Jennifer Moore

Healthcare executive with 20+ years of payer and provider leadership spanning revenue cycle management, revenue integrity, reimbursement, value-based care, financial performance, compliance governance, and multi-site operations. Proven record improving cash realization and revenue while reducing avoidable medical and administrative cost, including work focused on lowering medical loss ratio (MLR) without compromising access, quality, patient experience, or clinical integrity. Experienced building scalable operating models across multi-state organizations, using analytics, automation, AI-enabled workflows, and disciplined governance to identify leakage, improve productivity, strengthen controls, and support growth.

Brings an uncommon end-to-end view of healthcare economics from patient access and claims through payer adjudication, reimbursement, provider performance, and regulatory compliance.

Vice President, Revenue Integrity & Value-Based Performance - Ultimate Health Plans - Florida

(2026-01)

Lead enterprise revenue integrity, reimbursement, value-based performance, provider financial performance, risk adjustment, and regulatory strategy for a rapidly growing Medicare Advantage plan serving approximately 23,000 members. Drive financial optimization across revenue and medical expense by evaluating utilization, pharmacy, provider performance, coding, documentation, claims, and reimbursement trends, with focus on reducing avoidable MLR while preserving appropriate care, member access, quality, and clinical integrity.

• Implemented MAO-004 reconciliation, revenue controls, provider interventions, and performance governance that contributed to approximately 15% revenue improvement across two quarters.
• Built executive dashboards and operating reviews across RAF/HCC, quality, Stars, pharmacy PMPM, utilization, hospitalizations, provider recapture, and financial outcomes to identify cost and revenue opportunities and assign accountable corrective action.
• Lead technology and innovation initiatives using analytics, automation, AI-enabled eligibility/coverage detection, and claim evaluation to improve accuracy, efficiency, decision support, and scalability.
• Direct CMS audit and RADV readiness, encounter integrity, provider education, vendor governance, policy controls, corrective action, and cross-functional compliance across finance, clinical operations, quality, pharmacy, analytics, IT, and provider relations.

Interim Vice President, Revenue Cycle Management - ArchWell Health - Multi-State, 13 States

(2024-11 - 2025-12)

Led end-to-end revenue cycle and financial performance across 74 senior-focused primary care locations in 13 states during rapid market expansion, spanning patient access, eligibility, financial counseling, coding, billing, denials, collections, and patient experience.

• Identified inconsistent copay and front-end collection practices across markets, designed an enterprise standard, and drove implementation that approximately doubled point-of-service collections while maintaining a patient-centered financial experience.
• Used operational and financial analytics to isolate revenue leakage, reimbursement defects, productivity variation, and avoidable cost, then converted findings into standardized workflows, KPIs, staffing expectations, and executive accountability.
• Led technology and service RFPs, vendor performance, workflow redesign, and AI-enabled eligibility and claims processes to improve efficiency, accuracy, scalability, and cost-to-collect.
• Partnered with clinical, finance, compliance, IT, and market leadership to strengthen governance, coding and documentation accuracy, timely filing, clean claims, and sustainable financial performance across a distributed multi-state organization.

National Lead Director, Revenue Integrity - Aetna, a CVS Health Company - Multi-State / National

(2022-02 - 2024-11)

Directed multi-state revenue integrity, risk adjustment, and financial performance strategy in a complex national payer environment supporting Medicare Advantage and ACA populations that expanded from approximately 40,000 to 1.6 million members. Role overlapped with Aegis through February 2023; arrangement was disclosed and approved.

• Delivered approximately 25% revenue improvement and approximately 30% improvement in care-gap closure through analytics, reimbursement optimization, provider engagement, operational controls, and disciplined execution.
• Partnered across finance, claims, clinical, compliance, network, analytics, and technology teams to identify avoidable cost, improve payment accuracy, strengthen provider performance, and support MLR and margin objectives without sacrificing quality or appropriate care.
• Built executive dashboards and governance routines for revenue, quality, coding accuracy, provider performance, and risk, using root-cause analysis and corrective action to standardize execution across markets.
• Led technology-enabled workflow improvement, large vendor relationships, chart review, coding quality, provider education, member outreach, and audit readiness at national scale.

Director, Risk Adjustment, Compliance & Revenue Operations - Aegis Medical Group - Florida and Affiliated Multi-State Operations

(2019-01 - 2023-03)

Led revenue operations, compliance governance, provider performance, risk adjustment, and value-based strategy across 32 wholly owned locations and 148 affiliated providers, with multimillion-dollar financial accountability.

• Built the department, policies, audit controls, performance monitoring, education, and leadership infrastructure from the ground up, strengthening documentation accuracy, reimbursement, quality, and regulatory readiness.
• Extended ACO-affiliated performance work to an affiliate in New York, supporting provider alignment, clinical documentation integrity, value-based performance, quality, compliance, and accurate reimbursement across an additional market.
• Partnered with physicians and advanced practice leaders on access, care coordination, preventive care, coding, documentation, quality, and workflow adoption while balancing financial performance with clinical integrity and patient outcomes.
• Led technology adoption, RFPs, contracting, vendor governance, and operational improvement; developed a university-accredited clinician education program with the University of Texas.

Chief of Risk Adjustment Research & Clinical Operations Leader - Premier Medical Associates - The Villages, Florida

(2005-10 - 2019-01)

Advanced through senior leadership roles as the physician-led multispecialty organization grew to 26 locations across five counties, integrating practices, expanding services, recruiting physicians, and scaling clinical and administrative operations. Directed end-to-end revenue cycle, patient access, clinical operations, quality analytics, compliance, provider education, payer collaboration, budgets, and P&L performance across fee-for-service and value-based arrangements, with accountability for financial optimization and sustainable revenue performance.

• Led and developed 150+ employees through hiring, coaching, workflow redesign, productivity management, competency development, and leadership accountability across a multi-location model; built scalable domestic and international operating structures to support growth.
• Used clinical and financial data to improve reimbursement, utilization management, operating efficiency, and patient access while maintaining clinical integrity, appropriate care delivery, quality standards, and regulatory compliance.
• Traveled to India and Costa Rica to build and operationalize revenue cycle and Clinical Documentation Integrity (CDI) teams, establishing workflows, training, quality controls, productivity expectations, performance governance, and scalable support for U.S. operations.
• Built and expanded ancillary and community services, including surgery-center processes, pharmacy, transportation, and patient-access programs, supporting growth from planning through operational readiness.