SUMMARY

• Certified Six Sigma Green, Black Belt, Change Management, Business Process Improvement Analyst, Durable Medical Equipment with over 10 years of IT Front End Healthcare system deployments with Financial Background.
• Extensive experience in leading process improvement projects serving Medicaid, Medicare, Individual, and Commercial health insurance. Highly experienced in health insurance, quality assurance, compliance, patient benefits for Medicare, Medicaid, Commercial, HCFA 1500 claims, hospital UB92 claims processing, encounters, provider reimbursements, and medical records review for ACA and JACHO audit.
• Designed Employee Engagement Survey questions with MS PowerPoint template for system deployments.
• For Confidential, supported and coordinated special project for process improvement regarding Healthcare Reform.
• Processed HCFA 1500 claims, adjurations for three and a half years at Foundation Health Insurance.
• MACESS claims reduced provider payments and reimbursements to under 30 days at Confidential Health Insurance.
• Facilitated Six Sigma subject matter expert focused group five participants to develop level one process improvement standard operating procedures, policy and procedures and a checklist for each customer service inbound and outbound calls.
• Facilitated contact center knowledge management focused group for 10 management staff for updating standard operating procedures, policy and procedures.

PROFESSIONAL EXPERIENCE

Business Process Improvement Consultant

Confidential, Philadelphia, PA

Responsibilities:

• Agile methodology, systems analyst, Data analyst and deployment; Under the direction of Lean Six Sigma Black Belt Director/SharePoint Administrator: Process modelling/Managed, build, approved/entered system access deployed Contact Center first SharePoint 2013 ticketing system over 300 project requests from go - live. Provided end user support, training during, and after system deployments and tracked internal project request. Worked with governance guidelines.
• Agile methodology, systems analyst, process improvement; Operations team and I worked closely with IT development, software engineering group to enhance Customer Care process flows to ensure adverse events and reportable events, call center related issues are sent to appropriate departments for analysis and further processing in accordance with requirements.
• Agile methodology; Attended monthly leadership, Enterprise Core Transformation meetings, stand up meetings, new systems implementation and new line of business implementation meetings.
• Collaborated, research Six Sigma best business practice to develop level one process improvement associate goals, inbound and out bound calls, developed internal complaints audit MS Excel audit request to build in system for Complaints and Grievance Call Center. Interviewed SME’s and collected data. Internal compliance approved the request and currently being implemented.
• Collaborated, identified with cross-functional teams, to monitor and assess quality assurance with inbound and out bound call documentation in MACESS Exp and Verint.
• Communications employee engagement survey manager; Ensured clear, concise and effective communications of material Lead. D esigned the survey dashboard template for system deployments with reporting statistics. Developed go-live systems deployment survey in Survey Monkey. Communicated survey statistics via email with a staff of 400 internal associates, 15 managers, supervisors, and stakeholders. Data used to improve customer service operations by 30%.
• Directed Six Sigma process improvements, quality on gaps required in existing processes that impact call routing, forecasting, scheduling, change management and reporting for associates timely outbound campaign calls.
• Developed Six Sigma DMAIC customer journey mapping. Developed MS PowerPoint presentation for Vice President and stakeholder to demonstrate customer experience expectations on the first call and call backs. Monitored customer service recorded calls to make business recommendations.
• Enterprise operations business team member and consultant; Created, designed detailed MS VISIO swim lanes for business continuity planning from as-is to future state mapping for various business managers and stakeholders. Worked with IT Telecom to ensure all associates IGEL worked at home prior to inclement weather.
• Language; Worked with Spanish employee, peer and IT voice team to record voice.
• Meetings; Attended WebEx meeting and type notes “live” questions while on sharing screen with attendees.
• New business development; Gave business recommendations on best practice. Developed MS Word meeting notes, to-do list, and follow up to completion.
• Knowledge management lead; Managed, collaborated with Contact Center Knowledge Management stakeholder with contact center new process for all standard operating procedures, expired, renewal of policy, online track changes per quarter, and annually distribution by email and attended on-going meetings. Developed MS excel worksheet to track and report to upper management.
• Process improvement/Data Analyst; Developed Six Sigma continuous improvement programs approved by stakeholder to deliver recommendations associate and customer feedback, process modelling, send data to cross functional partners such as department managers and stakeholders during the pilot and go-live stages. Reviewed on a weekly basis during go-live and monthly.
• Process modelling; Worked with workforce planning manager, director and business analysts to coordinate associate time off the phones for up training, outbound campaign policies and procedures.
• Process modelling/Systems analyst; Worked with peers to established, lead and executed Customer Care training program with training department to support knowledge base and readiness of Customer Care staff related to new products and services.
• Reviewed approved vendor BRDs, RFPs scope documents to compare requested requirement for Web Chat and mobile app.
• Six Sigma, process modelling, quality, agile methodology; Developed employee performance management Created pilot MS Excel workbook for Complaints and Grievance Department team of 13. Worked with peers and SME’s. Developed Six Sigma internal level one quality checklist score card and presented to internal compliance and audit team to establish first audit system. Developed MS Word chart with one-page quality audit validation, improved documentation by department by 30%.
• Developed first time study on MS Excel per associate for finance tracking, budget and resource.
• Systems analyst/Data analyst; Worked with IT to enhance data collection for timely, accurate data analysis, reporting for monitoring and optimizing customer product use from end to end. Worked with IT in meetings to establish how many rings before call is answered and or dropped. IT created call flows and created additional workflows for repeat callers.
• Systems Analyst/Data analyst; Ran canned query reports in MACESS Exp to determine root causes for various process improvement projects and service level.
• Verint used to listen to incoming calls for auditing and employee feedback.
• Tableau-Learning phase of cleaning up canned reports for email distribution.
• Talent Acquisition onboarding/Systems analyst; Worked with human resource assistant and training SME and stakeholder to develop new hire systems access for within three days of start date.
• Interview: Interviewed prospective candidates for hire. Worked with peers on the reviewing the resumes selection and process.
• User Stories created on MS PowerPoint to show the process of the customer service and acceptance.

