Elizabeth Keeney Reyes
Orange Park
Summary
Healthcare industry professional, with over fifteen (15) years of combined experience; holding a remarkable understanding of managed healthcare organizations; extensive experience in management, research, legal document preparation and processing, provider healthcare network administration, product innovation, strategic planning and development, stakeholder engagement, operational leadership and process improvement; excellent communication, organizational, investigative, management and analytical skills; offering a broad array of services in drafting, reviewing and processing documents and assistance with the prosperous administration, operation and management of the healthcare provider network; unequivocal drive to achieve results that increase company profitability.
Overview
10
10
years of professional experience
6030
6030
years of post-secondary education
Work History
Staff Vice President of Provider Digital Tools, Strategy and Enablement/Health Solutions Team
Elevance Health
12.2022 - Current
- Lead enterprise strategy, governance, and execution for provider digital tools and EDI infrastructure, including Availity Gateway and Provider Portal, supporting all EDI transactions (claims, eligibility, authorizations, enrollment, remittance, attachments, and data exchange) across Elevance Health.
- Define and execute value-stream strategies to redesign and modernize end-to-end provider and stakeholder journeys, improving digital adoption, transaction quality, and operational efficiency at national scale.
- Drive enterprise-level strategic initiatives aligned to Elevance priorities, market growth, and provider experience, while challenging legacy operating models and advancing digital-first enablement.
- Serve as a senior strategic advisor and thought partner to SVPs and executive leadership across provider enablement, digital strategy, EDI, claims quality, and interoperability.
- Lead financial and vendor governance across an approximately $60M cost center, achieving sustained cost discipline with no negative variance through contract optimization and performance management.
- Oversee enterprise EDI and provider digital operations processing ~4.5B transactions annually, with sustained year-over-year growth managed through scalable platforms, automation, and disciplined operational controls.
- Lead enterprise EDI and data partnership strategy to improve claims in good order and right-first-time submissions, reducing rework, appeals, adjustments, and downstream operational friction.
- Champion front-door integrity through standardized EDI rulesets, pre-adjudication checks, and digitally enforced requirements embedded across provider workflows.
- Partner with medical policy, clinical, SIU, network, provider engagement, technology, and clearinghouse teams to design upstream interventions that reduce avoidable errors and payment leakage.
- Influence platform enhancements and enterprise data strategy to enable higher first-pass accuracy, scalable automation, and improved transaction outcomes.
- Own vendor ecosystem strategy for provider digital tools and EDI, including strategic sourcing, contract governance, performance management, and integration models.
- Evaluate and onboard emerging and tech-forward partners (EDI, automation, analytics, AI/RPA, platform innovators) to modernize provider and operational capabilities.
- Establish shared-risk models, performance guarantees, and ROI-driven value structures aligned to accuracy, avoidance, and operational efficiency.
- Oversee platform migrations and modernization initiatives across subsidiaries, ensuring journey redesign is aligned to future-state capabilities rather than current-state replication.
- Define future-state platform capabilities, readiness plans, migration playbooks, phased rollouts, and capability mapping to drive consistency, reuse, and enterprise value capture.
- Lead enterprise portfolio management, serving as executive sponsor accountable for funding, prioritization, delivery, and value realization of strategic initiatives.
- Direct daily operational management and end-to-end issue resolution across internal teams and external vendors supporting provider digital and EDI operations.
- Develop and execute strategic operating plans, governance models, policies, and procedures that optimize scalability, resiliency, compliance, and cost control.
- Capture, prioritize, and deliver digital improvement opportunities tied to measurable enterprise outcomes, including claims accuracy uplift, administrative cost reduction, provider satisfaction, employee productivity, and hard-dollar value capture.
- Lead provider digital adoption strategy, accelerating self-service usage and reducing reliance on manual, phone, and paper-based workflows.
- Led negotiation and execution of a $330M, 5-year strategic renewal with Availity, securing ~$27.5M in credits, limiting cost growth (~14% vs. >25% proposed), and introducing risk-sharing protections covering up to 35% of contract value.
- Structured innovative commercial model with provider workflow vendor generating $1M+ annual value (50% net new revenue)—a first-of-its-kind agreement with no vendor payout and direct revenue stream to Elevance.
- Drove operational efficiency through digital workflow transformation, increasing touchless prior authorization processing by 40%+ across pilot providers.
- Selected to represent Elevance Health on the Workgroup for Electronic Data Interchange (WEDI) Board, contributing to industry-wide healthcare data standards and policy discussions.
