto, Home Depot, Kroger, Lowes and Pep Boys
Director of Finance / Assistant Vice President – Finance (1999 – 2002)
Managed the Finance department including general ledger, budget and financial analysis, cost accounting, accounts receivable and accounts payable departments
Performed due diligence and integration on three successful acquisitions along with several other targets which were not purchased
Led the implementation of a new data warehouse
1993 - 1999 KPMG LLP Cleveland, OH
Audit Manager
Managed and coordinated audits for several clients including Century Business, General Electric Lighting, Premier Industrial, Sealy Corporation and Tranzonic Companies
Audited public filings including debt offerings and recapitalizations
Education 1993 Masters of Science in Accounting, Kent State University
1992 Bachelors of Business Administration in Finance, Ohio University
Licenses 1997 Certified Public Accountant (Inactive), State of Ohio
Awards 2017 Execution Excellence and Famous for Service Awards
2016 Execution Excellence Award
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