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Executive Manager

Location:
New York City, NY
Posted:
November 02, 2019

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Resume:

Josephine Incorvaia

646-***-****

adaqqw@r.postjobfree.com

executive with expertise in operations, finance, and business analysis

Strategy Tactics Leadership Results

Enthusiastic and experienced health plan executive with expert proficiency in operations, system implementations, claims workflow, financial modeling, strategy, planning & analysis, mergers & acquisitions, revenue optimization, medical economics and financial/regulatory/management reporting. Comprehensive understanding of management principles and execution. Analytical talent and corporate finance management experience immediately transferable to senior leadership positions across multiple businesses. Synthesize, review, and analyze data, contributing valuable input to the executive decision-making process. Establish performance based cultures at start-ups and rapidly growing companies. Develop performance and goal oriented cultures that demand accountability and measurement.

Strengths include:

ü Capital Budgeting / Project Management ü Revenue optimization/Cost Containment

ü Strategic and Operations Planning ü Board & Management Presentations

ü Establishment and Measurement of KPIs ü Interpersonal Communication Abilities

ü Continuous Process Improvement – Change Agent ü Auto-adjudication workflow development

ü Forecasting & Trend Analytics ü Staff Mentoring

Government Programs (Medicaid/Medicare) ü System Implementation

CFR/MMCOR

Statutory Reporting (NAIC, Blanks, Orange, MMCOR) ü Claims System Conversions

Professional Experience

UPMC, Pittsburgh, PA (June-2018 to Present)

Not-for-profit $16 billion world-renowned health care provider and insurer based in Pittsburgh, PA, is inventing new models of accountable, cost-effective, patient-centered care.

CFO, Community HealthChoices

Start-up – Launched LTSS services in Pennsylvania. SouthWest launched Jan 2018, SouthEast launched Jan 2019 and mid state launching Jan 2020.

Implemented EVV software (Sandata)

Converted managed care HHAExchange to Virtual Health software

Determine appropriate levels of reserves

Defined auto-adjudication rules for CHC

Budgeting, forecasting, staffing (tiered/metrics driven)

Modeling cost containment scenarios

Strategic planning for business successful development

Build and educate finance & operations team on new product in PA

Liaise with DHS Finance for all financial and implementation matters

Quantify impact of appropriate utilization management

Senior Vice President/Interim Change Agent, Finance & Administration

Social Services Agency, NYC, NY (July-2016 to March 2018)

Not-for-profit $200 million Social Services Provider An organization which drives scalable solutions to transform the lives of people with disabilities, people in poverty and people facing homelessness: solutions that contribute to righting societal imbalances, specializing in Veterans, Homeless, Developmental Disabilities, etc.)

Successfully restructured finance division to achieve monthly close deadlines, external reporting requirements, KPIs, cashflow optimization. Implemented new payroll system, new general ledger, new purchasing system and created position control reporting to include allocations to contracts serviced. Increased revenue by 11% by renegotiating provider contracts.

Serve as liaison between organization and various funding sources (OASAS, DHS, DVA, OMH, DOHMH, HUD, HRA, OPWDD, Medicaid and CMS)

Quarterly/Annual state and federal regulatory reporting (CFR, Stat Blanks & MMCOR)

Managed Health Home billing and collections through BTQ

Developing health home like structure for OPWDD

Managed cash flow and treasury/investments

Created strategic contingencies and exit strategies in the event of loss of funding sources

Developed budgets and what if scenarios to enhance board understanding of current business trends and concerns

Developed matrix driven staffing plan

Successfully migrated three general ledger systems to one comprehensive automated solution

Created a virtually paperless environment

Restructured workflows to ensure corporate governance polices

Improved relationships with funding sources to ensure timely cost reimbursement

Increased lines of credit

Renegotiated with managed care organizations to optimize payment for services provided

Negotiated risk based payment structures

Implemented health home for MH and DD services (BTQ servicing)

Outsourced Medicaid and Medicare billing to decrease denials and optimize revenue

Centerlight HealthCare, Bronx, NY (Feb-2015 to June 2016)

Managed Care Organization (MLTC, FIDA, PACE-largest Medicare/Medicaid PACE program in US, and ISNP), CHHA, LHCSA and Nursing Home, not-for-profit Company, with annual revenues of $900 million