Process Improvement Director/Anthem Business Excellence Team (ABX)
Anthem Inc
08.2021 - 12.2022
- Created and executed multiple Lean Six Sigma methodologies such as DMAIC (Define-Measure-Analyze-Improve-Control), Project Charter, RACI (Responsible-Accountable-Consulted-Informed), Data Collection Plans, Project Plans, FMEA (Failure Mode and Effects Analysis), Gemba walks, financial savings analysis (Annual Revenue/AR), statistical data analysis.
- Led one of the largest initiatives in ABX History: Matching Attachments. Claims are being denied due to missing provider attachments. This problem impacted over ~$1.7b dollars in claims benefits paid and constitutes a major portion of our Denied Then Paid (DTP) overall claims issue.
- Met with over 250 subject matter experts, leads and business partners to deep dive into the claims attachment process and identified over 140 pain points and 85 solutions that are in full execution.
- Reduced the average turnaround time of DTP claims (related to attachments), increased the match rate of attachments to claims. Assisted in the reduction of provider abrasion (non-par term analysis of UC Health alone shows 165m). Assisted in the reduction of penalty pay associated with DTP: Attachments (analysis from Claims Ops shows an annual prompt pay of ~5m).
- In terms of savings for Matching Attachments: Benefit forecast is $10.5m for 2022, $6.9m for 2023 and $11.9m for 2024.
- Led process improvement efforts for Anthem Business Data Operations Team (APDO): The data loading and error correction processes used to ensure accurate provider data contribute to slow updates, incomplete data, rework, increased costs, provider and member abrasion.
- Identified Key Performance Indexes (KPIs), mapped out existing processes, identified gaps and created the following for future state: Mass Org Structure, (Best Practices), Roles and Responsibilities, Scorecards, Issue Resolution Escalation Path, coordinated system training for existing employees (SPS, PLM, MACESS, Jira), formed SWAT for burndown of aging items in Escalations, and created requirements document for data change submissions.
- In terms of savings for APDO Initiative: Benefit forecast is 4.62m for 2022, 18.5m for 2023, 18.5m for 2024.
Associate Director/Director Contract Lifecycle Management Solutions
UnitedHealthcare
03.2020 - 08.2021
- Primary point of contact for executive level escalations to determine root cause and implement effective future prevention initiatives.
- Utilize data driven fact-based analysis to determine root cause and deliver operational efficiency process improvements that enhance the provider experience while simplifying the day-to-day process for UnitedHealthcare Network Management and Benefit Operations organization.
- Managed root cause and collaboration activities while developing staff of Business Analysts.
- Identified trending issues observed by key stakeholders or through proactive data analysis to deep dive into the issues observed and to understand driving factors.
- Program liaison for new contracting application migration from Emptoris to Contract Lifecycle Management (CLM).
- Developed and Directed the CLM Solutions Team responsible for CLM User, contract author and post contract migrations system support. The team collaborates closely with our Provider Operations partners and Contracting Teams to drive root cause, solutions and process improvements pertaining to the use of the CLM and CMD (Contract Management Database) Tools. If a user identifies an issue with the tools, a Helpdesk Ticket (HDT) via ServiceNow is submitted and triaged by CLM Solutions for resolution.
- Developed and maintained robust daily, monthly, and annual executive reporting (includes extensive data mining).
- Created the CLM Incident Intake Tool in conjunction with our Optum Tech partners (in response to process and efficiency gaps within the user space).
- Created and managed Team SharePoint (in addition to assisting other teams under the organization develop theirs).
- Created and managed the Organizations Communication Channel responsible for mass communications to product users’ enterprise wide (CLM, CMD, ServiceNow, Incident Intake Tool).
- Responsible for overseeing system/product defects, partnering with multiple sectors under the Organization to ensure resolution.
- Came into the program with a goal to build out the CLM Solutions Team (User Support/Program Postproduction space) and succeeded.
- In 4 months, statistically increased the closure rate of HelpDesk Tickets over 400% while the intake rate rose to over 300%.
- Found major process gaps that were causing the ticket submissions to rise drastically and successfully decreased the total monthly average submission rate by 50%.
- Built multiple processes, developed documentation such as Standard Operation Procedures, Process Flows, Staffing Proposals, Cost Based Analysis (related to budget costs, workforce management and hiring governance) and Project Plans to gain efficiency within the Post-Production space.
- Expanded the CLM Solutions Team from 1 FTE (fulltime employee) to 7.
- Successfully brought CLM Solutions to steady state.
Network Program/Product Manager Network Enablement & Analytics Team
UnitedHealthcare
03.2020 - 07.2020
- Managed internal and external adoption of Point of Care Assist (POCA) an Application Programming Interface that integrates patients UnitedHealthcare health and benefits data within the Electronic Health Record (EMR) to provide near real-time insights on care needs.
