Ryan Williams
Brooklyn,NY
Summary
Strategic-thinking individual experienced in leading multidisciplinary teams in value-based program design and provider performance management. Demonstrated success in driving performance improvements, fostering strategic partnerships, and delivering impactful presentations to senior leadership and external client
Overview
14
14
years of professional experience
Work History
National Payment Innovation Strategy Director, Medicare
Anthem, Inc.
04.2022 - Current
- Responsible for ensuring the optimization and accuracy of all Medicare Advantage Revenue within the East Region, spanning seven markets along the East Coast, covering 230,000+ Medicare Advantage lives and over $2.5 billion in revenue
- Directs a team of 36 associates on value-based provider engagement, HEDIS performance, risk adjustment data analytics, and risk contracting strategy deployment
- Manages multilayered physician partners on their value based contractual performance and negotiating contract parameters
- Assists the local and regional physician network team on strategies for expanding on high performing physician groups participating within value-based contracts.
- Strengthened internal controls by creating end to end contracting process to ensure for accurate value based contractual term development.
- Leveraged data analytics insights for informed decision-making in critical areas such as sales forecasting, budgeting, or personnel management.
Regional Director of Risk Adjustment Programs
Anthem, Inc.
12.2020 - 04.2022
- Responsible for ensuring the optimization and accuracy of all Medicare Advantage Revenue within the East Region, spanning seven markets along the East Coast, covering 230,000+ Medicare Advantage lives and over $2.5 billion in revenue
- Directs a team of 36 associates on value-based provider engagement, HEDIS performance, risk adjustment data analytics, and risk contracting strategy deployment
- Manages multilayered physician partners on their value based contractual performance and negotiating contract parameters
- Assists the local and regional physician network team on strategies for expanding on high performing physician groups participating within value-based contracts
- Leads meetings with physician groups to introduce the organizations to Anthem's Medicare value-based team and develop relationships by establishing points of contact and creating clear channels of communication
- Presents KPIs and overall risk adjustment and network performance overview to Senior Leadership
- Manages retrospective and prospective risk adjustment program deployment for a complex and diverse Medicare Advantage membership portfolio
- Monitors and evaluates staff performance to achieve Blue Chip priorities and other goals
- Provides mentorship for professional growth to staff and other associates
- Received “Value in Action” award for creation of CEO presentation outlining financial performance for the flagship market within the East Region.
Regional Financial Analysis Manager
Anthem, Inc.
04.2016 - 06.2018
- Provided complex financial analysis on a monthly basis and prepared results to be presented to regional Medicare leadership in areas such as membership, COC (Cost of Care), IBNR (incurred but not reported), benefit expenses, claims operations, and revenue
- Expanded role by developing and presenting tailored performance packages to value-based partners, consisting of large health systems and IPAs (independent physician associations)
- These packages outlined performance improvement plans and this information was a catalyst for upcoming value based contractual renewals
- Strategized with key internal stakeholders on expanding value based contracting; specifically advancing provider organizations along the risk continuum
- Developed, monitored, and communicated physician network optimization initiatives, such as unit cost remediation and physician terminations with regional and local leadership to drive network development
- Assisted regional leadership in competitive bid processes by tracking iterations of submissions, benchmark trends, understanding of benefit design, and profitability outlook
- Assisted and managed analytics relating to regional long term growth strategy, which focused on profitable growth within existing and new service areas
- Created an executive presentation for regional leadership to outline a financial remediation plan, emphasizing STARs improvement and network optimization
- Performed complex market and competitive analysis.
Senior Financial Consultant
Anthem, Inc.
12.2014 - 04.2016
- Presented complex financial analysis on a monthly basis to regional Medicare leadership
- Led weekly meetings with regional medical directors and CFOs to ensure that the regions stay on schedule with their COC initiatives, to brainstorm new programs and to present ad hoc analyses requested by leadership that aligned with potential and actionable items
- Represented Health Care Analytics and presented COC initiatives and financial trends to senior executive leadership at the Medicare Business Reviews
- Frequently presented the team's reporting suite to a variety of internal departments and communicated complicated results and analyses in a simplified manner to audiences that did not always have a Medicare Advantage, clinical, actuarial or financial background
- Ensured accurate reporting and timely updates to monthly reporting packages that would be presented to regional and Enterprise Leadership
- Trained new employees and managed technical projects for peers and other analysts
- Received “Value in Action” award in the first year for leading the trend analytics meetings, resulting in building credibility with regional leadership and within the entire Health Care Analytics department.
