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Jacqueline Garrett

856.321.1562 215.756.5169
jacqueline.garrett@verizon.net

HEALTHCARE EXECUTIVE
I am a professional with a track record of success in ACO development; provider engagement; project
management; IS team oversight; medical practice management; population health management &
PCMH principles; developing lucrative value based contracts and the development of multiple types
of select networks; creating interactive medical/clinical quality outcome programs to increase HEDIS
& HCAHPS scores; promoting superior hospital, provider and payer collaborations. I am a qualified
expert with strong organizational skills that are guaranteed to effectively project manage new
initiatives, maximize clinical outcomes, reduce overall costs, and grow patient volume.
During my career I have leveraged healthcares planning and management best practices and principles to direct the
operations of multiple major healthcare organizations. I excel in collaborating with and engaging federal and state
agencies, executive leadership, payers, hospitals, physicians and other network affiliated entities. I am equally strong
in negotiating the most beneficial and cost effective value based managed care, carrier, and service contracts for all
service and network types. I am an empowering leader skilled in developing, motivating, and rewarding high
performance teams. As well I am experienced in computer systems management, project management and all
aspects of physician practice operations.
CORE COMPETENCIES
Value Based Contracting Accountable Care Organization Development CMS Medicare & Medicaid Healthcare
Program Leadership & Oversight MS Project Management Medical Practice Management Payer Contract
Negotiation Innovative Quality Program Development & Outcomes Management Budgeting for large projects
Financial & Data Management Reporting & Analysis Maximization of Collections & Reimbursements
Marketing Staff Development & Reorganization CPT/ICDA-10 Coding Employer Healthcare Cost Containment
Program Development Credentialing

PROFESSIONAL EXPERIENCE

INDEPENDENCE BLUE CROSS, PA /AMERIHEALTH NJ

10/2011

MANAGER, INNOVATIVE PROVIDER PERFORMANCE PLANS


Responsible for all activities related to the ACO development, implementation and management of Commercial and
Managed Care programs in support of narrow networks and specialty shared service programs for tri-state
hospitals. Act as Project Designer and Manager charged to direct and mange tasks and responsibilities assigned to
the clinical director, actuarial, sales, informatics and contracting departments in the development of quality &
shared service program implementations leading to an increase in HEDIS clinical outcome scores. Manage all
activities relating to CMS reporting and auditing responsibilities. Responsible to create and manage Value Based
Programs for Family Medicine and Specialists. Work to create & document actionable reporting to assure continued
improvement in clinical outcomes and population management. With my vast experience in Medical Practice
Management, I serve as a consultant, advocate and source of support for our Network. Reported to the VP.
Select and Ongoing Accomplishments:
Successfully created and negotiated Value Based quality contracts and Innovative Quality Programs with
large hospitals & providers which reduced Medical Cost Ratios and raised HEDIS and Stars outcomes scores
in all cases and reduced overall spending by 2.5% of total claims spend. Included: Kennedy, Virtua and
Cooper Health Systems, Regional Womens OBGYN, Advocare, Partners In Care, and many other
organizations.
Created budget for and executed Integrated Provider Performance Programs for ten hospital systems within
six months. This included acting as the facilitator for internal meetings with IBC/Amerihealth leadership and
external meetings with hospital executives and physicians to assure successful program implementations.

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Project managed and lead the creation of Specialty Value Based Contracts for our narrow networks that
developed and supported the principles of Population Health Management and increased HEDIS based
clinical outcomes by 7% in year one and saved an additional 2.5% in overall medical costs which was
further shared between collaborators.
Project oversight and management of two large CMS grants: Comprehensive Primary Care Initiative (CPCI)
and a CMS Innovation Grant with Cooper Hospital as principal writer.
Developed and implemented primary care and specialty ACO models designed to create collaborative
member centric and cost savings programs that work to assure continued improvement in quality outcomes.
Expert in creating collaborative arrangements leading to relationships that include newly defined
relationships leading to full risk sharing opportunities.
Create and present presentations and educational materials to senior leadership relating to Healthcare
Reform and potential opportunities for collaboration and growth.
Assist in the development of coordinated care and bundled service models for hospitals and ancillary
providers who do not meet the requirements of the current enterprise wide program.
Introduce and support vendor activity in order to transfer data and to enhance program data and clinical
models Lumeris, Navinet, Versys, EPIC, Allscripts and Siemens.

