JOYA M. BOND
Saint Johns
Summary
Versatile results driven Managed Care executive with a uniquely broad background in compliance, health plan operations, auditing, product and program development, contract management, training, account management, product support, marketing and vendor operations management. Seasoned Compliance executive with proven success in establishing and maintaining an effective compliance program including a Broker Investigations Program which was noted as a Best Practice by CMS and the DMHC. Effective strategist skilled at transforming strategic plans and concepts into viable successful solutions. Highly analytical decision maker with experience building/optimizing organizational processes and infrastructure to maximize business results and mitigate risk. Seasoned executive with vision for new business development, leadership, organizational structure and process redesign and implementations.
Overview
17
17
years of professional experience
Work History
Chief Strategy Officer
Inovaare Corporation
Milpitas
01.2024 - 07.2024
- Developed enterprise growth and customer retention strategies.
- Created processes and controls to ensure product integrity and performance.
- Orchestrated creation and deployment of strategic initiatives focused on customer satisfaction, retention, and growth.
- Established performance enhancement framework and methodologies.
- Executed thorough examination of organizational framework, offerings, and services.
- Identified key risks and areas of opportunity.
- Functioned as strategic consultant to President/CEO.
- Collaborated with executive leadership on product development, product optimization, and branding.
VP, Medicare Operations
Guidewell Florida Blue Medicare
Jacksonville
07.2019 - 11.2022
- Developed and implemented Operational, Technology and Compliance initiatives to simplify and improve customer experience and outcomes.
- Designed and led operational activities to ensure compliance with all Federal and organizational performance metrics.
- Directed backend business operations encompassing claims, customer service, appeals and grievances, enrollment and billing
- Developed and launched a comprehensive Medicare Culture of Compliance initiative (board directive).
- Established Ops Risk and Integrity team along with processes ensuring compliance with all CMS performance requirements across Medicare segment.
- Spearheaded Member Engagement and Retention initiatives, contributing to 93% retention rate
- Designed and led Florida Blue Medicare Employee Development and Engagement programs contributing to a 7% increase in overall engagement and a 3-6% increase in targeted satisfaction categories.
- Served on numerous Enterprise and Segment Governance and Steering Committees: Stars and Risks, Compliance Portfolio, Product Development, Information Security (IT) CAHPs, Member Experience, Enterprise Caregiving, Digital Channel Experience, Quality Improvement, Equity Alliance.
- Spearheaded development of sales, operations, and provider performance dashboards enhancing team performance and real-time issue resolution
- Managed and achieved benchmarks on 4 of 7 Health Plan Scorecard performance measures: NPS, JOM POC, effective resolution of audit findings, and efficient, compliant operations.
AVP Medicare Operations (Corporate)
Molina Healthcare, Inc.
Long Beach
08.2015 - 07.2019
- Directed Operational Compliance, Sales Operations, and centralized Appeals and Grievances processes
- Prior responsibilities included leadership over Dual Support Services (CMS bid submissions), Member Materials, Delegation Oversight, Training and Clinical Support Services.
- Directed centralized Medicare Operations encompassing Appeals and Grievances, Organizational Compliance, Sales Operations and Compliance, CTM’s and Program Management.
- Championed CMS Star Rating advancement efforts for IRE-driven measures alongside six operational measures, boosting ratings from 3.00 to 4.00 – 4.5 Stars.
- Optimized operational effectiveness to meet CMS and State regulatory standards.
- Elevated accuracy by 41% while streamlining processing timeliness by 34% for Appeals and Grievances and 17% for CTMs timeliness.
- Developed audit and oversight mechanisms aimed at ensuring adherence to State and Federal regulatory requirements for Medicare and MMP product lines.
- Directed CMS audit readiness initiatives across Medicare lines of business.
- Managed system designs and operational workflows, defining operational goals and best practices for Medicare line of business.
- Co-directed Medicare Sales initiatives aimed at enhancing processes for sales and marketing activities.
- Managed the annual Medicare Application and Service Area Expansion processes.
- Managed creation and submission of all Member materials.
VP, Operations
Dynamic Healthcare Systems
Irvine
03.2014 - 08.2015
- Provided operational leadership to ensure organization met and exceeded its business objectives and 2-year growth projections.
- Led Account Management, Operations, Customer Support, IT, Implementations, Vendor Management, PMO, and Compliance teams.
Developed strategic initiatives to enhance team performance across multiple departments.- Performed as 'Client Care Officer' concentrating on product stability, improved client satisfaction, and up-sell initiatives.
