Keisha Johnson

Mount Arlington, NJ *****

adh4ra@r.postjobfree.com 973-***-**** www.linkedIn.com/in/KeishaL-Johnson

Managed care Account Management and Pricing Analysis

Solution-focused, self-motivated, detail and goal-oriented professional with extremely strong analytical, leadership and interpersonal skills. Adapt quickly to changes in priorities and responsibilities. Work well independently or in teams in a fast-paced demanding environment. Proven high performer. Articulate

Communicator.

Managed Care · PBMs · Key Account Management · Process Improvement · Variance Analysis · Market Share Analysis · Risk Management · GPOs · Specialty Accounts · Data Trend Analysis · Medicare Part D Commercial Contracts · SOX/SOPs · Contract Administration · Healthcare Finance · Term Sheets · Project Management · Reimbursement Rules · Health Plans · Government Impact · Regulatory Compliance · Medicare Pricing · Due Diligence · Pricing Reimbursement · PHI Audits · Rebate Utilization · Managed Markets Payers · Providers · Medical Devices · Workers Comp · State Regulatory Agencies · CMS Regulations · Fee Schedules · HIPAA · Healthcare Reimbursement · Regulatory Reporting · Licensure Research · Managed Care · Policy & Procedure Reporting & Writing · Legal Language · Red-lining · Drafting

Career Highlights

NESTLE HEALTHSCIENCE, Bridgewater, New Jersey 11/2020 to current

Human Resource Coordinator – Research & Development Dept. (Consultant)

Responsible for auditing employee files for the Nestle Internal Audit (NIA), filing, as well as entering content in Nestle’s Learning and Onboarding Management Systems.

·Work closely with HR Business Partner to assist in improving and assuring adherence to existing employee files by maintaining compliance requirements for documentation needed for the upcoming Nestle Internal Audit.

·Responsible for evaluating new hires or current employees for individual employee growth subsequent to training through iLearn by researching and updating transcripts.

·Assist Associate Manager of Talent with newly hired employee documents and system updates through Onboarding tasks.

FLIPT LLC, Jersey City, NJ 6/2020 to 6/2020

Compliance Coordinator – Compliance and Legal Dept. (Part-time Consultant)

The Compliance Coordinator supports the Chief Compliance Officer in maintaining compliance in all areas of operations with a focus on promoting a culture of compliance. Tasked with implementing and upholding policies and procedures that meet company standards.

·Prepare policies and procedures and manage HIPAA compliance related to vendor management, vendor audits, client audits and enforcement procedures.

·Support Flipt’s overall compliance program.

·Prepared drafted version of procedures to policies for Flipt’s Vendor Management Audit for July 2020.

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VERIZON, Basking Ridge, NJ 5/2019 to 11/2019

VBG Legal Contract Manager – Verizon Business Group (Part-time Consultant)

Contract Manager supporting sales, offer development and attorneys for the Verizon Business Group channels, drafting, redlining and managing service agreements and wireless agreements for Verizon's high value retail and hospitality customers. Management of contracting activities include research and maintenance of compliance contractual terms for the following contracts:

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·First Draft Simple Amendments

·First Draft In-Building Addendums

·New EAA template Agreement (Enterprise Account Agreement)

·New MAA template Agreement (Major Account Agreement)

·First Draft Renewal Amendment to Agreements no older than 2014

·Acknowledgement Letters

FANNIE E. RIPPLE FOUNDATION, Morristown, NJ 3/2019 to 1/2020

Contract Specialist – Non Profit (Part-time Consultant)

Draft, revise and manage contracts and agreements for Corporate Counsel. Research data privacy and terms of use. Manage all aspects of contracting to ensure regulatory compliance and performance.

DAIICHI SANKYO, INC, Basking Ridge, NJ 3/2017 to 8/2017

Contract Strategy Manager (Consultant) - Global Pharmaceutical Co.

Analyze, review, negotiate, draft and implement rebate and direct purchase contracts with corporate and regional account customers, (e.g. Managed Care Entities, PBMs, GPOs, Commercial and Medicare Part D sponsors) for marketed products within established company guidelines. Management of commercial contracting activities including language negotiations/redlining, drafting, analysis/negotiation of contracted prices, compliance with contractual terms and statutory provisions and recommendations concerning all outlier issues. Partner with Managed Markets Account Managers for the purpose of incorporating corporate/brand guidelines/policies and corporate /brand expectations into all business proposals and contracts.