- Managed internal and external adoption of UHC Insights program, a real-time data tool which integrates aggregated health systems claims, clinical, service and performance data for Network engagement.
- Managed root cause and collaboration activities while developing staff of Business Analysts.
Creator and Interim Director of the Veterans’ Data Assurance Representatives (VDAR)
UnitedHealthcare
07.2019 - 03.2020
- Partnered with Optum Serve to develop a program for the new Veterans Affairs Community Care Network (VA CCN) to meet the requirements and quality targets relative to provider data in the VA Referral Database.
- Created an end-to-end, closed loop remediation process that ensures accurate data reporting and improves provider and member experience.
- Responsible for training and development of all 50 plus employees under VDAR.
- Coordinated Deltek training for team and saw through to completion.
- Coordinated team IMPACT training for VDAR IMPACT form and saw through to completion.
- Created, presented, and maintain VDAR Project Model and Program updates for leadership.
- Partnered with Contract Analytics Team (CAT) in development of VDAR IMPACT submissions for out-of-scope items.
- Partnered with Network Management in development of system to filter Provider education opportunities.
- Partnered with the Provider Inventory Management System (PIMS) Team to facilitate the downstream updates into PIMS.
- Partnered with MPP Attestations and Benefit Operations to reduce provider abrasion (i.e., root cause analysis of rework, protocol review and standardization).
- Developed and maintain VDAR Team SharePoint.
- Created and maintain VDAR Performance Index and Scorecards.
- 183,171 unique provider locations (covering 55,089 MPINs/Managed Provider Identification Numbers) from the VA CCN contracted provider list required verification of data accuracy by the VDAR; all 183,171 provider locations have been called for provider network database (NDB) data verification from July 17, 2019, to January 31, 2020.
- September 30th, 2019, the VDAR Team developed a process to intake urgent demographic updates from the VA CCN call center (the team successfully maintained a 48-hour turnaround time).
Creator and Manager of the Provider Directory Data Assurance Team (PDDA)
UnitedHealthcare
11.2017 - 03.2020
- Developed a program for the California (CA) Community and State Market(s) to meet the Department of Healthcare Services requirements and quality targets regarding the provider directory.
- Created an end-to-end process that ensured accurate data reporting in the provider directory along with implementation of remediation processes to ensure accuracy and improve provider as well as member experience.
- Responsible for training and development of 9 employees under PDDA.
- Coordinated CSP training for team and saw through to completion.
- Coordinated team IMPACT training for PDDA Form and saw through to completion.
- Coordinated team MACESS training and saw through to completion.
- Created, presented, and maintain PDDA Project Model for leadership.
- Partnered with Quality Every Single Time (QuEST) to develop audit process for PDDA.
- Partnered with CAT in development of PDDA IMPACT submissions for out-of-scope items.
- Partnered with Network Management in development of system to filter Provider education opportunities.
- Partnered with MPP Attestations and Benefit Operations to reduce Provider abrasion.
- Developed and maintained PDDA team SharePoint.
- Created and maintain PDDA Performance Index and Scorecards.
- Created, presented, and maintained weekly PDDA slides for CA Sustainability Solutions Program.
- Created, presented, and maintained PDDA slides for CA Sustainability Solutions Program executive deck.
- Created PDDA Pipeline and PDDA Staffing Worksheet and involved in several Sustainability calls involving program national expansion.
- Conducted multiple national Medicare & Retirement (M&R) Secret Shopper pilots, consolidated all the data, prepared Power Point (PP) presentation and presented to executive and senior leadership.
- Since the start of the CA program, the team has successfully completed tens of thousands of outbound calls to providers along with demographic updates in the Network Data Base (NDB) and CSP Facets.
- CA PDDA Team has maintained a 99% - 100% QuEST demographic load score.
- CA PDDA Team has maintained a 100% score in terms of productivity.
- The State of CA has passed all state audits since the implementation of the PDDA Team.
- The CA PDDA Teams success led to an expansion into the Maryland (MD) Market in April of 2019.
- PDDA MD assisted in the MD Market successfully passing their State Audit (they also maintain an internal quality score of 99% and above).
National Standard Operating Procedure (SOP) and Policy Designer (Instructional Designer)
UnitedHealthcare
03.2017 - 10.2019
- Developed and maintained all national SOP and Policies for CAT (15 plus).
- Stepped in to train the CAT first and second waves of UnitedHealthcare Network (UHN) Escalation Load Training.
- Responsible for the ongoing maintenance of 35 plus shared contract loading documents.
- Developed, maintained, and owned a total of 11 eGRC Policies.
