LiveCareer
LiveCareer
  • Dashboard
  • Jobs
  • Resumes
  • Cover Letters
  • Resumes
    • Resumes
    • Resume Builder
    • Resume Examples
      • Resume Examples
      • Nursing
      • Education
      • Administrative
      • Medical
      • Human Resources
      • View All
    • Resume Search
    • Resume Templates
      • Resume Templates
      • Nursing
      • Education
      • Medical
      • Human Resources
      • Customer Service
      • View All
    • Resume Services
    • Resume Formats
    • Resume Review
    • How to Write a Resume
    • CV Examples
    • Resume Objectives
  • Cover Letters
    • Cover Letters
    • Cover Letter Builder
    • Cover Letter Examples
      • Cover Letter Examples
      • Education
      • Medical
      • Human Resources
      • Customer Service
      • Business Operations
      • View All
    • Cover Letter Services
    • Cover Letter Templates
    • Cover Letter Formats
    • How to Write a Cover Letter
  • Jobs
    • Mobile App
    • Job Search
    • Job Apply Tool
    • Salary Calculator
    • Business Letters
    • Job Descriptions
  • Questions
  • Resources
  • About
  • Contact
  • 0Notifications
    • Notifications

      0 New
  • jane
    • Settings
    • Help & Support
    • Sign Out
  • Sign In
Member Login
  • LiveCareer
  • Resume Search
  • Operation Improvement Manager
Please provide a type of job or location to search!
SEARCH

Operation Improvement Manager Resume Example

Resume Score: 100%

Love this resume?Build Your Own Now
OPERATION IMPROVEMENT MANAGER
Summary
Qualified Customer Service Manager offering a record of successful job performance, proven problem solving ability and experience developing and implementing innovative solutions. Innovative Customer Service Manager who effectively executes process changes to improve operational efficiency.
Skills

Very Proficient in the following applications: Microsoft Word, Microsoft Excel, Microsoft Internet, Microsoft Outlook, EzCap, Facets, Macess, Clinical Coding Expert, Pegasus Encoder Pro- Ingenix, HIMS, QStar, Image Onsite, Avaya CMS, Nice, Medi Span, Calabrio, Virtual Credentialing, Cisco Web view and SharePoint.

