Executive Director Product Manager
Resume:
MARK A. WILLCOXON MBA HCM ACHE
Executive Director Healthcare Economics, Informatics, Predictive Analytics www.linkedin.com/in/hwhliving
Phone: 602/819-2613 Residence: 19817 N 67TH Dr, Glendale, AZ 85308 email: *********@*****.*** Page 1 of 7
Panel Member at the Free2Care Conference, Library of Congress, April 1, 2019. Washington, D.C. Professional Profile for …
Mark A Willcoxon, MBA HCM ACHE ACHT
19817 N 67th Dr
Glendale, AZ 85308
*********@*****.***
8/28/2024
MARK A. WILLCOXON MBA HCM ACHE
Executive Director Healthcare Economics, Informatics, Predictive Analytics www.linkedin.com/in/hwhliving
Phone: 602/819-2613 Residence: 19817 N 67TH Dr, Glendale, AZ 85308 email: *********@*****.*** Page 2 of 7
PROFESSIONAL SUMMARY
Healthcare Management MBA experience in various executive and senior technical roles from product manager, data and business analytics, business systems analytics, project management, development, and quality assurance spanning over twenty years.
• More than twenty years’ technical experience for all healthcare lines of business (Commercial, Medicaid, Medicare, Federal Employee Program, Behavioral Health, Coordination of Benefits, and Property & Casualty) -
Healthcare claims processing.
Member demographic mapping and table storage.
Provider profiling and credentialing practices.
• More than twenty years’ expert systems development experience mapping and grouping ICD9/ICD10, LOINC, CPT4/HCPC, APC, and APDRG codes.
• More than twenty years’ Subject Matter Expertise –
Healthcare Predictive and Trend Analytics (PMPM, Utilization, and Rate analysis) Subject Matter Expert.
Quality Managed Care and HEDIS STAR Measures.
• Twenty years’ experience owner - Small healthcare informatics business (HWH Living LLC).
• Nearly fifteen years’ experience supervising large and small teams of internal and outsourced Data and Business Analysts, Project Managers, Developers, and Data Warehouse Managers. TECHNICAL SKILLS
Excellent communication and interpersonal skills to maintain an effective working environment in any organization.
• Senior Developer/Senior Business Systems Analyst –
More than twenty years’ expert level experience using SQL (Microsoft and Oracle).
More than five years’ novice experience using SAS.
More than three years’ experience using Waterfall and Agile Development Methodologies.
More than three years’ experience with Revenue Cycle Management design and implementation.
More than one years’ intermediate experience using Teradata.
• Senior Business/Senior Data Analyst –
More than fifteen years’ experience developing and analyzing metric reports.
More than five years’ experience developing business requirement specification and documents and use case documents.
• Senior Project Manager/Product Manager –
More than five years’ experience using Waterfall, Agile SDLC, and SWOT Analysis methodologies while maintaining a strong adaptability to changing project needs.
• Some additional tools and specializations –
Software: Microsoft Office, Lotus Notes, Outlook Express, Cognos, Clear Access, MacroMedia, Acrobat Professional, Mercury TD, Ingenix RCM, Ingenix GeoAccess Suite, EASY Group, Encoder Pro, Episode Treatment Group, ImpactPro, ImpactIntell, NetworksPro, Provider Online Lookup, iCES, and Sharepoint.
Case Management applications: VITAL, Think Med, Click4Care, and OptumOne.
Platforms: UNIX, Oracle, MS/SQL, PL/SQL, and CMAS.
Resources: HL7/FHIR.
Systems: FACETS, QNXT, HealthEdge.
Statistical applications: SQL Navigator, TOAD, SQL Server, SSRS/SSIS, and Teradata SQL Assistant.
Specializations - Metric Reporting Tools and Dashboards, Data Mining & Trend Analytics, and Data Migration.
EDUCATION
• MBA, Health Care Management, University of Phoenix – Jul/2004.
• BA, General Studies, Western International University – Mar/1998. 8/28/2024
MARK A. WILLCOXON MBA HCM ACHE
Executive Director Healthcare Economics, Informatics, Predictive Analytics www.linkedin.com/in/hwhliving
Phone: 602/819-2613 Residence: 19817 N 67TH Dr, Glendale, AZ 85308 email: *********@*****.*** Page 3 of 7
SOME ACCOMPLISHMENTS
• From 2021 – 2024, took full responsibility to own, design, build, and maintain raw eligibility, claim, pharmacy, and HEDIS data while leveraging available human resources.
• Participated in a 2019 National Opioid task force.
