Andrea L. Valk
Saugerties,NY
Summary
Team leader with 28 years of experience in Medicaid and Medicare managed care health plan management, programmatic and fiscal operations, New York State and CMS regulatory requirements, disease management, electronic health records, staff training, retail banking, property management, and excellent customer service. Proven excellence in strategic planning, collaborative initiatives, risk management, responding promptly to regulatory changes, and meeting stakeholder needs.
Overview
35
35
years of professional experience
5
5
Certifications
Work History
Executive Vice President of Government Relations and Corporate Planning
iCircle Services of the Finger Lakes, Inc.
Webster, USA
03.2022 - Current
- Led a multidisciplinary team to achieve approval of a Dual Eligible Special Needs Plan (D-SNP Medicare Advantage with Part D) by the Centers for Medicare and Medicaid Services (CMS).
- Submitted plan benefit package and plan bid (revenue and expense budget) to CMS annually.
- Successfully submitted all Medicaid Advantage Plus (MAP) Plan materials to the New York State Department of Health (NYSDOH).
- Trained all new staff on Marketing requirements.
- Configured Pharmacy Benefit structure with Pharmacy Benefit Manager (PBM) annually.
- Spearheaded selection of Medicare supplemental benefit options and maintained vendor contracts.
- Created and delivered staff training on Behavioral Health medications, interactions, and contraindications.
- Audited member records for Medicaid compliance.
- Established Policies and Procedures for existing and new lines of business.
- Established financial projections for new Medicaid line of business.
- Submitted Medicaid financial reports annually and quarterly (Managed Long Term Care Cost Report - MLTCCR, Value Based Payment Tracking Report - VBPTR, Medical Loss Ratio Report - MLR, Minimum Wage Reconciliation Cost Report - MWRCR).
- Fostered an ongoing relationship with the NYSDOH and CMS as an advocate and a liaison to achieve stakeholder goals.
- Precise implementation of industry initiatives while maintaining costs, improving member outcomes, and enhancing quality of care.
Vice President of Government Financial Relations and Corporate Planning
iCircle Services of the Finger Lakes, Inc.
Webster, USA
06.2020 - 03.2022
- Directed and implemented programmatic and fiscal activities for a Medicaid Managed Long Term Care Plan in a 30-county service area in upstate New York.
- Established Fiscal Policies and Procedures.
- Created financial projections for new Medicaid line of business in 14 counties.
- Submitted Medicaid financial reports annually and quarterly (Managed Long Term Care Cost Report - MLTCCR, Value Based Payment Tracking Report - VBPTR, Medical Loss Ratio Report - MLR, Minimum Wage Reconciliation Cost Report - MWRCR).
- Trained 160 staff on the requirements of Medicare Advantage and Medicaid Advantage Plus
- Led a Team in the pre-implementation processes for D-SNP Medicare Advantage and Medicaid Advantage Plus (MAP) lines of business.
- Interpretation of New York State Department of Health (DOH) contracts, regulations/regulatory requirements, and policy guidance.
- Spearheading process improvements with Quality and Care Management Teams to improve member outcomes.
- Responsible for the creation of the D-SNP MAP Marketing Plan.
- Cultivated relationships as a liaison with stakeholders in the Medicare and Medicaid Managed Care markets.
- Lead contact with our Pharmacy Benefit Manager (PBM), Over-The-Counter product vendor, and Behavioral Health vendor in the creation of business processes and in vendor contract negotiations.
- Responsible for maintaining Supplemental Benefits for our D-SNP MAP product.
- Responsible for submission of the MAP Member Handbook, Evidence of Coverage (EOC), and Summary of Benefits (SOB) documents to CMS and DOH annually, as well as other Marketing and Communications documents.
Government Affairs Analyst
iCircle Services of the Finger Lakes, Inc.
Webster, USA
02.2019 - 06.2020
- Performed programmatic and fiscal activities related to iCircle’s Managed Long Term Care (MLTC) line of business.
- Led a Team in Medicare Advantage D-SNP pre-implementation activities.
- Submitted Medicare application materials to CMS.
- Submitted Medicaid application materials to NYSDOH.
- Submitting a Plan Benefit Package to CMS annually.
