Manager Program
Resume:
JILLIAN BAKER
PROGRAM MANAGER HEDIS/STARS/RISK ADJUSTMENT
CONTACT
**************@*****.***
Spring Hill, FL 34606
PROFILE
I am a proven account and program manager with over twelve years of experience in health plan management at national health plans and industry-leading vendors. I have successfully lead enterprise-wide improvements in health plan initiatives, including STARS, Risk Adjustment, and HEDIS, through both prospective and retrospective member and provider engagement and measurement.
SKILLS
PROGRAM MANAGER
ACCOUNT MANAGER
TECHNICAL EXPERTISE IN SQL, CMS AND HEDIS DATA FILES, SALES FORCE, SHAREPOINT AND ALL MICROSOFT APPLICATIONS
EXPERIENCE
Florida Blue
March 2020- December 2020
I held the position of Consultant, STARS Program Manager for a one-year contract position. During my tenure, I helped coordinate with intradepartmental teams and across business groups to create a new STARS measurement tool. Additionally, I led the team that chose a STARS vendor for external data collection and aggregation for the organization.
Vatica Health
January 2019 – January 2020
I was the Program Manager for the newly created chart retrieval line of business for an industry-leading, provider-centered risk adjustment solution. I oversaw the development for the entire business solution, including operational procedures, reporting and measurement tools, and software development. During my tenure, we successfully expanded our footprint into new geographic regions, developing a more diverse client base with the new line of business.
Anthem Blue Cross Blue Shield
May 2017 – November 2018
As Revenue Account Manager, I successfully managed over $20 million dollars in revenue for risk adjustment programs. I oversaw all risk adjustment projects for the largest regional market within the Anthem Medicare division. I was responsible for assisting with budget
EXPERIENCE (CONTINUED)
creation, creating project plans and market analyses for each project, and monitored performance initiatives and key milestones to ensure the projects were completed on time and on budget. Key stakeholders included both large IPA groups, a diverse provider networks, internal operational and technical teams, and external data collection vendors.
Altegra Health (formerly Outcomes Health Information Solutions)
January 2007 - May 2017
During my tenure at Altegra/OHIS, I held various positions within the organization, and was promoted multiple times as my experience and expertise grew. The positions included Business Analyst, Operations Manager, Program Manager, and Senior Account Manager. I built influential relationships with the leaders of some of the nation’s largest Medicare Advantage health plans, and I was able to significantly expand our business and revenue within those health plans/clients. I also helped our organization build valuable technological tools to support both operations and client reporting. With these tools and reporting, we were able to streamline our data collection process and reporting, defining a new industry standard on chart retrieval and coding for both risk adjustment and HEDIS lines of business. During my last year, I successfully oversaw the retrieval and coding of over 300,000 medical records nationwide.
EDUCATION
Northern Michigan University
2003-2005
General Sciences
OHIS Technical Training
On-the-job training program to learn database reporting, SQL coding, and Excel expertise.
REFERENCES
Jenna Morgan
Senior Consultant, Attest Health Care Advisors
***************@*****.***
Michael Pryor
Director of Operations, Medicare Revenue & Reconciliation at Anthem
*******.*.*****@*****.***
D.A. Longhi
Senior Account Manager, ARC Group
*******@*********.***
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