SUMMARY:

• Results orientated leader and change agent bringing healthcare insurance experience and leadership in directing contact center operations, customer service, forecasting and compliance; developing and executing effective strategies, new technologies, building processes, and creative problem solving.
• 15+ years’ experience in leadership across several industries
• 10+ years in project management, business analysis, and process improvement techniques
• 6+ years in healthcare operations, call center environment, and provider analytics
• Key contributor to budget planning and forecasting
• 5+ years’ experience working with process flow, mockups, and backlog repository tools (Visio, VersionOne, SnagIt, Publisher, etc.)

EXPERIENCE:

Medicaid/Medicare Business Analyst

Confidential, Hopkins, MN

Responsibilities:

• Attended and led appropriate meetings for project topics and as part of operational reporting to the executive team
• Manage and maintain project deliverables and responsibilities to ensure that business and contractual requirements are met
• Created detailed project design documents and task - level project plans to organize team deliverables.
• Liaison between business and developers on feature requests
• Proactively addressed potential issues that may affect the system and worked with developers to resolve the matter
• Utilize Agile methodology approach to successfully manage projects.
• Performed as an interim Project Manager and continued assisting with Project Manager duties
• Research Medicaid and Medicare requirements for system automation
• Acted as a Medicaid and Medicare SME during discovery analysis
• Identify project requirements by interviewing customers; analyzing operations; determining project scope; documenting results
• Develops problem solutions by describing requirements in a work-flowchart and diagram; studying system capabilities; analyzing alternative solutions; preparing system specifications
• Developed As-Is and To-Be process flow and solution documents
• Develops project estimates by identifying phases and elements, personnel requirements
• Verify results by completing testing validation
• Maintains systems by researching and resolving problems; maintaining system integrity and security.
• Maintains quality service by establishing and enforcing organization standards.
• Prepares reports by collecting, analyzing, and summarizing information.
• Contributes to team effort by accomplishing related results as needed.

Provider Assistance Center Supervisor/Project Manager

Confidential, Minneapolis, MN

Responsibilities:

• Successfully Managed a team of 35+ Provider Assistance Representatives by monitoring Scheduled adherence to ensure that the Provider Assistance Center met their goal of answering 80% of the provider calls in 90 seconds or less
• Analyzed progress of the team by monitoring average handle time and call documentation to identify areas of opportunity and needed training, and to identify organizational trends for process improvement
• Increased the productivity related to provider follow up and issue resolution by 75%
• Decreased the handle time of representatives on an individual as well as a group level by 30%
• Managed a project to Develop PAC work instructions to assist the team with accurately triaging issues
• Successfully managed the Pilot Behavioral Health Provider Assistance Center team to provide a positive experience to this provider population
• Key contributor to the beginning phases of implementing an organizational system and team that helped track and trend known issues within the organization, and communicate to senior leadership
• Participated in implementation of a new CRM tool, and lead the change management communication plan for the Customer Service Department.
• Coached several representatives by helping them identify specific goals that resulted in promotional opportunities
• Identified root cause to help provider’s with internal and external errors by working with internal departments, or providing education and resources to the provider
• Assisted with DHS complaints and resolution by effectively communicating with key stakeholders and working with internal departments
• Worked with claims and configuration departments to resolve and reduce provider issues by analyzing and researching Medicare and Medicaid guidelines, fee schedules, and provider credentialing, contracting and licensing requirements
• Facilitated the Futures Committee for the Customer Services Department, which engaged employees by incorporating feedback received for training opportunities and reduction of call volume
• Developed training material for the Provider Assistance Center Representatives, and trained new and current representatives

Provider Assistance Center Representative

Confidential, Minneapolis, MN

Responsibilities:

• Developed Provider Assistance Center Training Material
• Updated the Knowledge Base system utilized by the Provider Assistance Center
• Trained new and current Provider Assistance Center Representatives
• Meet or exceeded the average handle time goal with average work time of under 10 seconds and average handle time of 7 minutes, averaging 70 to 80 calls per day
• Worked on several projects related to provider and claims issues assigned by leadership
• Contributor to System upgrade testing, development, and training as a corporate wide initiative at Confidential .
• Lead team meetings in the absence of the Supervisor
• Managed the workforce management tool to assist leadership
• Received several Top Hat Award Recognition nominated by other individuals throughout the organization
• Bright Idea submitted to add a broker portal to the organization

Medicare Member Service Representative

Confidential, Minneapolis, MN

Responsibilities:

• Attained and exceeds rating on quality while achieving a high productivity level.
• Answer, resolve, track, research, and document telephone calls from members, providers, internal departments, and external agencies in a timely and professional manner
• Educate Providers, members and external customers on policies and procedures related to member’s health care program
• Exceed customer expectations by providing outstanding and efficient customer service to members and provider
• Demonstrated proficiency of claims and billing.
• Demonstrated knowledge of Confidential policies and procedures, and regulations while utilizing appropriate resources to respond to member inquiries
• Identify trends and issues that emerge in calls/correspondence and inform the team lead or supervisor
• Assist in the development and communication of resolutions to internal staff as requested
• Demonstrate and maintain a thorough and complete working knowledge of appropriate Confidential information management systems and ACD telephone systems.