BRAVO HEALTHCARE, Philadelphia, PA

07/2008 10/2011

Director of Network Operations & Provider Engagement


Managed entire network of providers for all service types for a Medicare/Medicaid Population. Full Management and
roll-out for Hospital, Primary Care and Specialist Quality Incentive Programs for all network types which were
designed to monitor and to increase clinical outcome scoring, to improve STAR ratings and to maximize CAPHS
scores. Cultivate and maintain provider, hospital, and allied facility relationships. Oversee monthly financial
reporting to CMS and all clients. Directly responsible for lowering MCR and increasing HEDIS clinical outcome
scores. Trained and lead a team of ten direct reports. Led team of 10 direct reports; Reported to the VP Reported
to the VP
Selected Accomplishments:

Drove $3.5M in physician payouts for practitioners participating in incentive programs by leveraging
extensive practice management skills to train practice staff in integrating incentives, streamlining patient
scheduling, using expert coding to increase revenue, utilizing best practices to manage workflows, and
assisting providers in migrating to electronic platforms and restructuring medical practices.

Selected to manage and train Provider Account Managers enterprise-wide and is continuously sought after
to share best practices based on regions consistent delivery of excellent financial results.

Increased practice participation in quality improvement programs by 83% from 78 to 450 by delivering
practice presentations detailing program benefits, including patient specific data that enabled physicians to
better serve their patients. The overall benefit was a 10% decrease in the total medical cost ratio.

Generated $4M increase in premium revenue with first six months of launching Bravo Personal Healthcare
Profile Incentive Program.

Transformed the Baltimore and Western Pennsylvania regions to attain a 20% increase in provide
engagement and incentive program participation within six weeks by training and developing team into high
performance producers skilled in physician interactions and practice management principles.

Grew membership in New Jersey and Central Pennsylvania by 25% through service expansion and physician
engagement efforts.

Responsible for ensuring Federal and CMS standards of clinical care and reporting are maintained.

HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA, Philadelphia, PA

03/2005 07/2008

Business Manager
Directed all business functions for Radiology Department, including budgeting, revenue cycle management,
financial analysis and reporting, carrier contract negotiations, compliance management, and information services.
Led team of 15 direct reports. Reported to the VP.

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Selected Accomplishments:

Generated 18% increase in cash receipts and reduced charge lag by 10 days by developing and
implementing department-specific charge audits, upgrading billing practices and procedures, requiring staff
coding certifications, enhancing insurance verification policies, and instituting same-day billing.

Saved department $500K+ as Information Service support and project manager for conversion of two
hospitals into centralized billing model.

Facilitated enterprise-wide data capture for clinical clearance of high tech services by project managing
creation of WEBform.

Created new service models through marketing services of combined clinical departments which increased
income by $1M

Enabled department to enter demographic and billing information directly into billing services computer
system by streamlining charge capture system.

Added $2.5M in projected cash collections by creating 20-employee, enterprise-wide Radiology


PreCertification Team to obtain preauthorizations and benefits information required by carriers.

Optimized hospital performance and productivity by writing department-specific improvement plans and job
descriptions, revamping training manuals, centralizing workflows, and creating work plans to review,
monitor, and complete operations enhancements.

Improved coding score accuracy to 98% as Billing Compliance Manager monitoring all services performed.

Established enterprise wide onsite registration and charge entry by leading computer department to
integrate ancillary, registration, and billing activities using target achievement and benchmarking reports.

HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY, Marlton, NJ

11/2002 03/2005

Regional Administrator
Established, led, and provided exclusive, performance-based provider network of 50K+ physicians with education,
training, development, direction, contract management, and medical policy guidance. Directed team of 22 internal
and external personnel. Managed provider claims management issues state-wide.
Selected Accomplishments:

Saved $5.2M by successfully negotiating specialty service contracts for 27 providers in one year.

Enabled monitoring and analysis of traditional and managed care contract value through creation and
implementation of management standards and policies.

Increased representative visits to providers from 7 to 12 weekly by restructuring office staffing model.

Fast-tracked new provider credentialing for three large provider groups by creating and introducing
Delegated Credentialing Model.

Standardized medical policies and procedures for claims payment in conjunction with Anesthesia Society.

CHESTNUT HILL HOSPITAL, Chestnut Hill, PA Contract Position

11/2001 11/2002

Director, Physician Network Development & Medical Affairs


Directed all facets of hospital-owned physician practices, including contract negotiation and management, physician
recruitment and retention, marketing, and physician network development. Managed human resources, accounting,
reporting, budgeting, cash flow planning, financial analysis, policy and procedure implementations, and all daily
operations of Medical Affairs Department.
Selected Accomplishments:

Turned around OB/GYN practices from $250K loss to $59K gain by upgrading systems to include centralized
Call Center and Billing Office, physician salary incentives, cross-training, and overtime reduction.

Enabled service expansion to patients, while reducing direct expenses by nearly 67% by consolidating three
distinct practices into one corporation sharing services.

Managed Marketing Campaigns that increased brand recognition by 20%

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DOYLESTOWN & WARRINGTON FAMILY PRACTICE, Doylestown, PA

07/1998 11/2001

Executive Director
Directed all medical, clinical, and general practice operations encompassing staff recruitment, training, and
management; fiscal management; new business development; marketing; third party billing. Managed marketing
and contract negotiations for managed care population. Led efforts to secure and manage grant funds. Instituted
monthly financial reporting procedure.
Selected Accomplishments:

Returned corporation to profitability for first time in eight years by reducing expenses 35% over 12-month
period and increasing patient volume 40%. Cut staff in half, staggered physician schedules, offered
extended hours, introduced walk-in services, launched aggressive marketing campaign, and negotiated
resource sharing agreement with major hospital.

Ensured coding and billing compliance by creating clinical abstracting model and new hire training program.

Increased per-hour patient volume by 50% from four to six per hour by reorganizing workflow.

Delivered ~$42K increase in annual cash flow from major carrier by raising Quality Care Index, used to
determine reimbursement from this carrier, from 17.50 to 23.15.

Enabled corporation to maximize bonus income and directly manage patient survey process by creating and
securing carrier approval for quarterly patient survey.

Optimized performance in each department across entire corporation by creating improvement plans,
redefining job descriptions, enhancing operations directives, and revamping training manuals.

Additional Experience:
Director of Reimbursement at NovaCare Inc. in King of Prussia, PA
Executive Director at Rancocas Orthopedic & Radiology Associates in Willingboro, NJ
Practice Administrator, Neurology Department at St. Christophers Hospital for Children in Philadelphia, PA

CREDENTIALS
Master of Arts in Business International Theological Seminary in Pasadena, CA (866) 795-5062
Bachelor of Arts in Business & Computer Theory International Theological Seminary in Pasadena, CA
Health Care Manager Certification University of Pennsylvania in Philadelphia, PA (215) 386-4304
Certified Managed Care Negotiator Rutgers University in Rutgers, NJ (908) 445-5526
PMP Training Completed; Certification Testing, September, 2015 Rutgers University in Rutgers, NJ

AFFILIATIONS
Medical Group Managers Association
Founder, TOPEXEC Church Management Corp.

PUBLICATIONS
Managing a Successful Volunteer Team. Self Published.
So Youve Been Chosen as the Organizations Administrator Now What! Self Published.