Responsible for oversight of the operational team to handle the day-to-day functions of the department, management of client and partner agencies needs. Review and redesign current management controls and tracking tools to ensure that all assignments, tasks and performance standards are being met. Utilize professional knowledge of business administration to evaluate department processes, makes recommendations for redesigning workflows and streamlining operations to improve or create standards. Oversee development and preparation of financial, statistical and management reports.

Lead credentialing team in a fast pace and demanding business environment. Credentialing various healthcare providers for numerous clients, complying with Joint Commission, Client and state/federal requirement. Moved to electronic file environment and identified/implemented various process improvements.

Lead daily operations and associates credentialing medical practitioners for Anthem, various Blue Cross markets and external clients. NCQA certified CVO meeting Initial and Recredentialing requirements and deadlines. Client performance.

Built and maintained strong relationships with vendors, suppliers and business partners ensuring compliance with processing guidelines and rapid/effective problem resolution. Developed policies and procedures for supported accounts; compliant with State and Federal operational requirements, including HIPAA and Sarbanes Oxley. Participated in client audits. Led team located in MA, GA, IN and CA; primarily responsible for Medicaid business; budget responsibility for claims, customer service, membership and premium billing. Client satisfaction.

Subject matter expert in client review meetings, providing insight and real time question resolution. Managed client relationship and implementation process of new claim, membership and billing system from an operational perspective satisfying five new accounts and integrated with existing systems. Experienced in Zybex and Perot Systems, D950. Led opening of a new call center located in GA. Organized and presented program orientations educating providers in product and processing insights targeted at creating a more positive experience. Participated in client audits. Led team responsible for claims, customer service, membership and premium billing for Medicaid accounts. Client satisfaction.

Utilized in various projects focusing on improving client service and meeting contractual obligations. This included problem solving, assessing barriers to production and quality, recommending possible solutions as well as documenting and implementing process changes. Participated in annual state run Heath Fairs to promote and enroll membership into our health plan.

Worked with client and internal resources closely; effectively managing day to day expectations and ensuring contractual obligations met for claims unit. Participated in annual state run Heath Fairs to promote and enroll membership into our health plan.

Managed and implemented provider network expansion nearly doubling program membership. Organized and presented program orientations educating providers in product and processing insights targeted at creating a more positive experience. With the Finance Department, developed reimbursement rates/schedules including fee for service, RBRVS, percent of charge and per diem.