• Participated in a 2019 Drug Pricing Panel discussion at the Library of Congress in DC.
• Published a 2016 research study on Price Transparency, and the condition of health insurance in the United States, garnering national attention.
• Current and active participant in projects involving: ‘The Physician’s Revolution’, ‘The Center for the Physician’s Peer Review’, and ‘Practicing Physicians of America’, all designed to flatten healthcare pricing.
• Provided useful information to the Governor of Louisiana pertaining to Radiological Scanning abuse. This information was used in a Gubernatorial Conference, receiving national media attention.
• Met with the Insurance Commissioner of Utah to discuss research pertaining to the benefits of consumer driven healthcare policies.
• Received invitation and met with US Senate Medicare Reform panel to discuss results of a research project pertaining to the benefits of a Consumer Driven Health Savings Account.
• Member of BYU Division 1 NCAA Track & Field Team.
• Developed Oceanographic Sound Travel Research Tool for US Naval Submarine Force, with Secret Clearance.
• Dan 1 Tae Kwondo Black Belt and Adult Leader in the Boy Scouts of America. PROFESSIONAL EXPERIENCE
AZ Care Network May/2021 - Preesent
Phoenix, AZ
Senior Population Health Manager,
Data Processing Tool: SQL Server 2019, Neteza Aginity, Big Query Analyze the collaborative care efforts between Tenet Health, Dignity Health, Phoenix Children’s Network, Aetna, MercyCare, UnitedHealth, Cigna, Bright Health, and Intel.
• Created an algorithm to attribute all participating members to the PCP, simplifying the extract process for utilization information.
HWH LIVING LLC Apr/2017 – May/2021
Glendale, AZ
Business Owner and Independent Contractor, Board Advisor, Healthcare Economist, Product Manager, Design Engineer, Developer
Data Processing Tool: SQL Server 2019
Claim Processing Systems: FACETS, QNXT
Owner of HWH Living LLC, an Independent Consulting firm. Quality & Cost Management, working at the senior executive level. Specialize in Provider Profiling, improving the patient to provider relationship, and utilization trends and gaps. Clients include HPEC, HCW Hosted, CitizenHealth, Free2Care, Practicing Physicians of America, Physicians Against Drug Shortages, Texas Public Policy Foundation, Humanitarian Physicians Empowerment Community, The Center for Peer Review Justice, Best Industry Research, MPowering Benefits, and WOW Health Solutions.
• Designed business models and plans, identified pricing breakeven points, engaged investors and physicians, and negotiated vendor application pricing contracts.
• Reported on the Safe Harbor Act to multiple U.S. Congressmen at the Library of Congress in Washington.
• Conducted multiple client research projects on National Healthcare Expenditures, the economic outcome of Insurance/PBM Mergers, and the effect of NP/PCP Empowerment in 25 States.
• Conducted miscellaneous research projects for ‘Physicians Against Drug Shortages’. ‘Humanitarian Physicians Empowerment Community’, ‘Best Industry Research’, and ‘MPowering Benefits’. 8/28/2024
MARK A. WILLCOXON MBA HCM ACHE
Executive Director Healthcare Economics, Informatics, Predictive Analytics www.linkedin.com/in/hwhliving
Phone: 602/819-2613 Residence: 19817 N 67TH Dr, Glendale, AZ 85308 email: *********@*****.*** Page 4 of 7
NTT Data Sep/2020 – Mar/2021
Phoenix, AZ
Contractor, Healthcare Economist, Senior Data Analyst, and Business Analyst Offered subject matter expertise for the CMS Interoperability and Price Transparency Projects.
• Managed onshore and offshore staff and resources.
• Built report templates, user acceptance testing, developed report coding. CVS Feb/2020 – Sep/2020
Scottsdale, AZ
Contractor, SAS Developer
Improved pricing codes and drug rebate algorithms.
• Discovered $200 million nationwide pricing error, notifying decision owners toward corrective course of action. Cognizant Apr/2017 – Feb/2020
Norfolk, VA
Contractor, Manager of Provider Profiling Development Team Subject Matter Expert “Physician Disruption Analytics and Provider Profiling”.
• Negotiated a new contract, saving the company $120,000 annually over the prior contract. BlueCross BlueShield of North Carolina Oct/2016 – Mar/2017 Raleigh, NC
Contractor, Senior Clinical Informatics Analyst
Subject Matter Expert HEDIS STAR Metrics.