- Vendor contracting activities and submission to NYSDOH.
- Revising Mainstream Medicaid Managed Care application materials and submitting them to the New York State Department of Health.
- Implementing a second-level review process for an MLTC plan Credentialing Department to ensure consistency of review, including Medicaid exclusion checks.
- Working with the Quality Team on review of cases involving Fair Hearings, resulting in process improvements and improved member outcomes.
- Acting as a liaison between the iCircle Care MLTC plan and the New York State Department of Health.
- Providing clarification to staff on regulatory requirements.
Director of Residential and Outpatient Programs/Supervising Budgeting Analyst
New York State Office of Mental Health
Albany, USA
01.2017 - 02.2019
- Team leader responsible for budgetary transactions totaling $800M annually for Adult Residential programs, including ESSHI, and managing spending plan transactions in a timely manner to fund these programs and supervising staff.
- Approved funding for supported housing, community residence, and apartment treatment beds.
- Administered activities within the Community Budget and Financial Management Group.
Associate Health Care Management Systems Analyst
New York State Department of Health
Albany, USA
04.2014 - 01.2017
- Analyzed Medicaid Managed Long Term Care Certificate of Authority Application materials.
- Performed vendor and provider contract review.
- Accomplished plan management activities and policy implementation for 30 Medicaid Managed Long Term Care Plans (MLTC, MAP, and PACE).
- Engineered solutions to health plan and provider concerns regarding service coverage and billing issues.
- Team leader for implementation of FIDA-IDD managed care demonstration for Individuals with Developmental Disabilities and Plan Manager for proposed DISCO (Developmental Disabilities Individual Support and Care Coordination Organization) plans.
- Managed a collaborative initiative between MLTC plans, Health Homes, and the Office of Mental Health to offer members with Serious Mental Illness (SMI) additional residential options in the community.
- Collaboratively drafted the NYSDOH Administrative Services Agreement (ASA) Template.
- Innovatively drafted the MLTC Care Management Policy requirements.
- Executed diverse project activities within the Office of Health Insurance Programs, Division of Long Term Care, Bureau of Managed Long Term Care
Senior Health Care Management Systems Analyst
New York State Department of Health
Albany, USA
08.2012 - 04.2014
- Analyzed Medicaid Managed Long Term Care Certificate of Authority application materials.
- Presented a housing initiative to all NYC MLTC plans.
- Reviewed provider and vendor contracts.
- Performed health plan management, policy implementation, and conflict resolution regarding health plan and provider concerns.
- Performed plan management functions within the Office of Health Insurance Programs, Division of Long Term Care, Bureau of Managed Long Term Care.
Business Systems Analyst
New York State Statewide Financial System
Albany, USA
02.2012 - 08.2012
- Responsible for making configuration changes in the Statewide Financial Accounting System, assisting agencies in troubleshooting financial transactions, and creating edits to be applied to transactions based upon agency specifications.
Senior Health Care Management Systems Analyst
New York State Department of Health
Albany, USA
05.2008 - 02.2012
- Responsible for determining the feasibility of financial projections for new Medicaid Managed Long Term Care (MLTC) plans and existing plans looking to expand their current lines of business.
- Responsible for fiscal analysis of health plan and provider contracts for MLTC plans.
- Analysis of Managed Long Term Care Medicaid Managed Care Operating Reports (MLTC MMCORs) submitted by health plans (Annual and Quarterly) and follow-up inquiries to plans regarding the accuracy of data submitted.
- Also responsible for reviewing MAP MMCORs and PACE MMCORs.
- Responsible for formula testing, edits, and retesting in the MLTC MMCOR and MAP MMCOR Software on a quarterly and annual basis.
- Also responsible for updating the MLTC MMCOR and MAP MMCOR filing instructions quarterly and annually.
- Annual and quarterly review of cost report data including premium revenue review and reconciliation, administrative expenses, and care management costs.
- Communication of rate information to MLTC plans and responding to health plan inquiries regarding implementation of risk-adjusted rates.
- Calculation of retroactive rate adjustments for Health Recruitment and Retention (HR&R).
- Conducted software testing and formula changes.
- Provided recommendations for improvement of program structure.
- Created customized financial reports based on management requests.
