James Preston Email & Phone Number

Jacksonville, Florida, United States

Jacksonville, FL

• Novitas Solutions, Inc, Jacksonville, FLPrior Authorization Supervisor Claims, Medical Review Specialist’s & Provider Contact Center 2014 to present Supervised a team of 18 Claims Processors, 5 Medical Review.
• Conducted new- hire interviews for appeals, claims, medical review and business coordinator departments.
• Developed process flow maps for claims and appeals departments without benefit of historical inventory to model.
• Developed training curriculum for claims processors.
• Supervised production and PMP protocol for 18 claims processors 4 medical review specialists’ and 3 contact center employees.
• Developed and implemented several morale building initiatives that positively enhanced workplace climate.

Jacksonville, Florida Area

• Managed a team of Supervisors, Analysts, and admin staff in support of telephone and written medical claims inquiries from Florida providers for service rendered to out of state members. Directed Vendor Manager Support.
• Managed multi-million dollar cost center budget under stated goal, creating funds for reallocation by contracting out low impact work processes.
• Implemented an automated CI tool that reduced inbound call volume for claim status by 15% over a 12 month period.
• Identified and managed risks to performance by building relationships with business partners through monthly contact governance meetings.
• Strategically allocated resources based on forecasted call volumes and written inquiry inventory by developing cross-training process for front line staff in all skill sets.
• Routinely met or exceeded all performance guarantees and operational goals.

Jacksonville, Florida Area

• Managed a front-line team of subject matter experts, service advocates and offshore contracted support in resolving telephone and written medical claims inquiries, claims and adjustments from Florida providers for.
• Supervised a team of 25 Customer Service Advocates and 70 contracted support staff to resolution of telephone and written medical claims inquiries.
• Developed a process that identified the root cause of returned inventory, provided training, and reduced the number of claims requiring adjustment.
• Led planning for over 100 prospective hires, to include training requests, resume screens, development of interview template, selection, logistics, team assignment and evaluation of training effectiveness.
• Met all processing goals of over 100 thousand claims received monthly.
• Developed and implemented a Tactical Application Unit for new hire claims examiners upon completion of training. Unit was designed to measure training effectiveness and focused on 100% quality of processing results.

Jacksonville, Florida Area

Managed the Northeast Florida customer contact center. Led exempt staff of supervisors in attainment of performance metrics, to include:customer engagement and satisfactionquality auditing for adherence to guidelineshiring coaching for performance

Global

Leadership positions of increasing responsibility encompassing; Operations & Personnel Management, Program & Training Development, Budget Administration, Manpower Deployment, Public Relations, Records Management.

Education record

Activities and Societies: Kappa Alpha Psi

Education record

Activities and Societies: Football