Michelle A. Sears
Plainfield,CT
Summary
Motivated finance executive that develops strategic alliances with organization leaders to effectively create and support key business initiatives and strategic goals. Excellent planning, analytic, budgeting, and business management skills. Demonstrated problem solver that enjoys finding creative solutions in changing fast paced environments. Committed to building and retaining high performance teams by coaching, developing and motivating skilled professionals.
Overview
28
28
years of professional experience
1
1
Certification
Work History
Chief Financial Officer
Neighborhood Health Plan Of Rhode Island
06.2021 - Current
- Provide oversight for all internal and external financial reporting activities
- Responsible for development of annual budget and multiyear strategic forecasts for a $2.2B company
- Provide oversight to financial analytics team to assist with revenue and medical expense insights
- Development of an actuarial team assisting with rate development, medical expense trends, and member demographic trends
- Responsible for overseeing all provider contracting activities
- Responsible for internal audit activities to ensure control activities are operating effectively and process efficiencies are adopted
- Enhanced risk adjustment activities to improve revenue by more than $28pmpm by engaging members with their health plan and primary care practitioner
- Responsible for compliance with all federal, state, and contractual requirements
- Lead a diverse team consisting of nine departments and 70 employees
- Executive liaison for the Finance and Audit Committee and Investment Committee
Vice President of Finance
Neighborhood Health Plan Of Rhode Island
05.2020 - 06.2021
- Controlled accounting operations and oversaw transactions related to payroll, financial reporting, payables and receivables
- Responsible for financial analytics
- Responsible for analysis of rate proposals and response to governmental agencies
- Monitored budget, revenue, medical and variance trends for $1.5B company
- Responsible for review of all Internal and external financial reporting including NAIC quarterly reporting, Quarterly Business Review reporting, Medical Loss Ratio reporting, and monthly financial reporting
- Oversight of all budgeting and forecasting activities for the organization
- Developed detailed multi year forecast to assist with strategic planning
Director of Financial Services
Health New England
05.2017 - 05.2020
- Served as CFO for Baystate Healthcare Alliance ACO
- Oversight of internal and external actuaries
- Development of 3 year financial model to assist C-Suite in strategic planning and execution
- Provider value based contract modeling including contract language and exhibits
- Oversight of line of business variance analytics including trend and budget variance
- Development of C-Suite financial memo and line of business dashboard
- Oversight of Financial Optimization committees; review revenue performance and medical performance through benefit design, benchmark medical performance, and administrative cost savings initiatives
- Consult to underwriting department on internal audits of all medical inputs used to develop merged market and large group premium rates to ensure accurate rate development
- Provide actuarial support across organization related to regulatory filings, rates, and liability development
Interim CFO
Health New England, Inc.
02.2017 - 05.2017
- Oversaw preparation of all internal and external financials as well as all financial regulatory and tax filings
- Assisted in risk management and internal audit of procedures and processes
- Worked cooperatively with medical area to implement medical management initiatives and rating and underwriting to ensure financial stability of the organization
- Presented financials and other relevant information to the Board of Directors on regular basis
- Provided financial advice to the CEO and senior management team
- Supported and supervised team of 43 Finance, Accounting, and Underwriting professionals
Director of Financial Reporting
Health New England, Inc.
04.2015 - 01.2017
- Co-led design and implementation of Health New England's NAIC Model Audit Rule compliance and monitoring program, including risk assessment, documentation of process controls, routine monitoring, and corrective action plans
- Developed projections with Director of Pharmacy to track contract performance and pharmacy management initiative performance
- Implemented process to monitor rate and volume performance for current month and current year to assist executive team in decisions to drive positive performance
- Responsible for managing team of 14 including management and individual associates, performing skills gap assessments, providing training and coaching, and ensuring talent to execute and provide analysis on strategic initiatives to impact future performance
- Participate on cross-functional team to design provider payment strategies with emphasis on provider engagement, financial analysis, shared savings and alternative payment methodologies
- Review of accruals and payments to provider groups based on contracted incentive programs and goals
- Participate on two pillar teams to develop strong leaders and grow membership base to deliver on long term strategic goals
Manager of Financial Reporting
Health New England, Inc.
