J E N N I F E R L E W I S

1230 Thornapple Way, Troy OH 45373937-573-7216

Jllewis536@yahoo.com

PROFESSIONAL STATEMENT

My goal is to provide leadership and strategic direction within a highly motivated and innovative healthcare organization. I strive to provide excellent service to both internal and external customers.

EXPERIENCE

2007 – 2016 CareSource Dayton, OH2015-March 2016Director, Health Partner Resources Responsible for corporate leadership and development of the following:

Find A Doc and Provider Directories Corporate Provider Engagement Strategy and implementation to include

measurement/reporting of Market performance Develop, review and approval of all Provider Communications to ensure

consistency, training and delivery in the Markets Process Improvement of the End-to-End Provider Lifecycle, implementing

quality audit program and automation of existing processes Leader of the Provider Portal, innovating online tools to be simplified and

useable to our Provider partners2013 -- 2015Director, Business Development and Integration Responsible for strategic direction of business development opportunities focusing

on the following areas: Provider Network Development Value Based Reimbursement Contracting Provider Relations Sales and Marketing Online Presence – Member/Provider Portals as well as www.caresource.com

Responsible for development of Provider Networks to support Certificate of Authority (COA) approvals in all new markets. Complete COA provider network build requirements necessary to obtain Health Insurance licensures in Georgia, Indiana, Kentucky and West Virginia.

Lead contributor and writer for responding to Request for Proposals (RFP), to include multiple states and product lines, on behalf of CareSource; this includes development of adequate Provider Networks to maximize provider network points in all submissions.

Responsible for key elements in the RFP which contributed to CareSource being awarded the Georgia Families procurement. Led the development of a state-wide provider network (letters of intent)

completed in less than 90 days, with no existing relationships in the State of Georgia.

Implemented a Medicare/Medicaid Duals Demonstration project, MyCare Ohio. Responsible for developing and contracting with a network of traditional and

non-traditional provider types to include value based reimbursement models to support quality based reimbursement

Implemented enrollment processes between CareSource, Medicare and Medicaid as well as all customer service operations

Developed initial Just4Me – Marketplace product in multiple states (OH, IN, KY, WV) as well as multiple market expansions.

Led network development activities to ensure an adequate network as well as implementing the Just4Me online presence to include integration of online billing and invoicing (new functionality).

Responsible from the Qualified Health Plan (QHP) filing through implementation and warranty.

Implementing Medicare Advantage (MA) product in our Indiana and Kentucky Markets.

Responsible for all Sales and Marketing deliverable, to ensure compliance with CMS regulations; including all online presence elements. Managed the development of adequate Provider Networks in both Markets. Led MA implementation from filing through implementation and warranty. Created and implemented contracting models to support value based

reimbursement2007 -- 2013Director, Contracting and Network Development Network Development lead in building and maintaining quality networks to

support the following products and expansion opportunities: Ohio Medicaid – statewide expansion in 2007, ABD NE expansion in 2010, 3

region statewide rebid in 2012 CMS Special Needs Plan -- initial award in 2007 with expansion awards in

2009, 2010 and Statewide award in 2011 MyCare Ohio (ICDS) Demonstration award in 2012 CareSource Just4Me – initial award in summer 2013 for the Ohio Health

Marketplace Development and Implementation Network Strategy for all CareSource regions

and products allowing for expansion into new regions as well as new products in existing regions, renegotiations in existing regions to support corporate reduction of medical loss ratio, design and implementation of quality incentive plans to support the triple aim.

Responsible for multistate hospital, provider and ancillary contracting to facilitate optimal member access, successful business growth initiatives and sound plan financial performance as it relates to unit pricing. Over the past four years have netted an average annual savings of $10M in renegotiation efforts

Participate and develop innovative payment methodologies. Implementing the following:

Value Based Reimbursement Models HEDIS Quality Outcomes Incentives Global Payments for Specialists (in development) Health Care Home Pilot Program PCP Quality Enhancement Program

Develop contracting strategy and program on an annual basis and monitor key metrics for access and staff performance to ensure a high level of network adequacy, professionalism and staff performance

Responsible for robust provider competitive analysis, as well as for an aggressive recruitment program to include the development and facilitation of quarterly reports

Provide superior customer service to both internal and external customers by developing clear, consistent, measurable service goals to include; increasing the number of physician’s sites contacted to impact and increase provider satisfaction and compliance with CareSource quality initiatives, increase education and service initiatives, and develop training, evaluations and development of Provider Relations team

Management of the Provider Data Integrity team; ensure high level of accuracy of provider data in all appropriate databases and provider entry systems. Standardize database management function across plans and provide consistent and overarching CareSource approach to data maintenance.

Strategic lead on innovative solutions to minimize manual entry, consolidation of systems that require provider data entry and process improvement initiatives to maintain a lean department with high quality and productive measures. Have effectively implemented tools to maintain an ACR of less that 5% while developing and implementing new lines of business.

Ensure day-to-day operations of the department function correctly to include; maintaining appropriate staffing levels, development and refinement of CareSource Provider Services Model to include management of the Provider Business Process Management Program

Ensure Network complies with all regulatory requirements as well as with all CareSource mandated polices and procedures to include; appropriate member access to services ands well as monitoring provider performance, to ensure behavior of providers is in accordance to CareSource goals and objectives, regulatory and accrediting and contractual requirements

Maintain cost efficient and effective budget.

2001 - 2007 Summit Insurance Company Troy, OHManager, Network Management

1997 - 2001 Alliance Blue Cross Blue Shield St. Louis, MOProvider Relations Representative

EDUCATION

2005 – 2007 Bluffton University Bluffton, OH Masters in Business Administration

1994 – 1997 Ohio University Athens, OH Bachelor of Science Majoring in Health Services Administration, Minor in Business Administration

INTERESTS

2004 – Present Healthcare Financial Management Association Member

2001 – Present Academy for Healthcare Management (PAHM) Member

2005 – 2008 Hospice of Miami County Board of Trustees Member

2012 – Present Big Brothers Big Sister of Greater Miami Valley, Board of Directors

2012 – Present HPIO Access Collaborative Committee Member

2012 – Present PAC Committee Member

2013-2014 Chairperson, Troy Strawberry Festival Children’s Parade