Summary
Overview
Work History
Education
Skills
Achievements & Results
Certification
Timeline
Generic

Traci Nowell

Oakland,TN

Summary

Strategic and results-driven individual with extensive expertise in healthcare project management, data analytics, fraud detection, and internal controls. Proven track record in leading high-impact initiatives, optimizing operational efficiencies, and driving cost-saving strategies. Known for exceptional leadership, innovative problem-solving, and ability to translate complex data into actionable insights. Adept at navigating regulatory landscapes and ensuring compliance.

Overview

18
18
years of professional experience
1
1
Certification

Work History

Business Strategy Planning Director

Elevance Health
Indianapolis, IN
05.2022 - Current
  • Execution lead responsible for the Payment Integrity and Reimbursement Policy Management, Cost of Care workstreams, to include, but not limited to: Obtaining funding, removing obstacles that may hinder CoC initiatives, and partnering with leadership to help drive strategy and execution.
  • Offers subject matter expertise, investigates relevant practices, and keeps abreast of industry trends.
  • Led initiatives to drive additional cost of care opportunities as needed.
  • Establishes program governance as needed for issue escalation response.

Director, Healthcare Economics

Prospero-Health
Memphis, TN
09.2019 - 05.2022
  • Responsible for all internal operational reporting as well as external client-facing reporting.
  • Performed deep-dive analyses to determine trends of key metrics and reported findings and root causes to executive leadership.
  • Responsible for executive and operational dashboards that supported daily and month-end reporting of key clinical metrics.
  • Identified opportunities for improvement in operational performance metrics.
  • Developed and implemented comprehensive strategies to improve operational processes and organizational efficiency.

Cost of Care Director; Business Information Consultant Sr.; Business Information Consultant

Elevance Health
Indianapolis, IN
03.2014 - 09.2019
  • Assisted with management of the Cost of Care Investment Pool $100 million-dollar budget
  • Developed a SQL database to track the Cost of Care Investment Pool, as well as designed necessary reports required by management for projections and reporting.
  • Provided metrics and data to Program Integrity's executive management and financial coaching to initiative owners.
  • Provided support for all Program Integrity functional areas in regard to Cost of Care.
  • Identified potential overpayments resulting from fraud, waste, or abuse through analysis of claims payment data.
  • Led multi-state initiatives with staged implementations across multiple lines of business.

Manager, Enterprise Applications; Business Analyst

EDR, Inc.
Memphis, TN
10.2011 - 03.2014
  • IT professional responsible for the systemic processing of all accounting data, reporting and aggregation

Forensic Accountant

Federal Bureau of Investigation
Memphis, TN
09.2010 - 10.2011
  • Led forensic financial investigations, identifying associates and assets through public and private records analysis, supporting criminal cases with affidavits, subpoenas, trials, and litigation assistance

AVP, Coding Validation Initiative; Director, Provider Audits; Manager, Internal Audit

Amerigroup CORPORATION
Virginia Beach, VA
11.2006 - 09.2010
  • Implemented and managed the Coding Validation Initiative (CVI) to address abnormal coding patterns by healthcare providers for educational materials, post-payment review audits, and prepayment review audits.
  • Managed the implementation of cost-cutting reimbursement policies that effectively lowered medical expenses related to provider billing abuses.
  • Discovered new areas of fraud, waste, and abuse by analyzing claims payment data.
  • Created tracking tools for CVI provider audit results and savings from billing pattern changes.
  • Conducted audits to enhance claim payment accuracy by identifying system configuration and adjudication issues.
  • Conducted audits of operational, financial, and IT applications.

Education

Bachelor of Accountancy -

University of Mississippi
University, MS
01.2002

Skills

  • Business Planning
  • Proactive Learner
  • Strategic Leadership and Management
  • Verbal and written communication
  • Project Management
  • Creativity and Innovation

Achievements & Results

  • CLIA
  • Affordable Care Act
  • Transitions of Care

Certification

  • Certified Public Accountant (Inactive)
  • Certified Internal Auditor
  • Certified Fraud Examiner

Timeline

Business Strategy Planning Director

Elevance Health
05.2022 - Current

Director, Healthcare Economics

Prospero-Health
09.2019 - 05.2022

Cost of Care Director; Business Information Consultant Sr.; Business Information Consultant

Elevance Health
03.2014 - 09.2019

Manager, Enterprise Applications; Business Analyst

EDR, Inc.
10.2011 - 03.2014

Forensic Accountant

Federal Bureau of Investigation
09.2010 - 10.2011

AVP, Coding Validation Initiative; Director, Provider Audits; Manager, Internal Audit

Amerigroup CORPORATION
11.2006 - 09.2010

Bachelor of Accountancy -

University of Mississippi

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