• Researched and discovered missing HEDIS STAR Metric Hybrid diagnosis codes. Recoded the dashboards to include the missing codes, universally improving the overall STAR Rating from 3 to 4.
• Managed a ‘CareNet Initiative’ Project to provide support for the Care Management, Quality Management, and Provider Relations Teams to better utilize available resources and increase HEDIS STAR measures in conjunction with the group’s Call Centers.
• Utilizing the Agile Methodology, redesigned a Regulatory ‘Continuity of Care’ Report for accuracy and streamlining purposes. Prior to my availability, this report remained broken for two years. When users attempted to run the report, it took 20 minutes or longer, and several records would be missing. After redesigning the code, the time was reduced to 10 seconds or less, and included data previously missing.
• Using Teradata SQL Assistant (based both in Oracle [Medicare Market] and SQL Server [Commercial Market]), analyzed and graded the group’s Quality Measure process to maximize and improve the effectiveness of a call center’s patient care.
Mercy Maricopa Integrated Care Jun/2015 – Oct/2017 Phoenix, AZ
Contractor, Senior Project Manager & Systems Developer Managed the ‘Re-Adjudication POT Initiative’, grouping common errors into a single claim POT for manual processing, while developing Dashboards for claim reporting trends.
• Initially hired as a Project Manager, within three weeks took on a double role, working as a Senior Project Manager for the Provider Relations Team and Senior Developer in the Operations Department, juggling both jobs simultaneously.
• Conceptualized and put together a team to automate the ‘QNXT Provider Interface System’.
• Represented the Operation’s Analytics Team as the Subject Matter Expert for all issues pertaining to Claim Trends
(PMPM, Util/100, and Rate), Provider Profiling and Credentialing, and Member Demographic shifts.
• Using SQL Server, Stored Procedures, SSRS, and SSIS, built a BI Tool for trend analyses, allowing users to drill down to the claim line level for spikes of interest. 8/28/2024
MARK A. WILLCOXON MBA HCM ACHE
Executive Director Healthcare Economics, Informatics, Predictive Analytics www.linkedin.com/in/hwhliving
Phone: 602/819-2613 Residence: 19817 N 67TH Dr, Glendale, AZ 85308 email: *********@*****.*** Page 5 of 7
BCBS Advantage May/2015 – Jun/2015
Phoenix, AZ
Contractor, Senior Project Manager
• Lead Project Manager of the ‘VITAL Case Management’ project. Mapped the tool against current available resources and identified and resolved key gaps.
OPTUM MEDICAL NETWORK – Phoenix, AZ Nov/2011 – May/2015 Manager of Decision Support Analytics
Used SQL, SAS, and QA experience to develop and maintain over 60 daily, weekly, monthly, quarterly, and annual trend analysis reports for the various internal and external work groups. Maintained all 60 Stored Procedures.
• Discovered and reported a HEDIS compliance issue with the potential of saving corporate tens of millions of dollars.
• Lead the HEDIS chart audit team with timely reviews of the process, and status of ongoing assessments.
• Member of the Senior Leadership Committee, representing Corporate Healthcare Economics, Informatics, Medication Adherence, and Analytics.
• Conducted routine analytic evaluations of the collaborative return on investment for wellness programs within the Medicare Advantage local market with an emphasis on intervention, lifestyle, biometrics, and disease risk.
• Researched claims history to identify and improve areas of poor performance within the Care Management structure.
• Took initiative to build a premium audits report structure, recovering (on average) $150k per month in retroactive CMS Funds and claims claw back.
• Managed a staff of Direct Reports responsible for day-to-day Report Ad hoc productions.
• Offered executive summary level improvement opportunity decisions based on trend analyses. Mphasis Mar/2011 – Nov/11
Phoenix, AZ
Senior Business Analyst
Responsible for all Business Requirement Specifications and Use Case Documentation for the Analytic Reporting and Adjudication Modules of the Javelina Healthcare Payor System.
• Within a matter of days, found over a dozen report reconciliation errors while maintaining report integrity within the other 160 reports developed for Economic Trend Analyses.
• Managed the re-design of Javelina CRM Module.
• Using SQL Server, assisted in the development of the Billing & Admin Module (Broker Compensation Report). Anthem Mar/2009 – Dec/2010
New Haven, CT
Contractor, Ingenix Software Coordinator, Provider Profiling Subject Matter Expert, and IT Sponsor Directed all Ingenix software QA activities from Vendor Contracting to implementation and maintenance.
• Directed the Infosys off-shore coordination efforts.
• Directed asset management efforts for the entire Well Point Enterprise (over 30,000 users and 20 applications – Ingenix’s largest client).