Corporate Vice President, Interim dissolution CFO Finance & Operations–

Successfully reorganized the LHCSA and CHHA to enable the line of business to be sold. Implemented new programs and incentives to generate profit at the Nursing Homes in order for profitable sale to Centers Health Care. Key contributor to the strategic initiative to restructure or liquidate several managed care lines of business to create a profitable organization. Proven leadership skills; leading several key cross functional strategic initiatives and special projects. Key strength is understanding complex inter-relationships across departments and functional areas. Excellent analytical, facilitation, communication and change management skills. Led several projects to improve internal productivity, developed new business, sales channels through collaboration with executive leadership team and functional heads. Extensive experience leading and managing teams with cultural, geographic and domain expertise differences.

Serving as liaison to the Board and the NYSDOH rand CMS regarding reorganization.

Worked with actuaries for annual Medicare bid

Managed Treasury function and investment liquidation to enhance cashflow

Renegotiated credit line to increase borrowing ability.

Prepared and restated several years of regulatory reports both NAIC and Feds

Supervised a team of 48 employees within several departments: Accounting, Medical Economic, Provider Network and Contracting, Billing/Collections, Claims Operations, Financial/Regulatory Reporting (cost reports)

Negotiated union contracts for wage parity and living wage requirements

Created KPIs to track performance and identify trends

Developed analytical tool used to identify revenue optimization opportunities (HCC/STARS/QARR/HEDIS)

Reconcile RAPS and MMRs, track HCC changes and analyze cause

Led transition to new PBM and DME provider resulting in $6mm annual savings

Outsourced financial operations to ILS for the MLTC to prepare for sale to Centers Plan for Healthy Living

Identified PACE as being only sustainable line of business and downsized organization to focus on what they do best.

Specialties include KPIs, Cost Reporting/Statutory Reporting/Financial Reporting & Analysis, Strategic Planning. Management & Implementation, Change Management, Training, Designing and implementing new processes and applications.

Personal Touch, Bayside, NY (Dec-2013 to June 2016)

For-Profit, ESOP, Nationwide LHCSA and CHHA and SNF, organization with NY Managed Care Plans (MLTC and FIDA) with $600 million in annual revenue.

Start-up CFO/COO

Created and Managed day to day operations for the NY Managed Care Plans $120 million book of business servicing Medicare and Medicaid dually eligible long-term care members. Developed programs in the LHCSA to enhance revenue. Implemented change agents to reorganize the CHHA to create a profitable business. Established ESOP and prepared forecasts for valuation. Presented financial results monthly to the Board of Directors. Improved operating margins by over 3% by leveraging efficiencies with staffs and delivering value added services with the contract parameters. Full responsibility for the P&L and delivering results on or above plan.

Managed operations with focus on improving yield on each business segment

Created Medicare managed care line of business – Integra Plan (initial application thru operations)

Worked with actuaries for annual Medicare bid

Reconcile RAPS to Final

Filed Medicare application and developed protocols and workflows for MAPD line of business

Negotiated with 1199 and NYSNA for new contracts for home aides

Developed specialized training for aides to improve retention

Prepared regulatory filings (cost reports)

Increased annual revenue and operating income by of 15%

Started Medicare and MLTC Health Plan, from application to enrollment

Developed creative strategies for identifying revenue optimization opportunities (raising HCC scores).

Raised capital to fund the acquisitions that my team identified.

HCP IPA, Garden City, NY (Oct-2011 to Nov-2013)

$1bn New York IPA, and ACO - Private Equity Owned

Chief Financial Officer

Senior leadership position accountable for developing and executing the strategy, planning, analysis, and reporting for a healthcare provider with over 100 thousand covered lives. Primarily responsible for the overall P&L of the group, conducting comprehensive budget planning, performance analytics, market scenario modeling, and performance measurement. Developed, KPIs to inform executive management on performance results and issues on a continual basis.

Developed analytical tool to optimize revenue by increasing HCC scores ($25mm annually recovered).

Worked with actuaries for annual Medicare bid

Analyze RAPS, DME and RX data to determine changes in HCC scores.

Developed performance reports for each provider, identified operational metrics to monitor and target key objectives unique to each provider/specialty

Worked with provider networking groups to implement risk sharing pricing rates for all products

Leader of the cost containment committee, reduced administrative spend by 1.7%.

