Andrew K. Keenan
Columbia,MD
Summary
Accomplished Health Insurance Specialist with a proven track record at the Department of Health and Human Service, showcasing expertise in policy analysis and healthcare. Spearheaded initiatives saving over $1 million, demonstrating exceptional problem-solving and effective communication skills. Proficient in SAS Data Analysis and adept at translating complex regulations into actionable strategies.
Overview
28
28
years of professional experience
Work History
Health Insurance Specialist
Department of Health and Human Service / Centers for Medicare and Medicaid Services / Center for Medicare/ Performance-Based Payment Policy Group (P3)
Woodlawn, MD
04.2018 - Current
- Implement and improve the performance-based payment policy for the Medicare Accountable Care Organization (ACO) Shared Savings Program (SSP).
- Serves as COR (III) for the ACO Program Analysis and Operational Support Contractor.
- Proposed and implemented savings initiatives that resulted in over 1 million dollars in reduced contractor costs.
- Served as COR (III) to develop and award CMS's Hospital Price Transparency Compliance Contract.
- Lead Coordinator between the Shared Savings Program and the Center for Medicare and Medicaid Innovation's financial, provider, and beneficiary overlaps.
- Operations Lead for Repayment of Losses.
- Supports the evaluation of, and communication with, ACOs in need of technical financial assistance.
- Author of rule-making and policy-development sections for voluntary alignment and overlaps policies.
Health Insurance Specialist
Department of Health and Human Service / Centers for Medicare and Medicaid Services / Center for Medicare and Medicaid Innovation/ Business Services Group (BSG)
Woodlawn, MD
01.2015 - 04.2018
- Served as COR (III) for Innovation Payment Contract which the Center uses to process non claims based and alternative payments across a variety of innovative Medicare models
- The Program contractor has processed over 6500 provider payments totaling over 500 million dollars as well as 200,000 payments to individual beneficiaries
- Served as original Co-author of project SOW and authored modification rewrites
- Served as Chair of Technical Evaluation Panel for initial award and subsequent modifications
- Served as Contracting Officer's Representative (COR III certification) on CMMI and OCRO Risk Assessment/Operational Analysis and Enterprise Risk Management (ERM) contract
- Responsible for edited and revised Acquisition and Budget SOPs and A-123 Audit Controls
- Integrated with other contracts to develop risk assessment and management trainings across CMS
Health Insurance Specialist
Department of Health and Human Service / Centers for Medicare and Medicaid Services / Center for Medicare and Medicaid Innovation/ Planning and Programs (PPG)
Woodlawn, MD
05.2013 - 01.2015
- Developed templates and instructions for financial reviews of Health Care Innovation Awards Round 2 (HCIA2) applicants
- GTL for MITRE financial and actuarial review contract for HCIA2
- Served as secondary financial reviewer for HCIA2 applications
- Member of the Health Plan Innovation steering committee
- Member of the Portfolio Management Committee
- Incumbent lead for development of innovative ideas intake module and process
- Development-lead for Center-Wide Portfolio Tracker in coordination with a large scale center wide program data review platform
- Contracting Officer's Representative for Lewin HCIA 1 and 2 evaluation contract
Health Insurance Specialist
Department of Health and Human Service / Centers for Medicare and Medicaid Services / Center for Medicare / Medicare Plan Payment Group (MPPG)
Woodlawn, MD
09.2010 - 05.2013
- Perform analysis on the impacts of policy on payment to Medicare Advantage and Prescription Drug Plans
- Serves as technical lead around many Part C and D policy implementations and reviews, developing guidance and communications (written, in-person, and at the group conference level) out to both industry and internal, non MPPG, government parties
- Review and evaluate Medicare Part D bidding and provide analysis and review to management
- Directed multi divisional team responsible for the monitoring, reviewing and analyzing of Direct and Indirect Remuneration (DIR) plan submissions to ensure compliance with existing policy
- Crafting and clarifying guidance for Part D policy, most notably in the area of DIR and Low Income Subsidy
- Perform ad-hoc Medicare C and D reporting and analysis through the use of various platforms including but not limited to; Access, Excel, and SAS
- Served as Government Task Lead on the division sponsored study on the impact of Electronic Medical Records (EMR) on Risk Adjustment
- Performed special analysis of the Financial Alignment Demonstration (Duals), Employer Group Health Plan Payments, and expansion of Special Needs Plans (SNPs)
- Task Lead for IBM risk adjustment Medicare Advantage payment process with responsibility for the accurate and timely processing of Part C and Part D payment runs, reruns, and adjustments
- Responsible for the documenting and resolution of retroactive payment corrections
- Task lead (GTL) and COR for the Research Triangle Institute (RTI) risk adjustment modeling and federal health exchange risk adjustment (with CCIIO) contract
Consulting Underwriter
Coventry Health
Columbia, MD
04.2009 - 09.2010
- Rate and generate pricing for all Medicare coordinated care plans throughout the Coventry national network
- Maintain compliance with CMS program and pricing guidelines while utilizing individual market and community factors to find best plan/ price solutions available for an array of government subsidized (Medicare) retiree plans
- Work closely with both sales/marketing and actuarial to ensure that client and corporate needs are met
- Assisted with Large and small group underwriting and audit of Delaware and Maryland commercial plans
- Developed the operational platform and performed the 2010 Coventry MD/DE Small Group audit
Senior Product Financial Analyst
Americhoice (UHG company)
Vienna, VA
03.2008 - 04.2009
- Define and implement process for bank account adjudication as a component of the Healthy Indiana Insurance Product
- Reconcile complex real and notional account transactions (claims and contributions) from multiple sources to provide accurate reporting to membership and to the State of Indiana
- Management of error logs reconciliation and data analysis for ad hoc requests and interim solutions
- Maintain compliance with State Medicaid guidelines
HSA Operations Analyst / BA III
Lumenos, Inc. (Wellpoint/Anthem)
Alexandria, VA
07.2005 - 03.2008
- Provide support, analysis, and reconciliation of Health Savings Accounts (HSA)
- Develop strategies and outline requirements for managing the intricacies of new health insurance products
- Implement HSA plans for large self insured employers and facilitate relationship between clients and our banking partner
- Work includes the expansion of consumer driven healthcare initiatives into different and varied client groups
Senior Data Analyst
Optima Direct
Vienna, VA
11.2001 - 07.2005
- Oversee large volumes of sensitive financial data processing and verification programming
- Main areas of focus include the use of SQL Server and FoxPro to verify data integrity, run existing reporting tools and to generate ad-hoc reports as needed
- Other responsibilities include providing data supervision and quality control for a network of sub-vendors as well as problem identification, pattern mapping, and error
Consultant
Hummingbird, Inc.
