Summary
Overview
Work History
Education
Skills
Timeline
Generic

Jennifer Harris

Carthage,NC

Summary

Dynamic healthcare strategist with proven success at BlueCross BlueShield of North Carolina, achieving $392M in medical expense reductions. Expert in value-based contracting and data analysis, leveraging strong negotiation skills to drive operational efficiency and enhance provider partnerships. Recognized for innovative solutions and effective team leadership in complex healthcare environments.

Overview

13
13
years of professional experience

Work History

Principal Network Management Consultant - Contracting

Prime Therapeutics (Subsidiary of BCNC)
Egan, Minnesota
09.2024 - Current
  • Contracting all high-cost, complex therapy, Limited Distribution Drugs (LDDs) across all channels, including retail, mail, specialty, and quality-based lines of business for 37 million health plan members.
  • Developed a new contracting operational process to facilitate efficiency, while reducing internal overlap and processing delays.
  • Created a Parity Realignment Initiative to address LDD reimbursement imbalances among two entities for all specialty pharmacy agreements.
  • Manage specialty fee schedule procedures for biosimilars and new-to-market drugs to ensure alignment with supply chain COGs strategies for specialty drug management.
  • Implemented a new technology platform for our specialty drug delivery network to allow specialty pharmacies a real-time comparison of drug costs and access across the network.
  • Develop network initiatives by performing network analytics, concentrating on KPIs, cost, utilization, regional benchmarks, and market access growth.
  • Collaborate with Specialty Clinical Program Directors to identify potential performance gaps, while working with internal and external partners to develop and manage action plans.
  • Oversee contract negotiations of all terms, adhering to all Prime policies, and nationwide state pharmacy regulations.
  • Collaborate with reporting and analytics teams to create network rules for preferred and specialty pharmacies, while maintaining key compliance criteria and regulations.
  • Work closely with Prime's legal team to update contract documents, including agreements and applications for utilization in contracting/re-contracting activities, based on new network participation requirements.

Senior Manager, Healthcare Strategy Value Programs

BlueCross BlueShield of North Carolina (BCNC)
Durham, NC
06.2023 - 09.2024
  • Developed value-based program strategies for all lines of business (commercial, Medicare, and Federal), achieving $392M in reduced medical expenses in 2023.
  • Created value-based reimbursement policies (i.e., Shared Savings, Risk Stratification, Attribution, Bundles, Episodic) for provider groups, hospital systems, and ACOs to enhance value-based care delivery.
  • Managed a diverse team to align initiatives with corporate Cost of Care objectives.
  • Analyzed product performance and optimization through KPIs, trends, leakage, and member satisfaction metrics.
  • Implemented a lagging Digital MSK value program within six months, generating $18M in annual medical savings.
  • Created a comprehensive oncology solution to support independent practices, and facilitate a competitive edge against large hospital systems.
  • Designed cost containment strategies by tracking engagement data and mitigating internal overlaps.
  • Met regularly with C-suite leaders to present value program solutions, ROI projections, and program concepts.
  • Managed utilization reports for Medicare and commercial products to identify trends, develop cost containment tactics, quality improvement programs, or therapeutic solutions.
  • Created Diagnosis-Related Groups (DRG) dashboards to compare cost and utilization among all provider groups.
  • Led cross-functional committees to facilitate collaboration and execution of value-based program creation and delivery.
  • Regularly met with the Medical Policy team to review new procedures, techniques, and technologies to support member coverage.
  • Created a Health Equity/Social Determinants of Health (HESDOH) committee to support healthcare transformation.

