Teams at Healthfirst, Inc

Provide analytical support to Medicaid Product Strategy: build reports and forecasts, analyze financial and membership trends, create recommendations, maintain competitive and ad-hoc reporting, and develop models using Excel, Tableau, SQL/SAS. Collaborate cross-functionally and manage projects to support profitable market growth.

Lead strategy and operations for provider payment configuration, ensuring accurate reimbursement rates, benefits configuration, provider onboarding, credentialing, and provider database maintenance. Oversee testing, controls, regulatory compliance, and cross-functional alignment. Build and manage a team, improve provider payment experience, and support stakeholder requirements and audits.

Lead and mature a claim configuration quality audit function to validate provider reimbursement accuracy and compliance. Develop risk-based audit plans, testing methodology, analytics strategy, reporting, and remediation governance. Manage analysts, oversee audits and data analysis, quantify financial impact, present findings to leadership, and drive control and process improvements across claims, provider configuration, and payment validation.