Washington, DC
08.2000 - 11.2001
- Design and maintenance of LawPack (legal case management system) databases for wide array of government and private clients (DOJ, SEC, US Army, etc…)
- Extensive use of Oracle 7.3 and 8i as well as SQL Server 6.5 and 7 databases to store LawPack data as well as data manipulation using LawPack's front end toolkit, built in Powerbuilder
- Performed limited DBA tasks for our in house Oracle and SQL Server databases
Financial Analyst
Trammell Crow
Washington, DC
11.1999 - 08.2000
- Develop database (TransTrak) for tracking real estate transactions from inception to close
- System required MSAccess 2000, functional understanding of VBA, and a working knowledge of the real estate transaction process and procedure
- Other duties included maintenance of Strategen (Lease Management) database, generating reports in Strategen and custom data analysis and reporting through MSAccess
Project Assistant
American College of Preventive Medicine
Washington, DC
03.1999 - 11.1999
- Perform day-to-day tasks associated with managing the needs of a large membership organization
- Duties include tracking membership requests and payments, coordinating the enrollment of members, managing large amounts of data using MSAccess and MSExcel, performing office administrative tasks, ACPM Web page maintenance, and assisting on grant projects, notably Mt
- Sinai Children's Environmental Health Grant
Enrollment Coordinator
Health Services for Children with Special Needs, Inc.
Washington, DC
03.1997 - 03.1999
- Coordination of enrollment of potential members and disenrollment of members from a DC special needs managed care organization
- Research Medicaid case histories for members and potential members through the DC Human Services ACEDS database and other resources, both automated and human
- Maintenance of HSCSN enrollment databases
- (Access databases and Excel spreadsheets)
- Disposition, dissemination, and interpretation of reports generated from aforementioned information archives
Education
Value Issues in Public Policy, Management and Organizational Behavior
Georgetown University
Washington, DC01.2008
B.A. - Sociology
American University
Washington, DC01.1996
Skills
- Contracting Officer Representative, Level III (COR III)
- Healthcare
- Health insurance
- Proficient in Microsoft Office
- SAS Data Analysis
- Policy analysis
- Effective Written Communication
- Strong oral communication skills
- Quantitative Analysis Expertise
- Problem Diagnosis
- Concise Problem Solving
References
Available on Request
Timeline
Health Insurance Specialist
Department of Health and Human Service / Centers for Medicare and Medicaid Services / Center for Medicare/ Performance-Based Payment Policy Group (P3)
04.2018 - Current
Health Insurance Specialist
Department of Health and Human Service / Centers for Medicare and Medicaid Services / Center for Medicare and Medicaid Innovation/ Business Services Group (BSG)
01.2015 - 04.2018
Health Insurance Specialist
Department of Health and Human Service / Centers for Medicare and Medicaid Services / Center for Medicare and Medicaid Innovation/ Planning and Programs (PPG)
05.2013 - 01.2015
Health Insurance Specialist
Department of Health and Human Service / Centers for Medicare and Medicaid Services / Center for Medicare / Medicare Plan Payment Group (MPPG)
09.2010 - 05.2013
Consulting Underwriter
Coventry Health
04.2009 - 09.2010
Senior Product Financial Analyst
Americhoice (UHG company)
03.2008 - 04.2009
HSA Operations Analyst / BA III
Lumenos, Inc. (Wellpoint/Anthem)
07.2005 - 03.2008
Senior Data Analyst
Optima Direct
11.2001 - 07.2005
Consultant
Hummingbird, Inc.
08.2000 - 11.2001
Financial Analyst
Trammell Crow
11.1999 - 08.2000
Project Assistant
American College of Preventive Medicine
03.1999 - 11.1999
Enrollment Coordinator
Health Services for Children with Special Needs, Inc.
03.1997 - 03.1999
Value Issues in Public Policy, Management and Organizational Behavior
Georgetown University
B.A. - Sociology
American University
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