Principal Strategic Advisor, Healthcare Strategy

BlueCross BlueShield of North Carolina
Durham, NC
09.2021 - 06.2023
  • Redesigned value-based/risk contracts, saving nearly $164 million in healthcare costs in 2022.
  • Identified claims coding errors (paying INN rates for ONN providers), leading to projected annual savings exceeding $10 million.
  • Developed innovative healthcare reimbursement strategies for all business lines through healthcare redesign consultation and payer/provider engagement strategies.
  • Analyzed complex financial and cost/utilization data to identify value-based payment strategies, cost containment tactics, and performance metrics/targets to achieve enterprise goals.
  • Presented strategic concepts, data projections, medical expense/reimbursement trends, provider performance metrics, and impact assessments to both internal and external audiences at all levels, including C-suite leaders.
  • Created optimization strategies for Accountable Care Organizations (ACO) in response to significant increases in cost trends, within 12 consultative months, for various Episode Treatment Groups (ETG), and Diagnosis Related Groups (DRG).
  • Contributed to all hospital contract negotiations, providing peer analytics, benchmark data, and demographic attribution.

Manager, Provider Data Analytics and Compliance

BlueCross BlueShield of North Carolina
Durham , NC
06.2019 - 09.2021
  • Managed a diverse team responsible for all operations and provider data management regarding the BlueCross Association (BCA), Directory (MA and commercial), as well as all regulatory (Federal and State) requirements.
  • Created data crosswalk tables to align with all BCA regulations, and to facilitate directory accuracy and compliance.
  • Implemented all Information Delivery (ID) technical projects and Information Technology (IT) upgrades related to BCA to ensure that all requirements are executed successfully and on time.
  • Secured approval and funding from internal stakeholders to correct a 12-year non-compliance data issue regarding the Federal Employee Program, utilizing IT resources, developers, architects, and analysts.
  • Created technical procedures and automated queries to proactively identify data anomalies and variances.
  • Conducted positive and negative testing processes for all new technical applications, upgrades, and IT migrations.
  • Established new data audit procedures and processes to improve data accuracy and compliance requirements.
  • Restructured the Provider Data Team to improve efficiency and productivity.
  • Developed Provider Data Compliance and Accuracy Dashboards for internal stakeholders and external partners.

Manager, Provider Data and Network Management

BlueCross BlueShield of South Carolina
Columbia, SC
02.2018 - 06.2019
  • Recruited to manage all provider data files for the BlueCross BlueShield Association (BCA) and 20 National Alliance - BlueCross BlueShield Health Plan partnerships.
  • Developed custom networks (tiering/benefit design) for several Blue Cross Blue Shield health plans, ACOs, and clinically integrated networks.
  • Managed Inter-Plan Teleprocessing Services (ITS), supporting the nationwide BCBS Provider Network (BlueCard Program).
  • Managed all provider data, including pricing and demographic data, for Avalon Healthcare Solutions (Laboratory Benefit Manager).
  • Governed the implementation of new hospital and employer groups to ensure that all provider data is loaded accurately for claims processing, benefits, analytics, and network adequacy.
  • Executed all BCA provider data audits and compliance requirements, including implementing corrective action strategies when applicable.
  • Supervised operations for several online transparency-contracted vendors (Medicare Advantage, Rally Health, and KEYS Directories).
  • Collaborated with internal teams for all BCA National Program releases and mandates to ensure that BCBSSC is compliant with all BCA requirements.

Manager, Networks Innovation and Partnerships

BlueCross BlueShield of South Carolina
Columbia, SC
06.2015 - 02.2018
  • Created value programs, contracts, and partnerships for several fee-for-value programs, focusing on KPIs related to HEDIS, NCQA, CAHPS, performance benchmarks, and improved clinical outcomes.
  • Managed a team to monitor program performance, outcomes, reporting, and provider/member engagement strategies.
  • Conducted regular meetings with Medical Directors, physicians, and medical staff to review Scorecard Reports, reimbursement incentives, and strategies to facilitate healthcare transformation through cost of care, member experience, or reimbursement (i.e., ASC vs.). Hospital, bundle billing, risk arrangements, shared savings.
  • Revamped the Rewarding Excellence for Physicians Program for over 700 physicians to standardize quality scoring and reporting.
  • Delivered quarterly and annual quality outcomes for over 80 contracted provider groups to the Contracting Team to support annual negotiations.
  • Launched and managed the Oncology Care Model (OCM) program for seven independent oncology practices, in partnership with CMS, to ensure program compliance and cost containment for potential shared savings.
  • Collaborated on the development and implementation of the PCMH+ program, which is a strategic fee-for-value initiative that will have monthly risk-adjusted care management fees, and an annual performance-based incentive payment (bi-directional risk).
  • Implemented Clinical Integrated Networks (CIN) and ACOs into the market, leading provider recruitment, and contracting efforts.

