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PMHS/PPS Provider Selection Fallout-External Data Selection Management Team Resume Example

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PMHS/PPS PROVIDER SELECTION FALLOUT-EXTERNAL DATA SELECTION MANAGEMENT TEAM
Professional Summary

Outgoing, self motivated team player eager to contribute dynamic customer service, team building, and organizational skills towards supporting the objectives of an organization that rewards reliability, dedication, and solid work ethics with opportunities for professional growth.

Skills
  • CQI analysis
  • Organized
  • Multi-tasking
  • Workflow analysis
  • Microsoft, Word, Excel

EDSM/CQI Analytics

PMHS,PPS, and HCPM knowledge

Critical Thinking

Root Cause and data analysis

 

 
Work History
June 2013-Current PMHS/PPS Provider Selection Fallout-External Data Selection Management Team | CIGNA | 7555 Goodwin Road Chattanooga, TN 37421

 

  • Maintain proficient knowledge of all work streams to assist in identifying opportunities to improve the match rate and/or eliminate provider selection fallout for PCS, PPS, and HCPM.
  • Critical thinking and root cause analysis.
  • Working knowledge of microsoft, excel, word, power point, visio, QMF, CPF/PWB, PMHS, PPS, Facets, HCPM, Itrack, Webex, CQI EDSM Analytics, SIPOC.
  • Mapped process activities to desired outcomes to rectify operational inefficiencies.
  • Documented business processes and analyzed procedures to see that they would meet changing business needs.
  • Partnered with all matrix partners on CQI projects.
  • Provided complete meeting support including scheduling, preparing materials, and taking notes.
  • Created reports and presentations.
  • Coordinated special projects and managed schedules.
  • Made proactive recommendations based on system knowledge and analysis to improve performance and meet business goals.
  • Provided subject matter expertise in PMHS Provider Selection.
  • Monitored timelines and flagged potential issues to be addressed with offshore partners.
  • Collaborated with matrix partners onshore and offshore.
  • Offer research, attention to detail and organizational and problem solving skills.
  • Review all documentation for accuracy, quality and compliance.
  • Take corrective action to restore and/or maintain quality standards.
  • Performed system analysis, documentation, testing, implementation and user support for platform transitions.
  • Resolved or escalated problem tickets to resolve user issues.
  • Demonstrate ability to lead and motivate team.
  • Provide coaching and training for onshore and offshore partners.
  • Maintain proficient knowledge of all work streams to assist in identifying opportunities to improve the match rate and/or eliminate provider selection fallout.
  • Continued development of customer centricity.
  • Provided training/coaching to onshore and offshore partners.
  • Partner and volunteer with Netops Cultural Workgroup Committe and Bamboo Change Management Workgroup.

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August 2012-June 2013 PMHS Provider Selection Fallout-External Data Selection Management Team | CIGNA | 7555 Goodwin Road Chattanooga, TN 37421
  • Ensure the processing of manual fallout and deliver a highly satisfying customer outcome through accurate provider selection.
  • Maintain departmental standards for timeliness.
  • Deliver excellant performance results month over month.
  • Exceeding departmental metrix all year.
  • Self motivated and action oriented.
  • Producing 10-15% above the in office baseline goals.
  • Processed an average of 34 claims with a baseline goal of 26 claims per hour.
  • Subject Matter Expert for PMHS.
  • Proactive identification of non value work flow steps and or non workable scenarios that can be eliminated from manual process or systematically processed without manual intervention.
  • Excellent understanding of end to end selction process including portico, insight and other fallout tools.
  • Promoted a positive working environment including relationships with matrix partners, peers, and management.
  • Displayed required professional behaviors and core competencies supporting new customer centric model for Net Ops and EDSM.
January 2011-August 2012 PMHS Provider Selection Fallout- External Data Selection Management Team | Kelly Services | Shallowford6160 Shallowford Road Chattanooga, TN 37421
Education
2004 Certified Nursing Assistant: Health care Georgia Northwestern Technical College, 265 Bicentennial Trail Rock Spring, GA 30739
2004 GED: Georgia Northwestern Technical College, 265 Bicentennial Trail Rock Spring, GA 30739
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Resume Overview

Companies Worked For:

  • CIGNA
  • Kelly Services

School Attended

  • Georgia Northwestern Technical College

Job Titles Held:

  • PMHS/PPS Provider Selection Fallout-External Data Selection Management Team
  • PMHS Provider Selection Fallout-External Data Selection Management Team
  • PMHS Provider Selection Fallout- External Data Selection Management Team

Degrees

  • Certified Nursing Assistant : Health care
    GED :

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