- Extracted financial data from NYS databases for analysis.
- Comparison of data between multiple databases/data sources for accuracy.
- Participated in Public Management Intern (PMI) Program from 2008 to 2010.
- Administered activities within the Office of Health Insurance Programs, Division of Long Term Care, Bureau of Managed Care Financing.
Project Coordinator
New York State Department of Health
Delmar, USA
04.2008 - 05.2008
- Responsible for conducting research pertaining to an SSI grant study and for reviewing and processing Adult Care Facility Certificate of Need and Assisted Living applications, RFA application reviews, and calculation of Adult Home bed need based upon demographic information.
- Performed activities based in the Office of Long Term Care, Division of Home and Community Based Services, Bureau of Licensure and Certification.
Project Manager
New York State Department of Health
Delmar, USA
05.2005 - 04.2008
- Responsible for reviewing and processing Adult Care Facility (Adult Home and Enriched Housing Program) Certificate of Need and Assisted Living applications, participating in the administration and reconciliation of the 2005-2006 and 2003-2004 Quality Incentive Payment Program ($2.75M New York State Grant Program), RFA application reviews, and calculation of Adult Home and Assisted Living Program bed need based upon demographic information.
- Performed activities based in the Office of Long Term Care, Division of Home and Community Based Services, Bureau of Licensure and Certification.
Training Specialist
MedAllies
Wappingers Falls, USA
06.2004 - 05.2005
- Responsible for installation of the MedAllies clinical messaging, e-prescribing, and Electronic Medical Record systems in physician offices, providing computer training and support to physicians and staff, troubleshooting PC problems, Help Desk activities, creating HIPAA policy, researching Healthcare Information Technology advancements and vendor features through healthcare journals and other resources, meeting with vendor representatives, evaluating the utility of products, and making recommendations to key project stakeholders.
Rental Consultant
Tri City Rentals
Troy/Albany, USA
04.2002 - 06.2004
- Responsible for apartment rentals/sales, office management functions, property management functions, preparing rental contracts/leasing, scheduling maintenance tasks and repairs, and resolving tenant issues.
Retail Trainer
Charter One Bank
Albany, USA
12.2001 - 04.2002
- Responsible for training Bank Tellers on customer service, daily operations, policies, regulations, and all computer software functions.
Program Assistant
Northeast Health Diabetes Center/Diabetes Dimensions
Albany, USA
03.1999 - 11.2001
- Administration of a Disease Management Program. This was a collaborative program between a Hospital-Based Health System (Northeast Health) and an HMO (CDPHP).
- Organization of community events to increase patient awareness and to generate patient referrals for diabetes education to improve patient outcomes.
- Created patient reference materials and PowerPoint presentations.
- Performed manual chart reviews to collect data on diabetes self-management, lab values, and comorbidity.
- Database creation, analysis, and reporting – Prepared periodic reports based on data collected and recorded in a customized patient database.
- Marketing plan creation and implementation.
- Financial analysis and departmental budgeting.
- Hiring and management of multiple staff members.
- Contract negotiations, interpretation, and administration.
- Department of Health Grants – Responsible for submitting RFA applications, budgets, and other grant materials.
- Responsible for identifying billing/coding issues and assisting billing staff with resubmission of claims, as appropriate.
Customer Service Representative
Kaiser Permanente
Latham, USA
06.1998 - 03.1999
- Responsible for analyzing contract terms, claim payments & benefit information, appeals, enrollment, referrals, and provider affiliation and resolving customer concerns in these areas.
Bank Teller
Catskill Savings Bank
Catskill, USA
09.1997 - 05.1998
- Responsible for processing customer transactions and providing excellent customer service.
Bank Teller
Greene County Savings Bank
Catskill, USA
05.1997 - 09.1997
- Responsible for processing customer transactions and providing excellent customer service.
Floating Bank Teller
KeyBank/KeyCorp
Tannersville, USA
05.1996 - 09.1996
- Responsible for processing customer transactions and providing excellent customer service daily among four bank locations based on staffing need (Tannersville, Windham, Phoenicia, and West Hurley).