• Concentrated efforts on implementation, training, and maintenance of the GeoAccess Suite of products.
• Coordinated training, new user and upgrade installs, and application repair efforts.
• Created user networking functionality through the implementation and maintenance of Share Point.
• Maintained user compliance and departmental charge back information.
• Utilized Business Process Modeling to identify best business practices. 8/28/2024
MARK A. WILLCOXON MBA HCM ACHE
Executive Director Healthcare Economics, Informatics, Predictive Analytics www.linkedin.com/in/hwhliving
Phone: 602/819-2613 Residence: 19817 N 67TH Dr, Glendale, AZ 85308 email: *********@*****.*** Page 6 of 7
University of Phoenix Aug/2008 – Dec/2009
Nashville, TN
Facilitator – Healthcare Economics
Facilitate the learning experience of healthcare administrative students at the University of Phoenix.
• Member of Academic College of Healthcare Executives.
• Certified to instruct and tutor the following courses: Accounting, Finance, Quality Management, Marketing, Business Trends, Evaluation Methodology, Economics, Financial Resource Management, Financial Management, Measurement Standards, and Informatics. All courses were taught with an emphasis in the Healthcare industry. University of Phoenix May/2008 – Mar/2009
Franklin, TN
Healthcare Economics & Informatics Manager
Provide benchmark evidence valuing the need to outsource pre-authorization management.
• Created a Radiological Abuse Report that ultimately received national media attention. BCBS of Vermont Nov/2007 – Apr/2008
Franklin, TN
Senior Health Data Programmer/Analyst & Product Manager Managed the development of the ‘Group Reporting & Employer Analysis’ Tool.
• Offered employer group solutions to counter rapidly rising healthcare cost trends. Ingenix Apr/2006 – Nov/2007
Salt Lake City, UT
Senior Data Manager & Resell Network Manager
Managed the development of the ‘Network Performance Evaluator’ Tool.
• Conceptualized and built (from ground zero) an application that “scored” Property & Casualty networks based on cost, quality, market penetration, accessibility, network disruption, and client disruption.
• Automated the invoicing cycle, reconciliation and payment process for both receivables and payables. HWH Living LLC Feb/2006 – Apr/2006
Hill AFB, UT
Contractor, Product Manager
Managed the implementation of the COGNOS 8 BI Reporting Tool.
• A loss of federal funding cut this project short. HWH Living LLC Jan/2005 – Feb/2006
Salt Lake City, UT
Contractor, Senior Business Systems Analyst
Developed and maintained the Ingenix Rules Creation Management Tool (iCES).
• Developed the iCES ‘Cardiac Monitoring’ Rule, and twenty-six iCES ‘Obstetric’ Sub-Rules.
• Upgraded and maintained the iCES ‘Therapeutic Injection’, ‘Careplan Oversight’, ‘Standby Service’, ‘IV Conscious Sedation’, and ‘Telemedicine’ Rules.
8/28/2024
MARK A. WILLCOXON MBA HCM ACHE
Executive Director Healthcare Economics, Informatics, Predictive Analytics www.linkedin.com/in/hwhliving
Phone: 602/819-2613 Residence: 19817 N 67TH Dr, Glendale, AZ 85308 email: *********@*****.*** Page 7 of 7
The Regence Group Sep/1999 – Dec/2004
Salt Lake City, UT
Regence Healthcare Information Analyst II at BCBS of Utah Developed and maintained the COGNOS Web-Based Medical Directors Report, and produced Ad hoc reports on demand.
• Conceptualized, designed, built, and maintained the ‘Medical Directors Report’, allowing decision makers to visualize monthly trends based on line of business and type of service.
• Participated in a 4 x States committee, integrating the design of our reports to fit the regulatory requirements for each State.
• Developed and coded a standard ad hoc report for use by junior analysts in order to maintain consistency and reduce errors.
• Owned all GeoAccess Suite Reports, building and maintaining provider profile information for all four States. Lewiston, ID
Regence Product Manager at BlueShield of Idaho
Managed the development of the Click4Care (C4C) Case & Utilization Management Tool.
• Provided analysis & Project Management support during the Beta Implementation of the tool, increasing user base by 33%.
Seattle, WA
Regence Product Manager at BCBS of Washington
Developed and maintained a series of executive reports (standard and ad hoc) designed specifically for the Chief Executive Officer.
• Developed and maintained the CEO Standard Reimbursement Trend Report.
• Reduced report turnaround time from three weeks to one day.
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