Experience
Operation Improvement Manager
April 2011 to Current
Universal American Corporation - Houston, Texas
  • Create training manuals targeted at resolving customer issues.
  • Provide detailed monthly departmental reports and updates to senior management.
  • Resolve customer questions, issues and complaints.
  • Develop and implement policies, procedures and process improvement initiatives to improve retention rates and increase customer satisfaction.
  • Recommend changes to existing methods to increase the accuracy, efficiency and responsiveness of the customer service department.
  • Implement recommendations for improvement.
  • Conduct ongoing analysis of CTMs for continuous process improvements, improved efficiency and improved customer satisfaction.
  • Support quarterly physician meetings and resolve customer service issues identified by providers and their offices.
  • Support CMS audits Support off-site member retention and sales event meetings.
Call Center & Claims Research & Resolution Manag
March 2010 to April 2011
Universal American Corporation - Houston, Texas
  • Responsible for the professional and performance development of staff Review/create departmental policies and procedures to assess compliance with functional and operational requirements.
  • Responsible for monthly budget adherence.
  • Responsible for supervising and evaluating work flow and call volume.
  • Ensure department staff is appropriately trained and quality assurance goals are achieved.
  • Ensure adherence to Centers for Medicare and Medicaid CMS requirements, guidelines and standards.
  • Conduct monthly monitoring and auditing activities to identify and assesses areas of compliance risk and recommend opportunities for improvement.
  • Monitors team performance trends and coach staff to ensure adherence to policy, procedure, and the highest level of customer service.
  • Responsible for performance of all lines of business (PFFS, PPO and HMO) Responsible for meeting and exceeding monthly goals.
  • Responsible for reviewing all training materials for both Resolution and Retention units.
  • Responsible for tracking CSR productivity via daily, weekly and monthly productivity reports.
Call Center & Claims Research & Resolution Supervisor
March 2002 to March 2010
Universal American Corporation - Houston, Texas
  • Supervise HMO Call Center of 10 CSR's that consists of verification of eligibility, benefits, claims, authorization and appeal status to effectively implement specific client goals that develop an excellent rapport with clients.
  • Supervise Research & Resolution Call Center of 5 CSR's that consist of escalated calls, irate providers and provide images of cashed checks to the providers.
  • Run daily call stat reports for all Call Center skills on ACD calls, average talk time, abandonment rate, aux time, staffed time.
  • Perform Quality Assurance on CSR calls, provide feed back and coach as needed.
  • Incentive Program to recognize employees that go above and beyond on calls that score 100%.
  • Perform detailed reviews and analysis of support efforts including the implementation of process changes and other trends which improve client service levels and simultaneously, eliminating the possibility of penalties assessed by the client for under performance of call center performance goals.
  • Process claim payments in a timely manner and in accordance with contract terms which are specific to each provider resulting in overall increase in team productivity for Medicare, PFFS, PPO & HMO.
  • Review certificate of medical necessity for ambulance claims.
  • Utilized claim system to process claims, write up findings and actions taken to correctly adjudicate insurance claims.
  • Perform comprehensive research related to the facts and circumstances of a complaint, grievance, or appeal received and responsible for appropriate resolution to the appeal/ grievance in accordance with CMS guidelines.
  • Review certificate of medical necessity for ambulance claims.
  • Utilized claim system to process claims, write up findings and actions taken to correctly adjudicate insurance claims.
  • Perform comprehensive research related to the facts and circumstances of a complaint, grievance, or appeal received and responsible for appropriate resolution to the appeal/ grievance in accordance with CMS guidelines.

Medical Assistant
February 2001 to March 2002
Ramon Pineda, MD - Pasadena, Texas
  • Check patient vital signs, draw blood, vaccinate, assist physician with in office procedures and perform radiology x-rays.
  • Prepare lab specimens to send out to Labcorp and Quest Laboratory.
  • Contact patient to schedule an appointment for lab results.
Education
Certified Medical Assistant : 2005National Institute of Technology - Houston, TX
High School Diploma : 2001Willowridge High School - Missouri City, Texas
Professional Development

Universal American Corporation- Lean Sigma Yellow Belt

Build Your Own Now

DISCLAIMER

Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

Resume Overview

Companies Worked For:

  • Universal American Corporation
  • Ramon Pineda, MD

School Attended

  • National Institute of Technology
  • Willowridge High School

Job Titles Held:

  • Operation Improvement Manager
  • Call Center & Claims Research & Resolution Manag
  • Call Center & Claims Research & Resolution Supervisor
  • Medical Assistant

Degrees

  • Certified Medical Assistant : 2005
    High School Diploma : 2001

Create a job alert for [job role title] at [location].

×

Advertisement

Similar Resumes

View All
Operation-Manager-resume-sample

Operation Manager

GUJARAT TIN MANUFACTURING COMPANY AHMEDABAD Gujarat

Arlington, Texas

Operation-Manager-resume-sample

Operation Manager

Culinaire International

Naperville, Illinois

Operation-Manager-resume-sample

Operation Manager

Shoun Trucking Company, Inc.

Morristown, Tennessee

About
  • About Us
  • Privacy Policy
  • Terms of Use
  • Sitemap
Help & Support
  • Work Here
  • Contact Us
  • FAQs
Languages
  • EN
  • UK
  • ES
  • FR
  • IT
  • DE
  • NL
  • PT
  • PL
Customer Service
customerservice@livecareer.com
800-652-8430 Mon- Fri 8am - 8pm CST
Sat 8am - 5pm CST, Sun 10am - 6pm CST
  • Stay in touch with us
Site jabber winner award

© 2021, Bold Limited. All rights reserved.