Hospital Reporting Healthcare Analyst
Healthfirst
07.2013 - 12.2014
- Responsibilities consisted of monitoring risk pool performance, communicating financial results, and identifying areas of opportunity for Senior Management
- Examples include, creating financial risk assessments for a major hospital network during a risk contract reconstructing period
- Integrated data analytics and tracked performance during a major acquisition of a Managed Care Organization with over 200,000 members
- Produced and managed annual comprehensive hospital performance review packets
- Packets included analysis and trends on membership, MLR, risk pool performance, revenue, cost, and HEDIS/HQIP measures
- Mentored and educated junior analysts on SAS/SQL programming and various medical economic topics
- Educated Physician Relations Department on utilizing and analyzing various standardized financial reports
- Responded to ad-hoc analysis requests and provided analytic support for various internal departments and external customers; including hospital systems, IPAs, and consultants
- Requests consisted of contract analysis, risk adjustment, medical loss ratio (MLR), capitation, and Fee-for-Service reimbursement changes
- Lead analyst on the acquisition team overseeing NYSDOH regulatory requirements regarding accessibility to network, forecasted the financial performance that the acquired membership would have on all risk pools, and presented analytical summaries to Senior Management.
Data Integrity Healthcare Analyst
Healthfirst
12.2011 - 07.2013
- Used SAS/SQL queries from large datasets to create and maintain standardized financial performance reports for hospitals to access
- Facilitated and developed a client-facing portal solution
- Collaborated with a business intelligence and data visualization consultant to design a proof of concept demo to present to Senior Management during the revamping Healthfirst's provider portal
- Worked closely with Information Systems to streamline existing processes, user acceptance test IS, created outputs for accuracy, and implement new automated procedures
- Developed and maintained the department's Medicaid CRG (Clinical Risk Groups) Risk Adjustment database for accurate allocation of revenue for Equity Partners.
Provider Auditor II
Novitas Solutions, Inc.
07.2010 - 12.2011
- Lead auditor on several field audits, including one of the largest teaching hospitals in Pennsylvania
- Duties consisted of delegating assignments and reviewing work performed by staff auditors, while carrying a full audit scope of all Medicare reimbursement areas
- Supervised and reviewed all tentative settlement/reimbursement work papers completed by the department
- Managed and tracked project milestones, deadlines, and deliverables through the use of a cross-divisional project plan
- Presented various Medicare reimbursement topics at Healthcare Financial Management Association conferences covering areas such as Medicare bad debts, indirect and graduate medical education reimbursement
- Performed analytical reviews of submitted and accepted Medicare cost reports by scoping reimbursement areas for examination
- Customized audit programs to correspond with specific providers by designing audit tests, analyzing results, developing conclusions, and preparing work papers and audit adjustments
- Interacted with providers by issuing engagement letters and conducting audit entrance and exit conferences.
Education
Bachelor of Arts in Economics and Business -
Lafayette College
Easton, PA05.2008
Skills
- Extensive knowledge of Microsoft Office Suite (PowerPoint, Excel, Word, Outlook), SAS 92 & 93, Teradata, SAS Enterprise Guide 71, and Microsoft SQL
- Work experience in VBA Programming, Lotus Notes, Stata, GIS, Macintosh OSX, LexisNexis, Crystal Reporting, and Compu-Max
Additional Information
Payment Innovation Strategy Director - MedicareResponsible for leading the advancement of value-based payment arrangements for our Medicare business segment. This position will oversee, create, identify and lead profit and growth initiatives that yield positive membership growth and positive operating gains as measured in the annual goals. Primary focus will be creation and collaboration on value-based program designs and other strategies to meet VBS, Regional, Local Market and Anthem Enterprise business objectives.Primary duties to include, but are not limited to:Lead the advancement of value-based arrangements within out Medicare lines of business to progress providers along risk continuum to accelerate value, increase quality and improve member and provider experiences.Design, create, manage and facilitate strategic planning in coordination and collaboration with multiple matrix partners.Investigate and identify existing programs that should be implemented in alignment with VBS strategic direction; as well as partner with stakeholders to provide requirements, program changes and get adoption scheduled.Align payment models and incentives to achieve Anthem's value-based objectives.Responsible for payment model strategy as it pertains to Medicare productsCollaborate and coordinate work with other departments within the business unit, and many matrix partners within the company, including but not limited to Regional Leadership for line of business, Local Market Leadership for line of business, Provider Solutions, Finance, Actuarial, IT, Health Care Economics and HCM.Reports various results through various venues as well as to the leadership team.Qualifications
References
References Furnished Upon Request
Timeline
National Payment Innovation Strategy Director, Medicare
Anthem, Inc.
04.2022 - Current
Regional Director of Risk Adjustment Programs
Anthem, Inc.
12.2020 - 04.2022
Regional Financial Analysis Manager
Anthem, Inc.
04.2016 - 06.2018
Senior Financial Consultant
Anthem, Inc.
12.2014 - 04.2016
Hospital Reporting Healthcare Analyst
Healthfirst
07.2013 - 12.2014
Data Integrity Healthcare Analyst
Healthfirst
12.2011 - 07.2013
Provider Auditor II
Novitas Solutions, Inc.
07.2010 - 12.2011
Bachelor of Arts in Economics and Business -
Lafayette College
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