·Managed all aspects of account contracting to ensure corporate and regulatory compliance and performance. Includes, but not limited to, contract offer development, acting as the liaison for the account management team, negotiating terms and conditions, and develop pre & post deal analytics; requires strong

·collaboration with cross functional teams such as Finance, Legal and DSI Brand teams. Collaborate with Finance to ensure appropriate rebate forecasting.

·Collaborated with Managed Markets Account Management team by providing guidance and direction on corporate policies and expectations for all contract opportunities.

·Implemented and managed contract analysis tools and processes to improve contract content, negotiation support and compliance. Enhance and manage online contracting tools and content. Other projects, as directed.

·Corresponded with Operations and Finance to ensure key client deliverables and revenue goals were met. Assisted Finance Manager on project management related audits of direct purchase contracts on confidentiality clauses for updates to Government entities.

ONE CALL MEDICAL, INC., Parsippany, NJ 1/2012 to 10/2016

Compliance Research Analyst 1/2014 to 10/2016

Medical Cost Containment Co.

Assisted Legal and Corporate Compliance department in research of regulatory and industry-related topics, particularly fee schedules and reimbursement of medical expenses. Assisted in preparation and routine

maintenance of department documents and memos. Calculated state and federal workers’ compensation fee schedules for all business units; coordinated implementation of fee schedules into internal systems.

·Collaborated with cross functional project teams and business unit subcommittees for enterprise wide audit readiness (i.e, PHI, ICD-10 Coding).

·Evaluated risks and controls of our Transportation and Translation business to make sure our contracted drivers with Lyft were tested and licensed with insurance coverage.

·Identified compliance risks and advice in all product lines of business (i.e,Transportation & Translation, DME, Doctor & Dental and Diagnostics).

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·Worked with Audit Manager on assigned business units to monitor system and process improvement upgrades for the nationwide ICD-10 code change based on HIPAA regulated requirements.

·Reported on Diagnostics and DME fee schedules to key stakeholders. Summarized the impact of updates and coordinated actual reporting for our Workers Comp and Auto Business.

·Support and assist with monitoring activities in predefined areas of risk.

·Researched regulatory and workers’ compensation industry related topics for Legal and Compliance.

·Monitored and reported on potential and proposed legislation for assigned states (i.e, CMS & State Agency updates).

·Acknowledged and researched statutes, rules and regulations (and any changes thereto) governing One Call’s operations and products particularly with regard to reimbursement of workers’ compensation medical expenses, guaranteeing compliance and ability to do new business.

·Identified, continually monitored, and reported (verbally and in writing) on potential or proposed fee schedule and reimbursement rules revisions for all One Call Business Units, enabling provider contracting and development head start to re-contract while allowing Financial Analysis team to forecast measures on revenue.

·Managed notifications for launch of fee schedule pricing and correct system updates, enabling departments to pay claims and drive contract negotiations.

·Provided integrated analyses and trend reports for internal stakeholders and external customers.

·Selected to complete budget, submitting to Chief Compliance Officer for budget committee review and approval.

·Collaborated with IT Managers on process improvement measures to streamline pricing mainframe applications.

·Contributed to Corporate Compliance and Risk Assessment initiatives, including development and implementation of policies and procedures and training needs.

Pricing Analyst 1/2012 to 1/2014

Executed pricing audits and financial analysis on client accounts to ensure billing was in accordance with state fee schedules. Executed strategic pricing through utilization of price modeling tools; competitive price checks, external market share data and market specific strategic pricing initiatives.

·Saved company $300K in bad debt due to monitoring of National State Fee Schedule and Medicare program changes.

·Analyzed impact of pricing changes on One Call Care Management’s financial results for Fee Schedule pricing submitted to stakeholders for reporting purposes.

·Supported analytical input into development and implementation of pricing strategies used for lobbying efforts for the Government Relations Department, enabling management to present in the field.

·Selected to assist Compliance Manager with due diligence efforts during merger and acquisition activities,

NOVARTIS PHARMACEUTICAL CORPORATION, East Hanover, NJ 6/2006 to 12/2010

Managed Care Contract Analyst, Managed Markets - Global Pharmaceutical Co.