Trended unusual claim experience including special investigations unit

Implemented multi-level profitability model (pcp, facility, professional, and specialty) by lob, by county

Prepared and presented monthly, quarterly and annual financial and management reports to the executive leadership team and the owner

Started Alpha Care of NY (managed Medicare and managed long term care plans): application s with NYSDOH and CMS. Hired staff, built budgets and subsequently sold to Magellan BH.

Fidelis, Rego Park, NY (June-2010 to Nov-2011)

Not-for-profit $2.5bn New York Government Sponsored Health Plan and Commercial Health Plan

Controller

Senior leadership position accountable for executing the strategy, planning, analysis, and reporting for a managed care plan with over two million covered lives. Primarily responsible for the overall P&L and reporting of the group, conducting comprehensive budget planning, performance analytics, and performance measurement. Developed, KPIs to inform executive management on performance results and issues on a continual basis.

Restructured Finance division including claims processing to achieve synergies across functions and platforms

Developed performance reports for each provider, identified operational metrics to monitor and target key objectives unique to each provider/specialty

Managed staff of 48 professionals including financial operations, payroll, A/P, A/R and provider reimbursement

Assessed new business opportunities for for-profit subsidiaries

Worked closely with Chief Marketing Officer to develop membership growth goals and determined which lines of business were profitable so as to focus enrollment growth efforts

Closely worked with provider services to increase provider satisfaction with the goal of increasing QARR scores (including developing incentive programs)

Worked with actuaries for annual Medicare bid

Prepared and presented monthly, quarterly and annual financial and management reports to the executive leadership team and the owner

EmblemHealth, New York, NY (Oct-2007 to June-2010)

$10 bn New York Commercial and Government Sponsored Health Plan and

Director – Strategy

Senior leadership position accountable for executing the strategy, primarily focused on writing the S-1 to convert from not-for-profit to publically traded company and IPO .

Developed public company financial statements.

Implemented treasury strategy

Prepared S-1, 10k, 10Q and 8K

Worked with investment bankers, CMS and NYSDOH to prepare the filing

Prior Work Experience (1984 to 2007):

Worked in a variety of industries, public/private structures, and different sized organizations with different business models, customers and service or product delivery techniques. The range of diversity within this collection of career experiences required constant change and flexibility. Along with the differences between companies, I developed confidence in my ability to learn and adapt to changes in market conditions and company specific product and operational challenges. Through these interactions, I developed an effective way of communicating up and down the hierarchy of the organizations.

Previous companies and positions held:

GWA, Chief Financial Officer- Interim; Private Equity Owned 2005-2007 – International (FASB/IAS, Forex) IPO

RGP, Interim CFO Consultant Mergers and Acquisitions & Private Equity Backed Fund. 2002-2005

Lehman Brothers, Sr.Vice President International M&A 2000-2002

Credit Suisse, Vice President; Equities and Equities Derivatives 1998-2000

FHLB, Manager, AVP and Assistant Controller; 1995-1998

Gruntal & Co., Started up a PE backed sub-prime mortgage bank Controller; 1991-1995 sold to the money store

Donald Lufkin & Jenrette Finance Manager MBS–1987-1991

Salomon Brothers, Senior Accountant – 1984-1987

Systems

Proficient in

Operational/Clinical Systems

Virtual Health/HELIOS, PLEXIS, Sandata, EMEDNY, EMDEON, HHA Exchange, 3M ICD9/10 grouper, VISOVA.

Financial Systems

SAP, Great Plains, SAGE, QuickBooks, Lawson, EDGAR, Geneva, Hyperion Enterprise and Pillar, PeopleSoft Financials, Midas, GEDS, SQL Fncls, Principea, Oracle & Oracle (query), MAS 90/200, McCormick & Dodge, ADP, Cognos, Crystal Reports, MS Project, Access and Excel Business Objects.

EDUCATION

UOP -

Master of Science– 3.98/4.0 ongoing

Manhattanville at Purchase New York

Bachelor of Arts – 4.0/4.0

Key Skills:

KPIs, regulatory reporting. budgeting, workflow optimization, financial planning, strategic planning, modeling, valuation, business analysis, management reporting, revenue generation, developing performance based culture and organization.



Contact this candidate