Experience

SeniorBridge

• United States
• Hospitals and Health Care
• 100 - 200 Employee

• Business Improvement Lead

  • Dec 2019 - Present

  Develop consistencies and process improvements across the business, including recruiting, retention and caregiver training oversight. Develop consistencies and process improvements across the business, including recruiting, retention and caregiver training oversight.



Humana

• United States
• Insurance
• 700 & Above Employee

• Claims Interest & Penalties Manager

  • Jan 2017 - Dec 2019

  • Manage the research and review of claims for reinsurance claims with Actuarial department• Assign, track and respond to auditor inquiries and criticisms regarding claims payment determinations• Develop and improve interest and penalty reporting capabilities• Manage claims letter intakes and process improvements• Reduce provider interest and penalty payments through operational efficiencies• Manage analysts and consultants on both personal and professional development

• Strategic Vendor Alliances Manager

  • Dec 2013 - Jan 2017

  • Manage $39M vendor budget across multiple programs.• Provide key operational insights and support, optimizing the business model.• Monitor performance metrics and SLAs in accordance with the contract.• Resolve risks and issues in a timely manner, facilitating resolution between vendor and Humana key contacts.• Improve operational efficiencies both internally and externally.• Support compliance with annual audit, working with vendor to resolve any identified corrective action plans.• Publish monthly dashboard, tracking key metrics and budget.• Ensure Code Repository, Claims logic, PAL codes and vendor reviewed codes are all maintained and aligned.

• RxMentor Manager

  • Apr 2011 - Dec 2013

  •Develop consultation efficiencies for Medication Therapy Management (MTM) program.•Develop operational efficiencies within the RxMentor call center team.•Build trust and human capital within team and department.•Manage auditing & training of MTM pharmacist consultation program.•Manage auditing & training of RxMentor call center representatives.•Produce yearly CMS reporting and submissions in accordance with CMS guidelines and specifications.•Increase internal CMR consultations by 200%•Collaborate with vendors to improve operational efficiencies with retail pharmacy network.•Manage daily work and project assignments of staff of analysts and consultants.

• Strategic Consultancy Business Consultant

  • Sep 2008 - Apr 2011

  •Develop Provider Quality SharePoint site, housing all department metrics, documentation and training material, as well as creative space for team interaction.•Create new associate onboarding SharePoint site.•Develop and implement QuickTurn process to reduce audit cycle time, increase inter-departmental communication and improve productivity for hospital and physician teams.•Overhaul Dental metrics and database reporting.•Produce audit metrics for Physician, Hospital, CIS and Dental teams on multiple platforms.•Gauge repeatability and reproducibility of audit teams and establish calibration sessions to close identified gaps.•Develop and manage the audit sample process for CIS, Physician, Hospital and Dental, restructuring as needed according to business impact.•Manage daily work, project assignments and production of nine analysts.

• PNO Claims Process Consultant

  • Jul 2007 - Sep 2008

  •Improve Humana payer ranking to #1 as liaison with athenahealth, reducing the denials of claims through batch and RTCA.•Implement $1.6M process improvement through Urgent Care Black Belt project.•Participate in key projects to improve and standardize claims processes.

• PNO Claims Policy Consultant

  • Jul 2006 - Jul 2007

  •Research and develop Business Cases for Policy and Process issues.•Perform analysis for CBAs, showing value of business cases.

• Service Operations Front Line Leader (Supervisor)

  • Jun 2005 - Jul 2006

  •Score in 75th percentile of Q12 as Front Line Leader.•Assist in automation of Prex letters and claims payment processes for Prex.•Manage daily work and production of Team Lead and 15 Specialists.•Improve quality and production for Prex team.

• Service Operations Analyst

  • Jan 2005 - Jun 2005

  •Analyze audits, claims and adjuster feedback to develop process improvements.•Create training materials for use with the Metavance platform.

• Service Operations Team Leader

  • Aug 2004 - Jan 2005

  •Validate over 90% of original Ex Codes in Mentor, used by all Metavance claims adjusters.•Develop relationships with numerous support areas in both LV and GB.•Act as go-to person for Claims Processing specialists.

• Service Operations Claims Processing Specialist

  • Oct 2003 - Aug 2004

  •Adjust claims with high productivity and quality, based on Mentor guidelines.



Service Systems Associates

• Human Resource/Cash Manager

  • Jan 2000 - Oct 2003

  •Interview, hire and train 75+ employees annually.•Create new hire documentation and updated training materials annually.•Count, deposit and maintain banking for $1.5M+ sales annually.•Implement Rewards and Recognition program.•Provide daily and weekly A/R, A/P, payroll and sales reports.•Process payroll and maintain employee files for 75+ employees annually. •Interview, hire and train 75+ employees annually.•Create new hire documentation and updated training materials annually.•Count, deposit and maintain banking for $1.5M+ sales annually.•Implement Rewards and Recognition program.•Provide daily and weekly A/R, A/P, payroll and sales reports.•Process payroll and maintain employee files for 75+ employees annually.



United Artists Theatre Circuit

• Payroll Coordinator

  • Apr 1998 - Jan 2000

  •Process in-house payroll for 5000+ employees nationally.•Process garnishments for 200+ employees nationally.•Write payroll training manual, distributed nationally among theatre managers.•Receive Employee of the Month honors, October 1999. •Process in-house payroll for 5000+ employees nationally.•Process garnishments for 200+ employees nationally.•Write payroll training manual, distributed nationally among theatre managers.•Receive Employee of the Month honors, October 1999.