- Critical in enhancing client account renewals leading to 80% renewal rate and $2 million increase in annual revenue
- Optimized operational and IT systems to secure compliance with Federal and State regulations as well as Health Plan contractual obligations.
- Functioned as Executive Sponsor overseeing development and implementation of Medicaid state-specific solutions.
- Oversaw all CMS FDR related submissions, monitoring and audits activities.
- Engineered processes and systems essential for executing client requirements and internal business goals from initial implementation to sustained production.
- Engineered and executed onshore operational infrastructure systems (IT) and processes aimed at supporting rapid growth objectives and gross margin expectations.
- Oversaw client deployments and enhancements to key functional environments.
Sr. Director State Operations
WellCare Health Plan Inc.
Tampa
09.2012 - 08.2013
- Acquired Easy Choice Health Plan in 2012.
- Co-Led transition and integration efforts.
- Administered state health plan operations and managed State and Federal complaints and investigations.
- Managed all membership operations and accounting functions, encompassing call center, member enrollment, disenrollment, and retention units, eligibility, capitation and premium reconciliation, along with identification, investigation, and implementation of revenue recovery opportunities.
- Oversaw all CMS and DMHC level complaints and investigations.
- Directed cross-functional senior leadership team in ongoing identification and resolution of operational compliance issues.
VP (COO), Chief Compliance Officer
Easy Choice Health Plan Inc.
Long Beach
07.2007 - 09.2012
- Dual Role - VP (COO), Chief Compliance Officer.
- First hired, recruited to create, implement and oversee all aspects of start up company’s Regulatory Affairs and Compliance program.
- Contributed to design and implementation of comprehensive organizational structure and processes, driving significant membership growth, over $55 million in revenue, and two acquisitions within 11 months.
- Developed and maintained company compliance program and applicable policies and procedures designed to effectively prevent and or detect violations of laws, regulations, policies and the Code of Conduct.
- Functioned as HIPAA Privacy and Security Officer
- Designed, implemented and enforced HIPAA Compliance Program.
- Designed, organized, and executed comprehensive company-wide compliance education and training program.
- Conducted investigations into reported or suspected violations and questionable conduct; formulated corrective action plans as needed.
- Functioned as main liaison facilitating communication between Health Plan and Federal and State Regulators.
- Acted as business advisor to CEO, President, and Board of Directors regarding Federal and State Managed Care regulations and statutes.
- Formulated health plan structural design
- Partnered with the CEO to recruit and hire all key leadership positions.
- Oversaw all organization Federal and State mandated submissions, including Service Area Expansions.
- Spearheaded Star Ratings enhancement initiatives, driving projected ratings growth from 2.5 to 3.0 within 3 months.
- Oversaw CMS Part C and D data validation audit processes.
- Designed and deployed internal and external auditing systems and methodologies.
- Oversaw internal and external compliance audits.
- Developed and presented monthly, periodic and annual Compliance Program reports to the Board of Directors.
- Established and directed health plan Compliance committee
- Functioned as integral member of Senior Executive Marketing Strategy Team.
- Developed and directed comprehensive broker sales investigation and oversight processes.
- Established and directed broker online training and certification process with integrated web-based platform
- Acted as chief liaison between Health Plan and contracted entities on compliance-related issues.
- Designed, launched, and managed all Membership Operations activities.
- Oversaw all membership accounting functions, including but not limited to, eligibility, capitation and premium reconciliation, the identification, investigation and implementation of revenue recovery opportunities.
- Managed Human Resources operations, coordinated interactions between contracted vendor and organization,
- Designed and maintained health plan website, increased Website hits by 28% within 2 months
Education
Bachelor of Science - Business Management
University of Phoenix
Southern CaliforniaSkills
- Healthcare Operations
- Regulatory Compliance
- Internal and External Auditing
- Broker and FWA Investigations
- Contract Negotiations
- Customer Retention
- Performance Optimization
- Strategic Planning/Execution
- Vendor Management
- Change management
- Workforce Engagement
- Cross Functional Leadership
References
References available upon request.
Timeline
Chief Strategy Officer
Inovaare Corporation
01.2024 - 07.2024
VP, Medicare Operations
Guidewell Florida Blue Medicare
07.2019 - 11.2022
AVP Medicare Operations (Corporate)
Molina Healthcare, Inc.
08.2015 - 07.2019
VP, Operations
Dynamic Healthcare Systems
03.2014 - 08.2015
Sr. Director State Operations
WellCare Health Plan Inc.
09.2012 - 08.2013
VP (COO), Chief Compliance Officer
Easy Choice Health Plan Inc.
07.2007 - 09.2012
Bachelor of Science - Business Management
University of Phoenix
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