Performed contract administration functions for Managed Care and Medicare market segments. Conducted detailed analysis, validation and calculation of rebate claim data and payments. Established effective customer relationships.

·Analyzed, redlined and drafted rebate direct purchase contracts with corporate and regional account customers for marketed products within company guidelines.

·Researched proposed contract terms and conditions and price concession; includes discounts, rebates, best price, administration fees, product options, marketshare and formulary for all Brands and customer channels to determine if terms aligned with the customer’s requirements and comply with regulatory guidelines;

·Evaluate all contract proposals to ensure price concessions can be calculated and processed within contracted timelines and according to policies, procedures, and guidelines.

·Partnered with internal Managers and Account Managers for the purpose of incorporating guidelines into proposals and contracts.

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·Identified as Contract Pricing and Chargeback Component (CPCC) Super User managing all issues or concerns that arose in Managed Markets.

·Collaborated with IT to enhance CPCC mainframe application and develop and implement solution for paperless environment, resulting in substantial expense savings.

·Selected as SOX/SOP Team Leader training Contract Administrators in proper contract setup, improving contract workflow by 50%. Selected for two years to present contract strategy process flows to external auditors (PWC) PricewaterhouseCoopers.

·Participated on Special Projects team, testing spreading of rebate bundles for Deficit Reduction Act regulations.

·Administered and acted as a subject matter expert and team lead for the Contract Management and Rebate Department Hybrid project.

·Responsible for group and one-on-one training on contract management processes and systems.

Baxter Healthcare, New Providence NJ, Sales Operations Analyst, 2/2003 to 11/2004

Sales Operation Analyst – Healthcare Company

Implemented and managed risk sharing programs and reviewed and analyzed risk-sharing agreements in rebate analysis. Calculated capitated annual rates. Worked with Marketing Manager and Field Sales on GPO/Hospital agreements for healthcare equipment. Processed incentives / rebates. Provided contract incentives to clients. Generated monthly statistical sales reports, analyzing pricing trends via financial models.

·Recognized as proven high performer by executive management, resulting in assignment of largest region in the United States consisting of 220 client accounts.

·Collaborated with Marketing team to review and analyze product pricing to evaluate CAP Financial Module, market trends and potential Risk-Sharing accounts, determining following year’s sales incentives which drove increase in sales and overall profit.

PREVIOUS PROFESSIONAL EXPERIENCE INCLUDES:

Equiserve LLC, Jersey City, NJ, Risk Analyst, 2/2001 to 2/2002

Performed Business Unit risk assessments identifying regulatory compliance issues. Recommended process improvement solutions to decrease company’s risk exposure. Acted in a troubleshooting capacity to Legal Counsel offering “real time trading” options through the new Broker Gateway system. Facilitated the Security Exchange Commission (SEC) Reconciliation Project by compiling regulatory reports. Assisted the Internal Audit Department by preparing documentation for external auditors.

·Selected to serve as a Consultant for various Business Units in developing new products, planning initiatives and procedural changes.

·Utilized acquired knowledge of Corporate Action Processes and dispersion of stocks, bonds and certificates to participate in a Migration Project resulting in the identification of improperly dispersed certificates worth $1M.

Federal Reserve Bank of NY, New York, New York, Junior Reports Analyst, 6/1997 to 2/2001

Ensured adherence to Federal Reserve regulations by Foreign Banking Organizations (FBO’s). Verified regulatory compliance supervision by U.S. banking authorities. Reported findings and recommendations regarding holding companies’ reporting activities to senior level management. Trained Junior Analysts on proper protocol of data and technical statistical reporting.

·Through extensive monetary policy statistical analysis increased regulatory compliance of Foreign Banking Organizations’ (FBO’s) by approximately 30%.

·Selected to participate in executive meetings with foreign clients as a subject matter expert after analyzing and identifying unusual trends in data reporting by banking institutions.

EDUCATION

Bachelor of Science (BS), Business Administration, New Jersey City University, Jersey City, NJ, 1996

Negotiating and Contract Management Course, County College of Morris, Randolph, NJ, 2012

Business Writing Course, American Management Association, New York, NY, 2015

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