SUMMARY

• Trusted Manager with extensive analytical skills and experience in both the healthcare and finance industries.
• Known for developing highly effective teams that meet quality and productivity standards.
• Recognized for creatively solving complex systems issues with creative thinking.
• A collaborative communicator, with a strategic and innovative style to effortlessly increase automation, by streamlining processes for optimal efficiencies, to aid in reducing cost.

Areas of Expertise

• Business Partnering Relationship Management Operational/Analysis
• Sr. Management Communication
• Customer Focus/Satisfaction
• Inventory Management/Reduction
• Strategic Initiative Implementation
• Client/Vendor Management
• Roster Reporting/ Data Specification/Metrics
• Due Diligence - Controls
• Managing Projects
• Documentation: Ops Procedures, BRD’s
• Internal/External Audit Mgmt.
• Process Improvement
• Ops Efficiencies/Reengineering
• Compliance/Risk Management
• Process Documentation
• DataAnalysis: QA/UAT/TESTcases/Big Data

TECHNICAL SKILLS

Operating System: Salesforce, FPRS, DST, Monument, Oracle, Bene-Soft

Hospital Reimbursement Payment Methodologies: APR-DRG, MS-DRG, eAPG

Manager/Supervisor: Ability to align myself with the vision of a successful organization; Applies job/business knowledge to aid in making effective decisions and sound judgement; act with integrity; leads and influence others; encourage inclusive and collaborative behavior, contributes creative ideas, embrace and manage change.

Finance: Knowledge of ERISA laws, Qualified/Non-Qualified Retirement Plans, Form 5500 Reporting

Healthcare: Public Sector (M-Caid/M-Care), Plan and Supplemental Benefits. Solid understanding of EOHHS/CMS Regulatory Requirements, CPT, HCPS, ICD-10, various coding guidelines.

PROFESSIONAL EXPERIENCE

Confidential

Enrollment Analyst/ Supervisor

Responsibilities:

• Managed, coached, and developed a team of direct reports, responsible for processing enrollment applications for providers within the Steward Network.
• Monitored work queues for volume control, and ensure associates met SLA’s.
• Facilitated team meetings and conducted coaching sessions on associates, growth and development
• Participate in meetings with external vendors, as well as other SHCN departments on issues and updates
• Prepare, reconcile, and transmit enrollment data files to various Health Care Payors
• Evaluate enrollment business requirements and provide solutions for optimal effectiveness
• Identify gaps in business processes and provide methods needed to streamline inefficiencies
• Develop and maintain timely file transmissions between external vendors and SHCN
• Assist in developing and distributing daily, weekly and monthly enrollment reporting
• Work closely with development teams in documenting, testing and implementing enhancements

Confidential

Reimbursement Configuration Supervisor

Responsibilities:

• Queried and quantified data for accurate reporting specifications as well as for preparation of Quarterly dashboard reports.
• Completed QC of all configured changes in TEST environment
• Documented, Maintained and Implemented department policies and procedures
• Build effective relationships with business partners, took initiative to streamline processes
• Analyzed complex configuration processes and assisted in providing methods for solutions
• Developed and maintained custom reporting to track inventory and productivity, actively monitor work queues for distribution and prioritization
• Completed metrics for staff compensation, documented and conducted annual performance appraisals and development plans, approved EE timesheets timely
• Supported and participated in the Implementation and Testing of departmental projects, initiatives, system driven fixes, and enhancements
• Managed Account Set up and ongoing maintenance of claim research and reconciliation

Confidential

Service Operations Manager

Responsibilities:

• Managed, coached, and developed a team of 12 direct reports, responsible for correcting issues with participant loans, withdrawals, transfers, exchanges etc.
• Monitored work queues for volume control, and ensure associates met SLA’s.
• Facilitated team meetings and conducted coaching sessions on associates, growth and development
• Conducted qc on New Business account set up, as well as ensured 100% qc of less tenured associates
• Documented and delivered associates reviews, and development plans
• Perform QA on production upload of nightly pricing files from various outside mutual fund companies
• Escalated and fixed pricing errors before nightly cycle of production activity
• Analyzed monthly reports for trending purposes, utilized in senior management departmental organizational updates
• Participated as a subject matter expert in requirement sessions for system fixes and enhancements

Confidential

Conversion Analyst

Responsibilities:

• Worked independently as part of a project team to successfully move over 50 Billion in assets to an open architecture platform
• Created, maintained, and amend documents, and plan service agreements based on legislative changes or plan sponsor request
• Constantly communicated with wholesalers, brokers and client/relationship managers to ensure clients expectations and deadlines were met
• Act as primary interface between Project Managers, Business Unit and Systems Development areas
• Created and designed the Plan Administrators Manual for new Client Conversations
• Documented requirements, and operational processing to accomplish New Business Objectives
• Utilized codes from an Integrated (Oracle) Data Base, to design, build, and develop detailed Client Reporting specifications
• Interpreted systematic problems and provide initial analysis toward resolution
• Developed test cases and identified Test populations for UAT and Regression testing
• Assisted in Testing of Web and Phone System for New Business client Onboarding
• Assisted with the identification of test data cases and / or performed UAT on various projects, installations, or system enhancements