RAYMOND A. JIMENEZ

Wesley Chapel, FL

954-***-**** ò adjjb9@r.postjobfree.com

https://www.linkedin.com/in/jimenezraymond/

Senior Executive Operations Management ò Managed Care ò Healthcare Economics

Relationship Building ò Strategic Planning ò Performance Development

A dynamic, accomplished, visionary Healthcare Senior Executive highly regarded for performance optimization, multi-state and cultural team integration, strategic business unit development and execution. Leader of healthcare operations, healthcare IT and operational programs to drive growth for industry trailblazers like ChenMed and Access Health Care Physicians. Known as a decisive leader with in-depth experience with value-based care, managed care, expertly working with national health plans on HEDIS, Medicare, Medicare Advantage and PPO plans. Recognized for superb communication acumen, managing multi-state, cross-functional teams of 1,000+ employees while driving constant performance development. Out-of-the-box thinker who generates innovative operational solutions for Medicare Risk Adjustment, Risk Adjustment Factor, HEDIS quality initiatives, Patient Centered Medical Home, Accountable Care Organizations, and Independent Physician Associations. Devoted to building passion-driven leaders and driving employee engagement.

Selected Highlights

Drove company reorganization, repositioning 50% of the company to drive increased profitability, build infrastructure for growth/innovation and reduce waste.

Implemented 30+ strategic initiatives addressing opportunities in customer/patient experience, operational excellence and service delivery.

Spearheaded integration of lean operations techniques to billing process, reducing waste, cutting related costs by 7%, increasing yield, and increasing quality scores by 10% within the first 90 days.

Elected to execute a superlative managed care service model across 4 states (FL, KY, LA and IL), successfully onboarding 125+ primary care physician practices managing 20K+ lives.

Chosen to chair outstanding enterprise cross-functional teams that successfully onboarded and launched 14 Payers across 6 states in 2016-2017, representing a record-breaking $65M in new revenues.

Originated and implemented a custom-tailored collection initiative yielding a pace-setting $53M over a two-year period, growing to a run rate of $40M per year.

Led operationalization of multiple physician practice services model addressing crucial opportunities in clinical outcomes, technology enhancements, clinical case reviews, claims reviews, diagnostic services, encounter and claims billing, practice management, and risk management.

Accomplished 23% reduction in billing cycle time via continuous process improvements and business process outsourcing.

Core Competencies

Operations Management

New Business Development

Workflow Optimization

Budgeting & P&L Management

Strategic Planning

Continuous Improvement

Managed Care

Healthcare Economics

Change Management

Staff Management/Development

Relationship Building

Executive Leadership

Professional Experience

Access Health Care Physicians ò Spring Hill, FL ò 2018 – Present

Chief Operating Officer - COO

Reporting to the Chief Executive Officer (CEO) and member of the corporate Board of Director’s. Oversight of $120M operating budget, responsible for designing and implementing the strategic plan of the organization, developing high-quality, cost-effective, and integrated clinical and operational programs for value-based care organization to increase EBITDA to shareholders. Lead business planning and oversight of 200 physicians, across 150+ locations, 5 Independent Physicians Associations, 2 Accountable Care Organizations and 1,200+ employees.

Driving cultural definition and implementation, consistently modeling a passion for values alignment, patient focus, simplicity, and clarity across the organization.

Implementing operational strategy designed to improve performance of managed care model, building high performing teams across organization to include: capital improvements (revenue/costs), resourcing and staffing management, culture and talent development, operational excellence, quality programs, inventory management, IT team restructuring, comprehensive goals for performance and growth strategies, continuous process improvement, physical security, clinical operations, records management, workforce management and leadership development.

Oversight of Utilization Management, Claims Management, Case Management, Disease Management, HEDIS/Star Ratings, Meaningful Use, PQRS, Regulatory Compliance, OIG Work plan, application of Federal and State laws (DOH/DEA).

20 direct reports with over 1,000 indirect reports spanning all enterprise business units.

Direct oversight of $180 million-dollar P&L

ChenMed ò Miami Gardens, FL ò 2011 – 2018

Managing Director – Operations/Shared Services

Handle revenue cycle management of $650M annual claims processing, payment and revenue generation. Overseeing the quality, cost, reliability, and automation of encounter/claims billing leading a team of 30 resources serving 45 clinics nationally. Accountable for monitoring and closing submission gaps related to HEDIS and RAF scores. Manage all aspects of medical Credentialing, Provider Enrollment with Payers and Pharmacy Benefits Manager contracting. Oversee staff operations, business planning, and budget development. Ensure services follow professional regulations, bylaws, state and federal regulatory requirements. Lead transportation organization driving quality and targeted profitability on transportation projects, as well as assisting with managing staffing and resources to ensure patient experience is executed with a high level of efficiency and technical excellence.

Selected to drive the strategic direction and manage service team/customer service operations, ensuring superior patient experience and consistent performance increases of up to 30% in key performance indicators, including revenue, profitability, first-call resolution, service level, abandonment rate, and agent occupancy.

Championed lean operations techniques to billing process, reducing waste, cutting related costs by 7%, increasing yield, and increasing quality scores by 10% within the first 90 days.

Helmed implementation of a modified Agile Development Practice, including use of SCRUM Meetings; reduced

average project cost variance by 10% while maintaining on-time completion.

Restructured medical Credentialing/Payer Enrollment process flow, implementing improved tracking tools, reshaping team purpose highlighting the clinician experience, and establishing team goals/metrics for performance, leading to an 30% upsurge in average patient satisfaction scores.

