SUMMARY

• Development & Delivery
• Technical Writing
• Quality Assurance Testing
• PBM Management
• Project Management - Implementation
• Process Improvement
• Test Plan development
• User Acceptance Testing
• Various reporting functions
• Performance Coaching & Feedback
• Performance Metrics Development
• Adult Learning Principles
• Organization skills
• Effective communication skills
• MS Windows proficient
• Mac OS X proficient

PROFESSIONAL EXPERIENCE

Confidential, Richardson, TX

Provider Services Representative

Responsibilities:

• Respond to and resolve on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence.
• Help guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to include managing their health and well-being by selecting the best benefit plan options, maximizing the value of their health plan benefits and choosing a quality care provider
• Intervene with care providers (doctor's offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance when needed
• Assist customers in navigating myuhc.com and other UnitedHealth Group websites and encourage and reassure them to become self-sufficient
• Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member
• Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues
• Provide and status on previously submitted pre-authorizations or pre-determination requests
• Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance
• Health care provider support of benefits and eligibility, claims processing, and medical intake
• Data driven analytical service support role
• Knowledgeable of medical coding and billing
• Knowledgeable of Medicare / CMS guidelines
• Experienced with iSet, UNET, Prime, and CDB

Confidential, Dallas, TX

Testing Administrator

Responsibilities:

• Administer both written and computer based testing. (Teaching cert., college testing, state mandated assessment test for students entering college, GED testing, etc.
• Confidential Testing Center check-in. Security verification. (Photo I.D.)
• Travel to area high schools within DISD to administer college assessment tests.
• Receives testing materials and maintains records and logs of materials and testing times.
• Forwards completed exams to instructors.
• Serves as back-up to staff by assisting with administrative duties as needed.

Confidential, Richardson, TX

Med-D PA Admin/Clinical Services Supervisor

Responsibilities:

• Resource allocation planning and prioritization of client implementation schedule.
• Create BSR identifying proposed system enhancements.
• Create test plans for functional code testing and regression testing.
• Manage a team of 22 analysts. Software testers. User acceptance testing (UAT)
• Create test case scenarios to execute functional code testing and regression testing.
• Lead monthly software deployments; code updates, security enhancements, client update request.
• Managed user provisioning for UAT group.
• Lead quarterly audit of client configurations in to ensure compliance.
• Lead internal sessions in the areas of compliance, functionality, updates to policy and procedures.
• Monitor the production and quality of direct reports.
• Create colleague evaluation and development plan.
• Provide coaching and feedback.
• Experienced in SalesForce (CRM)
• Skilled in clinical services systems, MedHOK, AS 400 / RX Claims.

Confidential, Coppell, TX

Support Center Supervisor

Responsibilities:

• Managed a team of 15 customer/field support agents
• Created business processes in the areas of, workforce management and employee development
• Wrote standard operation procedure documents
• Developed performance metrics (quality assurance, schedule adherence, interactions per hour, productivity, etc.)
• Coaching and Feedback
• Quality calibration sessions
• and development co-coordinator
• Meet performance measurements in the areas of team performance, timely payroll submission, weekly analysis to center director, team attendance, participation in developmental

Confidential, Richardson, TX

Business Analyst

Responsibilities:

• Data analysis to identify opportunities
• Develop curriculum
• Create standard operating procedure document
• Developed performance metrics
• Performed quality audits
• Lead monthly calibration sessions
• Coached support-agents to performance goals

Confidential, Irving, TX

Business Analyst

Responsibilities:

• Lead a 12 person team tasked with high value commercial accounts in arrears
• Lead Process Improvement Team calibration sessions
• Authored / updated standard operation procedure documents
• Developed and delivered
• Reduced a back-log of accounts in arrears (per criteria) from over 40,000 to under 10,000 in months
• Collected over 2 million in revenue from accounts that were in arrears due to billing disputes or errors in billing

Confidential, Addison, TX

Responsibilities:

• Develop and deliver software to internal and external clients
• Travel to customer site to deliver software raining; 75% travel
• On site delivery of shaft ware to multiple end-user groups
• Maintain Service Level Agreeements with clients in the areas of on-site and service support
• Create client presentations outling services and support structure
• Various reporting functions
• Lead implementation team during data and software conversions