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Skills

  • Pharmacy operations management
  • Member satisfaction program development
  • Project oversight
  • Seasoned in medical clinical procedures
  • Appeal process improvement
  • Managed care program audits
  • Cost avoidance strategies
  • Claims auditing and documentation
  • Occupancy strategies
  • Multidisciplinary team collaboration

Work Experiences

  • Planned surgeries, handled pre-certifications, and double-checked insurance coverage.
  • Achieved revenue growth in 2024.
  • Provided information on various immunizations to patients and patrons, including flu, DTaP, and HPV vaccines.
  • Created and updated HIPAA, benefits administration, and general liability policies and procedures while adhering to statutory, regulatory, and local, state, and federal guidelines.
  • Collaborated with finance, claims, and third-party vendors.
  • Collaborated with payers to resolve disputes.
  • Boosted team compliance understanding by 75%.
  • Analyzed clinical and financial data to identify improvement areas, resulting in a 44% increase in cost avoidance for high-utilization members.
  • Hired, trained, and supervised all employees, as well as providing direct supervision, ongoing staff development, and continuing education.
  • Collaborated with claims and legal departments.

Summaries

  • With more than 10 years of experience managing operations in patient-centered medical offices, this professional is highly skilled and enthusiastic.
  • Achieved 82% timely completions.
  • Advanced proficiency in healthcare regulation compliance.
  • Analyzed clinical data.
  • A gifted individual who speaks 2 languages fluently.
  • Coordinate patient admission and discharge.
  • Exceptional communicator and proven problem solver.
  • Achieved a sustained annual increase of 77% in member satisfaction.
  • Accomplished at managing high-impact care optimization efforts, driving a 45% reduction in emergency room utilization across Columbus over 2018.
  • Astute professional with extensive experience in pharmacy operations and performance metrics.

Accomplishments

  • Designed and delivered provider training programs on care optimization protocols, contributing to a 80% reduction in readmission rates.
  • Created and implemented reimbursement training programs that improved claim approval rates by 64% while reducing appeals.
  • Successfully negotiated contracts with 7-plus payers that achieved a 64% increase in per capita reimbursement rates.
  • Oversaw a transition to paperless billing for 2 managed care providers, trimming administrative costs by $5,000 per month.
  • Implemented proactive claims and reimbursement audits, leading to the recovery of $72,000 in previously unclaimed revenues.
  • Analyzed member satisfaction surveys and implemented actionable improvement steps that increased satisfaction rates by 85%, reversing previous negative trends.
  • Led telehealth policy initiatives that increased member access to care and reduced overall healthcare expenditures by $234,000 per year.
  • Implemented digital claims submission protocols that reduced administrative days to payment by an average of 16 days per claim.
  • Facilitated contract renegotiations with 15 payers, achieving 24% more favorable terms for the organization.
  • Collaborated with team of 11 in the development of program.

Affiliations

  • International Association of Administrative Professionals
  • Rotary International
  • Association for Supply Chain Management (APICS)
  • Certified Medical Compliance Specialist (CMCS) through Summit Group - Expertise in Managed Care
  • Member of the Academy of Managed Care Pharmacy (AMCP)
  • Association of Information Technology Professionals
  • Leader of Care Coordination in Population Health Council for Lakeside Partners Portland
  • Lions Club
  • Association of Managed Care Professionals (AMCP) Member
  • American Medical Informatics Association

Certifications

  • Certified Public Accountant (CPA)
  • CompTIA A+ Technician
  • SHRM Senior Certified Professional (SHRM-SCP)
  • CompTIA Security+
  • Project Management Professional (PMP) - process
  • First Aid/CPR Certified
  • Accredited Health Care Fraud Investigator (AHFI) – NHCAA, 2016
  • National Committee for Quality Assurance (NCQA) Health Plan Accreditation – 2022
  • Cisco Certified Network Associate (CCNA)
  • Certified Coding Associate (CCA) – AHIMA, 2020

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