Regional Executive - Pharmacy

Pruitt Healthcare
Lexington , SC
01.2014 - 05.2015
  • Managed territory operations, marketing, sales, partnerships, and solution development for South Carolina.
  • Analyzed market trends and competitive pricing to identify opportunities to maximize sales, profitability, and customer relationship management.
  • Created and presented contract proposals, including pricing, operational solutions, and service deliverables.
  • Cultivated relationships with key decision-makers by providing excellent communication, customer service, and solutions to influence profit margins.
  • Participated in the Pricing Committee Team to gain insights on market trends regarding prescription drugs, prescribing patterns, and cost containment.
  • Attended pharmaceutical tradeshows and conferences to promote our comprehensive pharmacy and product delivery solutions.

Director Marketing Operations

HealthSouth Rehabilitation Hospital
Columbia, SC
08.2012 - 10.2013
  • Managed inpatient admissions and field operations to drive inpatient census through strategic planning, programs, outreach, and referral tactics.
  • Managed a clinical team to increase referrals, admissions, and program outreach to achieve monthly and quarterly goals.
  • Analyzed metrics, including reimbursement rates, average length of stay, and patient mix, to maximize revenue potential.
  • Facilitated collaboration among physicians, clinicians, patients, and families to support continued patient care, and improve patient experience and satisfaction.
  • Developed targeted marketing strategies and presentations to facilitate awareness, drive referrals, and admissions.
  • Worked closely with internal departments such as Finance, Quality, Therapy, Case Management, and Nursing to support hospital goals, operations, and metrics.
  • Participant of the Senior Leadership Team, and the South Carolina Hospital Committee.

Co-Owner

The Village Apothecary
Whispering Pines, NC
02.2017 - 12.2021
  • Negotiated and maintained vendor contracts with pharmacy benefit managers and product suppliers.
  • Increased revenue by 35% within first year, achieving consistent growth annually.
  • Monitored pricing margins and controlled inventory to maximize profitability.
  • Developed Community Wellness Events and Immunization Campaigns to enhance public awareness.

Education

Bachelor of Science -

University of North Carolina at Charlotte

Skills

  • Contract negotiation and management
  • Value-based contracting
  • Data analysis and performance metrics
  • Network and operations management
  • Regulatory compliance and risk assessment
  • Operational efficiency and cost containment
  • Team leadership and innovation management
  • Business strategy and process reengineering
  • Problem-solving and performance measurement

Timeline

Principal Network Management Consultant - Contracting

Prime Therapeutics (Subsidiary of BCNC)
09.2024 - Current

Senior Manager, Healthcare Strategy Value Programs

BlueCross BlueShield of North Carolina (BCNC)
06.2023 - 09.2024

Principal Strategic Advisor, Healthcare Strategy

BlueCross BlueShield of North Carolina
09.2021 - 06.2023

Manager, Provider Data Analytics and Compliance

BlueCross BlueShield of North Carolina
06.2019 - 09.2021

Manager, Provider Data and Network Management

BlueCross BlueShield of South Carolina
02.2018 - 06.2019

Co-Owner

The Village Apothecary
02.2017 - 12.2021

Manager, Networks Innovation and Partnerships

BlueCross BlueShield of South Carolina
06.2015 - 02.2018

Regional Executive - Pharmacy

Pruitt Healthcare
01.2014 - 05.2015

Director Marketing Operations

HealthSouth Rehabilitation Hospital
08.2012 - 10.2013

Bachelor of Science -

University of North Carolina at Charlotte

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