07.2014 - 04.2015
- Managed quarterly and annual regulatory and statutory reporting functions including review of all regulatory financial reports for three insurance companies including NAIC filing (blue book), medical loss rebate reporting, ACA reporting for transitional reinsurance, and risk corridor, and external reports to Federal and State entities (Medicare & Medicaid)
- Provided leadership and oversight for all accounting and general ledger activities, financial reporting and analysis, and budget activities for $900 million regional health plan
- Prepared and coordinated review of financial information for Health New England's Board of Directors, committees, and senior management monthly
- Implementation and oversight of transition to non-profit 990 tax filing for Health New England, Inc. including working with external tax consultants and review of 990 filing
- Financial implementation leader for Minuteman Health (Massachusetts) Third Party Administrative Services project
Accounting Manager
Health New England, Inc.
01.2008 - 07.2014
- Designed and implemented accounting system to track, monitor and report financial information for start up Medicare line of business
- Implemented accounting processes and controls to ensure CMS and state regulations were implemented and followed for Medicaid line of business
- Created and designed measures and metrics to monitor and track performance, identified opportunities for improvement, and implemented new processes including automating accounts receivable increasing capacity by 46%
- Increased revenue $700K from 2010 to 2015 by leading cross-functional team to implement reconciliation of daily enrollment and payment information for Massachusetts Medicaid line of business
Accounting Supervisor
Health New England, Inc.
10.2006 - 12.2007
Senior Accountant
Health New England, Inc.
10.2000 - 09.2006
Senior Accountant
Sisters of Providence Health System
02.1998 - 10.2000
Education
MBA - Business Administration
Our Lady of the Elms College
Chicopee, MA2014
Bachelor of Science - Business Administration
Westfield State College
Westfield, MA1998
Skills
- Builds High Performing Accountable Teams
- Performance Analysis
- P&L Management
- New Business/Process Implementation
- Strategic Planning
- Financial Improvement Activities
- Financial Planning/Budgeting
- Workflow Planning
- Regulatory Compliance
- Coach, Motivate, and Mentor Leaders
Accomplishments
- Board level presentation skills.
- High Performance Training and Coaching Certification.
- Creation of Financial Optimization teams designed to increase revenue through product design and volume; decrease medical expense through trend analytics, provider contract performance and utilization metrics.
- Reduced the accounting close process by three business days by improving processes and creating a culture of accountability around financial reporting time frames.
- Redesigned the budget process to enhance modeling, assist in projecting ROI on capital and project requests improving the timing of the budget process by three weeks, and reducing meeting time by 12 hours for 7 executives and 16 directors.
- Creation of three year forecast with multiple scenarios for strategic planning.
- Designed and implemented a ledger system to report performance by line of business, inform associates on operating performance, and enhance line of business decision making.
- Identified process improvements to increase capacity and reduce administrative expense.
- Streamlined manual statutory reporting process and reduced monthly reporting turn around time by two days.
- Implemented financial summary statement for C-Suite executives to disseminate monthly financial reporting.
- Implemented monthly financial review process to encourage discussions on financial performance and annual initiatives.
Certification
Certified Health Insurance Executive (CHIE) AHIP certification
Timeline
Chief Financial Officer
Neighborhood Health Plan Of Rhode Island
06.2021 - Current
Vice President of Finance
Neighborhood Health Plan Of Rhode Island
05.2020 - 06.2021
Director of Financial Services
Health New England
05.2017 - 05.2020
Interim CFO
Health New England, Inc.
02.2017 - 05.2017
Director of Financial Reporting
Health New England, Inc.
04.2015 - 01.2017
Manager of Financial Reporting
Health New England, Inc.
07.2014 - 04.2015
Accounting Manager
Health New England, Inc.
01.2008 - 07.2014
Accounting Supervisor
Health New England, Inc.
10.2006 - 12.2007
Senior Accountant
Health New England, Inc.
10.2000 - 09.2006
Senior Accountant
Sisters of Providence Health System
02.1998 - 10.2000
MBA - Business Administration
Our Lady of the Elms College
Bachelor of Science - Business Administration
Westfield State College