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Resume

Qa Manager, TraineE

SUMMARY:

A detail oriented, highly ethical, results driven executive, experienced in implementations, client relationship management and process efficiencies. Proven ability to build and maintain strong business relationships with end goals of high satisfaction and retention. Able to prioritize multiple tasks, manage conflicting priorities, and utilize excellent communication skills.

SPECIALTIES:

  • Implementation (SaaS)
  • Project Management (Agile)
  • Client Service Management
  • Credentialing (NCQA)
  • Provider Liaison
  • Account Management
  • Recruitment (Onboarding)
  • Customer Service Management
  • Operations Management

SKILL:

  • Leadership
  • Communication (verbal /written)
  • Problem Solving / Conflict Resolution
  • Relationship Building
  • Time Management / Multi - tasking
  • Collaborative / Team building

EXPERIENCE:

Confidential

QA Manager Trainee

Responsibilities:

  • Learning all aspects of the Confidential department’s processes and procedures for appointment and Re-appointment of Hayes Locums providers as per NCQA and JACHO accreditation standards. Review files prior to sending for approval from Risk Management.

Credentialing Auditor

Confidential

Responsibilities:

  • Review credentialed files for new provider applicants, prior to approval by committee to ensure all verifications meet NCQA standards, and information is correct in Cactus.
  • Provide overall score and corrective feedback to credentialing coordinators to make any necessary corrections.

Director of Implementations

Confidential, Miami, FL

Responsibilities:

  • Managed Epic's at-large panel of physicians, including all customized physician panels
  • Provided all compliance review for the onboarding process of the Confidential Telehealth Technology Platform from recruitment to activation.
  • Created a work flow process for the onboarding and implementation of new physicians for both Confidential ’s panel of physicians, as well as customized physician platforms(SaaS micro-sites)

Confidential, Sunrise, FL

Project Manager

Responsibilities:

  • Responsible for streamlining and managing the provider onboarding process, interacting with executive leadership in the recruiting, credentialing, training, and scheduling departments; analyzed the workflow process and created SOP's as needed to eliminate any "stop gaps"; established deadlines for completion; ensured that operational issues were managed, focusing on the project scope with executive leadership, project, and technology teams.
  • Acted as a single point of contact for facilitating resolutions to cross functional departments or executives
  • Participated in clinical/credentialing delegation audits with Confidential ’s EVP of Clinical Ops, acting as a liaison for client to include: audit prep (task delegation, follow up, completion), onsite audit, and post audit follow up
  • Participated in weekly calls with operations/clients as needed to provide credentialing updates
  • Managed Confidential ’s panel of providers for any sanctions or actions taken on their medical license; conducted monthly reconciliations to ensure inactive providers were removed.
  • Managed Provider roster; managed new provider profiles (Behavioral Health and Medical) following affiliation approval by committee
  • Acted as main point of contact to address issues with payroll, licensing, or other concerns; assisted providers with additional training on platform (SaaS)
  • Developed key processes to streamline and manage physician onboarding from recruitment to activation with established timelines for completion, which resulted in a 30% increase in total active providers for the year.
  • Created a CVO manual for Clinical Operations t to include detailed workflows for all steps in the appointment/reappointment process
  • Assisted EVP of Operations for audit preparation for NCQA accreditation; completed project successfully, resulting in obtaining NCQA accreditation.

Implementations Manager | Client Services Manager

Confidential, Sunrise, FL

Responsibilities:

  • Post "Go LIVE" - Managed up to 50+ client accounts with end goals of high client satisfaction and utilization
  • Completed assigned tasks and projects according to appropriate timelines agreed upon with client and internal stakeholders
  • Built relationships with key decision makers and main points of contact at member employer groups
  • Monitored and communicated clients' interests and 'hot topics' to the marketing and sales teams on a regular and ongoing basis and ensure clients utilize Confidential services to realize value
  • Provided monthly, quarterly, and yearly reports for client’s utilization
  • Developed effective strategies for maintaining visibility of services and deliverables
  • Established and executed specific initiatives outlined in service level agreement (SLA)
  • Identified opportunities to develop and market additional product functionality
  • Interacted cross functionally with other department team leaders to provide issue resolution for clients to prevent escalation
  • Tracked/documented client-related escalations and appropriate action taken
  • Notified appropriate internal management of client issues and complaints
  • Participated in the development of department procedures
  • Maintained a 95% client retention rate for the year

Physician Recruiter

Confidential, Coral Gables , FL

Responsibilities:

  • Obtained provider applications through cold calling and email
  • Presented job opportunities to providers that met or exceeded their needs
  • Set up Interviews / negotiated contracts / contract execution / set up housing (if requested)
  • Established and maintained strong business relationships with physicians, in an effort to build up a working base of providers

Operations Administrator (Network Account Manager) | Physician Recruiter

Confidential, Miami Beach , FL

Responsibilities:

  • Identified physician network needs, sourced/ onboarded candidates, through various leads, cold calling and email
  • Managed provider contracts; source verification, set up NCQA credentialing
  • Trained physicians (providers) on platform (SaaS); retrain providers as needed for any software updates
  • Conducted sales webinars for potential clients; sales presentations; assisted with implementations as needed
  • Created/generated reports and spreadsheets on a weekly and monthly basis to identify needs
  • Liaison - Established and maintained positive working relationships with all “In network” physicians, both by phone and email, to address any concerns and resolve issues between the physician and CADR’s internal departments, in order to maintain retention.
  • Managed a panel of 250+ contracted physicians, maintaining an 88% retention rate over a two year period

Server/Bartender

Confidential, Oakland Park, FL

Responsibilities:

  • Obtained nursing applications through cold calling and email
  • Set up interviews / negotiated contracts / contract execution / set up housing (if requested)
  • Sourced for new job leads for internal account management department
  • Maintained ongoing communications in order to build up a working base of nurses (retention)
  • Achieved company goal for number of working nurses within the 6 month time frame

Inside Pharmaceutical Sales Representative

Confidential, Boca Raton , FL

Responsibilities:

  • Contacted physician offices and interface with doctors and their staff to educate and share information about well-advertised prescription drugs and pharmaceutical products
  • Offered samples after presentation to promote use with patients to increase product saturation
  • Conducted 30/60/90 day follow up with offices to get feedback
  • Completed an average of 150 calls per day
  • Sent emails as needed
  • Consistently achieved monthly goals as set by the department for bonus incentive

Recruiter | Account Manager

Confidential, Fort Lauderdale , FL

Responsibilities:

  • Maintained a minimum candidate base of 100 +physicians
  • Cold called prospective clients for acquiring new client accounts; identified specific needs; contract negotiation/execution
  • Created job postings; maintained an average of 65 active clients
  • Matched qualified candidates with clients and set up interviews
  • Prepared candidates for interview
  • Negotiated contracts to complete the placement process
  • Maintained ongoing relationships with both candidates and clients; generated reports as needed.

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