Substitute Teacher/Substitute Teaching Assistant
Hunter-Tannersville Central School
Hunter, USA
06.1994 - 05.1996
- Responsible for performing Substitute Elementary Teacher and Substitute Teaching Assistant Functions, including classroom instruction, test administration, one-on-one special needs education, and music lessons.
Cashier
A&P/The Great Atlantic & Pacific Tea Company
Tannersville, USA
05.1991 - 09.1994
- Responsibilities included cashier, customer service, office tasks (i.e., rainchecks, complaints), audit functions/internal control processes, monitoring for shrink, tracking inventory and ordering new stock, and stocking shelves in the areas of dairy, grocery, Health and Beauty Aids, and frozen foods.
Education
Master’s - Business Administration (MBA)
University at Albany
Albany, NY05-2001
Bachelor’s - Economics, Minor in Business Administration
University at Albany
Albany, NY05-1997
Associate’s - Business Administration
Columbia-Greene Community College
Hudson, NY05-1995
Skills
- Team Leadership
- Project Management
- Government Relations
- Strategic Planning
- Financial Analysis
- Contract Negotiation
- Vendor Management
- Regulatory Compliance
- Policy Writing
- Operations Management
- Problem Solving
- Staff Training
- Financial Reporting
- Financial Projections
- Healthcare Management
- Stakeholder Engagement
- Quality Improvement
- Conflict Resolution
- Data Analysis
- Strategic Partnerships
- Process Improvement
- Customer Service
- Creative Thinking
- Ethics and Integrity
- Medicare Advantage
- Medicaid
Computer Expertise
- Microsoft Office (Excel, Access, Word, PowerPoint, Visio)
- SharePoint
- Health Commerce System (HCS)
- Health Plan Management System (HPMS)
- Uniform Assessment System (UAS)
- eMedNY
- BI Query
- Medicaid Data Warehouse
Activities
- Pet Rescue Advocate
- Member of Delta Sigma Pi Professional Business Fraternity
- Member of Phi Theta Kappa National Honor Society
- Junior Achievement Program to educate elementary school students about the business world
Certification
Journey Team Leadership Training - Level Five Associates, Melbourne, FL, 2024 to Present.
Timeline
Executive Vice President of Government Relations and Corporate Planning
iCircle Services of the Finger Lakes, Inc.
03.2022 - Current
Vice President of Government Financial Relations and Corporate Planning
iCircle Services of the Finger Lakes, Inc.
06.2020 - 03.2022
Government Affairs Analyst
iCircle Services of the Finger Lakes, Inc.
02.2019 - 06.2020
Director of Residential and Outpatient Programs/Supervising Budgeting Analyst
New York State Office of Mental Health
01.2017 - 02.2019
Associate Health Care Management Systems Analyst
New York State Department of Health
04.2014 - 01.2017
Senior Health Care Management Systems Analyst
New York State Department of Health
08.2012 - 04.2014
Business Systems Analyst
New York State Statewide Financial System
02.2012 - 08.2012
Senior Health Care Management Systems Analyst
New York State Department of Health
05.2008 - 02.2012
Project Coordinator
New York State Department of Health
04.2008 - 05.2008
Project Manager
New York State Department of Health
05.2005 - 04.2008
Training Specialist
MedAllies
06.2004 - 05.2005
Rental Consultant
Tri City Rentals
04.2002 - 06.2004
Retail Trainer
Charter One Bank
12.2001 - 04.2002
Program Assistant
Northeast Health Diabetes Center/Diabetes Dimensions
03.1999 - 11.2001
Customer Service Representative
Kaiser Permanente
06.1998 - 03.1999
Bank Teller
Catskill Savings Bank
09.1997 - 05.1998
Bank Teller
Greene County Savings Bank
05.1997 - 09.1997
Floating Bank Teller
KeyBank/KeyCorp
05.1996 - 09.1996
Substitute Teacher/Substitute Teaching Assistant
Hunter-Tannersville Central School
06.1994 - 05.1996
Cashier
A&P/The Great Atlantic & Pacific Tea Company
05.1991 - 09.1994
Master’s - Business Administration (MBA)
University at Albany
Bachelor’s - Economics, Minor in Business Administration
University at Albany
Associate’s - Business Administration
Columbia-Greene Community College