Danielle G. Email & Phone Number

United States

-Leads the PBM Operations Execution team to support and execute strategic initiatives.-Evolves workforce management practices by overseeing a tenured operations team, implementing daily standups, and triage to ensure operational efficiency.-Collaborates and consults with operational leadership to ideate, drive, and execute initiatives aimed at improving overall quality and efficiency.- Conducts retrospective reviews of service delivery failures to identify areas for improvement, driving continuous enhancement of processes to improve quality and timeliness.-Proactively assesses and forecasts capacity needs based on historical and planned work, making informed recommendations for staffing plans.-Provides advanced data analysis capabilities to the department, working closely with leadership to identify trends and drive strategies for continuous improvement.-Drives the development of operational reports and dashboards, ensuring Operational leaders have clear visibility of accurate and reliable data to support day-to-day service execution.- Oversees the centralized management of PG reports, including development, enhancements, and maintenance. -Proactively reviews trends to identify risks, drive necessary changes, and achieve targets.-Monitors metrics post-implementation to measure effectiveness, making continuous improvements as necessary.

• Leads contract operation administration activities including roadmap and strategy, execution of policy, oversight and audit of performance guarantees, and training.• Leads client pricing and billing contract operations and governance including initial intake of pricing and billing requirements, process improvement execution and oversight, and auditing.• Builds and maintains, strong internal stakeholder partnerships/relationships with C Suite and Sr Leadership levels, within the enterprise.• Develops and oversees the process of intaking client billable and pricing requirements and ensuring all internal protocols cross functionally are adhered to including SOX controls, informing different technology systems, and developing reporting to ensure the protocols are effective.• Manage client contract renewal process across account management, pricing, and configuration teams.• Work very closely with leadership and operational partners to facilitate a strong cross functional solution and implement strategic initiatives. • Identifies trends, risks, and provides solution-oriented recommendations as aligned with business goals. • Builds and lead an organization with customer focus and exceptional communication with a focus on decisive, fast-moving solutions, quick and constructive resolutions to conflicts, and a “no barriers” mentality.• Reviews and direct the distribution of work, allocation of resources, work methods and performance standards for client contract operations.

United States

• Managed the health and wealth of Health Plan clients inclusive of Medicare and Medicaid plans representing over 300K lives and 9 figures in total drug spend.• Partnered with clients to analyze membership and suggest cost savings. Provide strategic recommendations for products, programs, and services. • Maintained thorough knowledge of the contractual obligations, including financials, performance guarantees terms and reporting/compliance. Manages adherence to mitigate risk of financial penalties of service team. • Oversaw total account service, ensuring strong, long-term relationships and satisfaction.

Twinsburg, Ohio, United States

2020-2021 Elixir Client Services Rookie of the YearHeyward Donigan Applause! Award Recipient Business Program Lead for Elixir’s Associate Mentorship ProgramManaged Account Management team of 10 servicing a book of business of approximately 400K+ lives, across several hundred clients – Third Party Administrators and Coalition segment. - Analyzed, developed, and implemented standard operating procedures, P&P’s or job aids as aligned with the client’s respective plan design and business need. - Worked cross collaboratively with other departments to support new implementations, existing clients and transitioning clients. - Led and managed cross segment and cross departmental large-scale projects; inclusive of charter drafting, executive stakeholder buy-in through project plan execution. - Point of contact for client and team escalations, ensuring timely and accurate resolution, mitigating risk. - Managed client retention, client contract renewal process, and ongoing segment profitability ensuring account service exceeds client expectations.

Philadelphia, Pennsylvania, United States

- Engaged with executive leadership to identify areas where analytics and process improvement can drive business value and fiscal revenue targets set.- Managed new plan implementation including timely updates, issue tracking and resolution.- Developed and implemented cross-functional processes, policies, and procedures to support existing and new plans, upsells, products and services offered.- Developed opportunities for education of team members to mitigate future errors through QA. - Managed network, pharmacy and provider terminations, suspensions, and audits.- Led and managed contract and performance guarantee adherence for multiple large health plans simultaneously; including but not limited to process improvement, reporting enhancements, contract analysis, risk mitigation, and the Performance Guarantee dispute process.

Philadelphia, Pennsylvania, United States

Long Beach, Ca

- Supervised all administrative activities within the practice, including: all protocols, community outreach, expansion, people operations, contracts, and patient billing. - Supervised all clinical activities within the practice, including clinical protocols, provider scheduling, referrals, and clinical escalations. - Executed expansion efforts alongside CEO; including but not limited to third party vendor negotiations, SOW creation and review, service level agreements and business terms.- Executed agreed upon strategies with pull through for all retail offerings to ensure maximum revenue growth for the company.- Developed compliant insurance billing: training, updating CPT and diagnosis codes, credentialing providers to streamline processes and maximize reimbursements. - Oversaw contractual and operational partners during the expansion of the physical office space.

Bellevue, Washington

- Oversaw all clinical practices, managed billing, and compliance.- Hired, onboarded and trained new staff members. - Developed and implemented all company seasonal marketing initiatives.

Seattle, Washington

- Managed all clinical services for families undergoing the surgical process. - Worked cross functionally with the OR, Clinical Staff and Service Line Directors to ensure maximum utilization of time and resources.

Dallas/Fort Worth Area

- Partnered with cross functionally with patients, insurance carriers and Patient Financial Services Department to provide compliant financial support. - Managed member enrollment into Medicaid and Medicare programs.- Worked cross functionally with physicians and hospital staff to ensure all procedures and services were billed and complaint. - Provided compassionate support and relief to families in the middle of financial and health crisis.

Dallas, Texas

Dallas/Fort Worth Area

- Managed all day to day clinical processes, programs and coordination. - Implemented Medical-grade spa packages based on in-house technology. - Managed multiple physician surgical schedule; optimizing resources and mitigating risk. - Increased cosmetic surgical procedures by 60% within 7 months. - Hired, developed and retained staff of 5.

Experience in •Creative writing •Website content•Articles & Guidebooks•Career re-branding•Editing Previous work includes poetry, short stories, and articles for companies within the event planning, wedding, real estate and health/beauty industries. Specializing in career re-branding; translating your passion and technical skills onto paper in the form of a resume, cover letter or portfolio that truly represents who you are and where you're headed.My passion for writing has allowed me to assist others by creating eye catching and memorable content for their respective clientele, generating increased business and placing words to exceptional talents throughout various industries. For more information visit:wordsbydanilee.com Or contact: wordsbydanilee@gmail.com

Honolulu, Hawaii

• Executed all aspects of event and wedding account management; including but not limited to cross functional collaboration with vendor contracts, renewals, facilitating beginning to end acquisition of clients, sales, and pricing negotiations. Close partnership with CEO and CFO to roll out strategic business initiatives and projects.

Medical Billing Specialist/Cpc, Medical Billing And Coding

In Progress, English Language And Literature, General

Diploma, High School/Secondary Diplomas And Certificates

Certification, Medical Billing & Coding