- At the request of Chief Operating Officer of UnitedHealth Networks, authored and published eGRC Policy NC-60 Submission Requests for Loading Facility or Ancillary Care Providers with an Outpatient (OUT) Record (required collaboration with Network Management, CAT, Pricing Configuration, Legal, Compliance and Rate Loading (PCRL) and Benefit Operations).
- Authored and published eGRC Policy NA-23 IMPACT Case Creation.
- Authored and published eGRC Policy NC-63 Network Account Management (NAM) when submitting loading/processing request(s) to CAT.
- Assisted Blackbelt in the Rework Escalations Unit (RESCU) Submission Standardization Project and identified knowledge gap in OneSource PhyCon Submission document.
- Assisted with the consolidation of 32 PhyCon Submission SOPs and conversion to UnitedHealthcare Networks (UHN) PhyCon Submission OneSource.
- Partnered with UHN University and Quality to create training video regarding Exchange Network Wrap Indicator.
- Processed 100s of document update requests across all regions, taking requests from Network Account Managers, CAT, Regional Operations Leads, Credentialing, Benefit Operations, Legal and Compliance.
Network Physician Contract Manager
UnitedHealthcare
Iselin
11.2015 - 03.2017
- Evaluated Network to determine location inadequacies and assist in recruitment to expand and fill needs.
- Evaluated, negotiated, and prepare contracts in compliance with UnitedHealthcare and Oxford contract template, reimbursement, and configuration standards.
- Requested, analyzed, interpreted, and utilized actuarial/financial models.
- Developed and maintained contracts in health insurance contract management software such as Emptoris, IMPACT, Sales Force, Echo Sign, PhyCon, Facets, Navigator, MSPS, SharePoint Model Request, SharePoint Fee Schedule Build Request, SharePoint Trackers, SharePoint United Cost Reporting Template (UCRT) and WebCSA.
- Communicated and interpreted contract terms, language, configuration, and reimbursement rates for providers.
- In-depth knowledge of Medicare reimbursement methodologies (i.e., Resource Based Relative Value System - RBRVS).
- Collaborated with internal departments to ensure contracts are executed and loaded timely and properly.
- Expert knowledge in contracting methodologies and contract administrations.
- Familiar with UnitedHealthcare and Oxford lines of business (LOBs) both commercial and Community and State (Medicaid, Medicare, PPO, Non-PPO, Dual Special Needs Program).
Education
Lean Six Sigma Black Belt Trained and Certified -
Bachelor of Arts - Psychology & Cognitive Science
Montclair State University
Montclair, NJAssociates in Liberal Arts -
Hudson County Community College
Jersey City, NJSkills
- Written communication
- Oral communication
- Leadership
- Program development
- Program deployment
- Microsoft Office Suite
- Java Applications
- Windows based programs
- Cloud Technology
- Macintosh
- Internet search engines
- Litigation software
- Healthcare administration software
- Collection Master
- JEFIS
- LexisNexis
- Accurint
- Westlaw
- Emptoris
- Network Claims Databases
- Community and State Portal Facets (Citrix)
- Physician Contracts (PhyCon or Pega Based systems)
- Internal Management and Provider Account Collaborations Tool (IMPACT)
- Salesforce
- EchoSign
- DocuSign
- Deltek
- SharePoint
- Navigator
- Core
- Knowledge Central
- Enterprise Governance Risk and Compliance (eGRC)
- MACESS
- My Practice Profile (MPP)
- Exari
- Coupa
Timeline
Staff Vice President of Provider Digital Tools, Strategy and Enablement/Health Solutions Team
Elevance Health
12.2022 - Current
Process Improvement Director/Anthem Business Excellence Team (ABX)
Anthem Inc
08.2021 - 12.2022
Associate Director/Director Contract Lifecycle Management Solutions
UnitedHealthcare
03.2020 - 08.2021
Network Program/Product Manager Network Enablement & Analytics Team
UnitedHealthcare
03.2020 - 07.2020
Creator and Interim Director of the Veterans’ Data Assurance Representatives (VDAR)
UnitedHealthcare
07.2019 - 03.2020
Creator and Manager of the Provider Directory Data Assurance Team (PDDA)
UnitedHealthcare
11.2017 - 03.2020
National Standard Operating Procedure (SOP) and Policy Designer (Instructional Designer)
UnitedHealthcare
03.2017 - 10.2019
Network Physician Contract Manager
UnitedHealthcare
11.2015 - 03.2017
Lean Six Sigma Black Belt Trained and Certified -
Bachelor of Arts - Psychology & Cognitive Science
Montclair State University
Associates in Liberal Arts -
Hudson County Community College