Directed closure of HCC billing gaps achieving 98% match of CMS accepted HCC’s versus EDPS submissions.

Account Executive

Report to Chief Administrative Officer; manage end-to-end setup of local market and national level complex health plan and TPA contracts. Designed and controlled policies and procedures for health plan and TPA implementations. Formalized and maintained ownership of systems for ensuring compliance with the contract terms, laws, rules, regulations and accreditation requirements.

Chaired outstanding enterprise cross-functional teams that successfully onboarded and launched 14 Payers across 6 states in 2016-2017, representing a record-breaking $65M in new revenues.

Drove flawless execution regarding the development and maintenance of enterprise policies and procedures related to health plan and TPA implementations, including overseeing application of SOPs to ensure consistent implementation, working to standardize the forms and processes used throughout.

Organized extensive workflow sequences to enhance productivity by 38% across all metrics, driving an end-to-end mapping of stakeholders needs and interdependencies across organization.

Elevated a wide variety of vital operational efficiencies while simultaneously driving readiness to implement an additional 20 Payers for 2017 Annual Enrollment Period.

National Director Client Services/Market Operations

Report to Vice President Managed Services Organization and Affiliates, lead the enterprise operations multi-state expansion driving market growth and development, operational performance, relationship management, contractual compliance and provider adoption of value-based model of care. Managed utilization costs ($200M under management), medical loss ratios, Medicare risk adjustment, and HEDIS quality outcomes.

Chosen to execute a superlative managed service model across 4 states (FL, KY, LA and IL), successfully onboarding 125+ primary care physician practices managing 20K+ lives.

Operationalized multiple physician practice services model addressing crucial opportunities in clinical outcomes, technology enhancements, clinical case reviews, claims reviews, diagnostic services, encounter and claims billing, practice management, and risk management.

Controlled multiple physician practice acquisitions while using specialized software solutions, ensuring full data integration, training, practice management and staff integration.

Advanced implementation of multiple coordinated clinical care models under strict timelines and budget constraints, guiding independent physician practices to Global Risk Compensation.

Arise Virtual Solutions Inc. ò Miramar, FL ò 2010 – 2011

Senior Client Services Manager

Managed 400 virtual agents, with direct oversight of performance, service fees, and training. Handled client relationships, engaging with clients via strategic and operational reviews to evaluate client needs. Directed growth of existing client relationships, expanding contract and services rendered. Met gross profit margins and call volume targets.

Integrated best practices to generate a record-breaking $6M in annual revenue with a gross margin of 30% growing contractual services to seven applications.

Nation Safe Drivers ò Boca Raton, FL ò 2009 – 2010

Operations Manager

Directed national operations team, managing a portfolio of multiple outsourced partner call centers, including training, program launches, monitoring service levels and performance scorecards.

Streamlined complex servicing infrastructure and identified and implemented outsourcing efficiencies to fortify servicing infrastructure, resulting in an improved network which exceeded performance metrics by up to 40%.

American Express ò New York, FL ò 1994 – 2008

Manager, Operational Excellence

Oversaw operational efficiencies, managing multi-million-dollar outsourced vendor relationships of key processes gaining cost benefits. Led cross-functional team processing 45M payment representing $80 billion in receivables.

Designed and implemented a custom-tailored collection initiative yielding a pace-setting $53M over a two-year period, growing to a run rate of $40M per year.

Directed migration of Domestic and Latin American transaction processing to Canada resulting in $434K in reengineering saves; reengineered commodities material management yielding cost saves of $144K dollars.

Improved quality performance throughout outsourced vendor network thru process reviews and

improvement recommendations resulting in quality ratings of 5.54 Sigma or 26 DPMO against a goal of

5.35 Sigma or 60 DPMO.

Led application of Business Continuation Plans to safeguard processing of 860,000 payments

representing $684 million dollars in receivables.

Authored audit/compliance policies and procedures used in identifying $248M+ in lost recoveries.

Exposed $1.1M dollars of counterfeit check exposure.

Successfully implemented servicing infrastructure for new card launch; managing a portfolio of 10K

cards with $7M in monthly spend, overseeing all aspects of the external service delivery network.

Multiple roles of increased responsibility in the areas of legal, risk management, business process outsourcing, payment processing, new product launch and operational reviews.

Education

Manhattanville College – Bachelor of Arts, History

Honors: Study Abroad- St. Claire’s University Oxford, England

Certified John C. Maxwell Leadership: Coach, Trainer and Speaker

Additional Credentials

Technical Skills

Microsoft Office Suite / Salesforce

Languages

English, Spanish

Honors & Awards

Security Award – American Express

Professional Development

Professional Coach, Speaker and Leadership Tainer

Situational Leadership I &II

Six Sigma Green Belt Training

Negotiating with Suppliers

Project Management

Crucial Conversations

Conflict Resolution

Valuing Diversity- Inclusion

Lean Six Sigma

Scrum Agile Framework

Organizations

American College of Health Care Executives

Medical Group Management Association

Healthcare Information and Management Systems Society

Medicare Advantage Health Plan Colleagues

Harvard Business Review

Lean Six Sigma

On Startups- The Community for Entrepreneurs

Volunteering Experience

Junior Achievement / Adventist Development and Relief Agency / Volunteer Florida / Pembroke Pines SDA Mission Group / Mentorships

Interests

Mission trips, fitness, healthy eating/learning about nutrition, travel, experiencing new cultures, golf, Christian counseling (taking classes), family time, amusement parks and all types of church activities

Contact this candidate