Business Process Improvement Consultant

Confidential, Silver Spring, MD

Responsibilities:

• New business; Worked with peers on communication and project. Provided daily assistance to EDI coordinator; researched all-new remits from providers for EDI 999; list providers name, TIN, clearing-house, and clearing-house name on EDI form for IT to establish request.
• Systems analyst; Used business objects database to validate MAS, new and existing vendor master set-up for electronic billing and reimbursement. Used business objects applications and tools used to process electronic paper data request from new vendors and submitted to IT to set-up on back end.
• Data analyst: Evaluated data pertaining to claims, and encounters in order to enhance efficiency, quality, and cost effectiveness with key business units, providers, and vendors.
• Provided accurate, compliant and timely support to claims administration by ensuring that activities follow different organizational, regulatory, and industry standard.

Provider Network Operations Specialist SME

Confidential, Miramar, FL

Responsibilities:

• Employee performance; Leadership Initiative Project Member selected for a committee to streamline and improve employee relations.
• New business development; Worked with peers from various teams on Healthcare Reform implementation. Attended weekly two year meeting for development of new business strategies for new product lines commercial, dual Medicare and Medicaid for go-live implementation.
• Provider network contracts; Manager Mid-West USA region provider deals for CMS Medicare, Medicaid deals as per contract. Worked with peers on USA territory market sales representative on provider contract, terms, negotiation, rates, premium and bad debt percentages.
• SharePoint used to pull contracted provider signed approved and pending contracts.
• Process improvement/data analyst; Worked with customer service, enrollment, provider contract to reduced MACESS EXP claims aging from over 120 days to under 30 days for contracted providers.
• Supported and coordinated 2014 special project for Healthcare Reform process improvement implementation.
• Systems analyst/data analyst; Managed Lotus Notes database enhancement upgrade and created MS Word training documents.
• Worked with peers on SharePoint MS VISIO as-is modelling to future state to migrate Lotus Notes Database into new SharePoint system go-live deployment.
• Hodmod 4 used to manually enter provider rates and reimbursements.
• Canned market reports; Manually ran MS access database SQL canned query provider payment reports for monthly team meeting.