Cheryl Pelas Email & Phone Number

Florida, United States

Remote/Client On-Site

• Monitored development/configuration work and quality testing to ensure that client deadlines were met.• Troubleshot any “Bugs” reported by client to promote application functionality.• Ensured software applications for client/healthcare companies met functionality and compliance needs for Utilization Management, Quality Review/Control, Customer Service, configuration of applications, member enrollment, claims, performance metrics finance and service level agreements and their financial obligations.• Managed multiple projects simultaneously and approximately 100-150 incoming client emails and calls per day, consistently meeting deadlines while maintaining high standard of quality workmanship.• Developed comprehensive documentation to support end-users and facilitate future enhancements.• As part of BPaaS and Implementation Teams, represented company for on-site client visits for requirements gathering requirements and Go-Lives for implementation of HealthRules Payor.• Assisted with testing and configuration in following modules of HealthRules Payor.

Pensacola, Florida, United States

Directly managed 10-15 Utilization Review and Case Management non-clinical staff members and assisted HS Manager in management of additional 10-15 Utilization Review and Case Management clinical staff members ensuring company and client SLAs for state, local and Governmental compliance regulations were met.• Enhanced team performance and improved case turn-around time by implementing effective utilization management processes and strategies from 90% to 98% through staff training and optimizing resource assignments.• Increased compliance with regulatory requirements by monitoring adherence to guidelines and protocols within UM department.• Built strong relationships with external stakeholders such as hospitals, clinics, provider networks, and insurance carriers to facilitate seamless coordination in service delivery.