Multi-talented Consultant offering 20 years of experience in orchestrating operations activities, financial support, scheduling and resource management to achieve project objectives. Poised and cooperative in driving stakeholder meetings to determine estimates, build financial forecasts, develop budgets and define project timelines. Detailed in operational growth and sustainability. Motivated to deliver projects on time and within established budget by monitoring progress, enforcing deadlines, ensuring cost controls and resolving problems quickly and effectively. Expert in managed care, process improvement, technology and provider satisfaction.
· Developed a strong understanding of United HealthGroup's strategic business objectives and operations
· Provided project management oversight, monitoring, data collection and analytical support.
· Worked with Regional management ensuring that objectives are met. Confirming with project stakeholders understand the scope and deliverables of each project.
· Developed process plan for current initiatives and assists with improvement design. Provided facilitation support as meeting as needed. Developed trusted relationships with cross functional department leads.
· Coordinated activities in defining the scope of projects, developed project plans ensuring progressive momentum of project toward stated goals. Tracked and monitored project work plans including objective tasks and time frames to ensure deliverables are completed on time. Identified and respoms to changing project circumstances and communicated issues to project leadership
· Planned training to educate internal/external parties for new process or policy changes
· Prepared reports defining project progress.
· Implemented and managed project changes and interventions. Provided solutions and handled issues as they arose during implementation or after.
· Participated in the design and delivery of presentations to senior management.
· Escalated operational issues to management assists with developing solutions and coordinating implementation.
· Prepared root cause analysis on providers aged accounts receivables – processed for settlements if needed.
· Primary Contact for all department of insurance and member complaints/appeals, performed internal and external (vendor) investigation and research, collaboration with internal cross functional team and external vendors to reach a final resolution within allotted time frame, communicated with C-level management, and then to appropriate person(s) or agencies.
· Analyzed monthly UCRT reports for cost savings opportunities, worked directly with Affordability Team to implement a campaign to effectively target the identified cost savings opportunities. Monitored and reported monthly status to C-level management.
Reconciliation of national provider locations vs. UHC provider directories
· Mentored peers in daily activities; built team skill set and expertise
· Communicated industry changes – policy, market trend, technology and corporate staff changes
• Contracted supervisor to manage the enrollment of NuHealth medical staff into managed care plans.
• Established strong external relationship with managed care representatives.
• Management of staff (03) clerks
• Developed various status reports for C-level management
• Presented policy updates in regards to managed care procedures and policies to C-Level management.
• Built and maintained positive provider relationships in assigned territory
• Developed and maintained contact with providers, ensuring they were aware of changes in products, policies and/or processes.
• Ensured that provider expectations were met on all levels
• Maintained a strong knowledge of industry standards
• Oversaw project management of all provider projects, with high level working knowledge of all projects to assist in issue escalation/resolution
• Created various provider reports and creative projects- provide brief documentation to keep internal/external parties aware of status and outcome.
• Developed client ready presentations
• Demonstrated consistent follow up on all external and internal issues
• Maintained accurate timeline reporting and updates via Excel and Tableau
• Developed simplified automated work flows
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