Responsible for delivering optimization consulting services using process engineering. Consultative services to clients which included facilitation of assessments of a clients existing operation and their business processes, pain points, modeling their existing business processes, analysis, design and modeling desired business process and making recommendations on improvements in people, process and/or technology use. Prepare written and verbal deliverables, reports, and presentations to management.

Manage and oversee implementations of various business process improvement operations for Health Plans. Wide-range interface with clients, vendors, and internal staff (offshore and onshore), Coordinated all departmental efforts, including IT, operations, finance, telecommunications, reporting, quality improvement, and training. Monitors project plans and milestones to ensure all deliverables are met within expected timeframes and budget.· Project manager for Health Plan business process improvement initiatives, included facilitation of meetings with all stakeholders. Developed business process requirements, facilitated JAD (Joint Application Design) session, garnered approval of business requirements, and worked with technical teams on design. Many projects focused on Medicare Enrollment, CMS and Client reporting, Medicare approved letters, automation of Credentialing and Recredentialing, utilizing multiple vendors (Council for Affordable Quality Healthcare, American Board of Medical Specialties, and the National Practitioner Databank), Lotus Notes to Outlook Exchange migration, and Desktop Refresh.· Reporting manager within a Program Management Office (PMO) for a health plan system software implementation. Managed reporting for all projects within the PMO and facilitated the review and approval process to all executive levels up to the Board of Directors.· Firm resource for behavioral health program operations

Built and maintained an excellent working relationship with new and existing customers by listening to and meeting their needs and requirements. Coordinated with all areas of the organization to ensure full and effective performance of obligations to increase the program value while keeping within the scope of services.· Served as Account Manager for Southern Company, Cerner, and Indiana Comprehensive Health Insurance Association· Implementation and Account Management of Schering-Plough, WellCare, and final phase of two operating companies for Southern Company.· Corporate Steering Committee member for overall web development restructuring.

Oversee and manage new business implementations and business process improvement for medical and behavioral health products. Extensive interaction with clients and vendors, coordinate all interdepartmental efforts, including quality improvement, customer service, IT, telecommunication systems, sales and marketing, and clinical and non-clinical policy and procedure development. Actively designs and monitors project plans and workflows to ensure all deliverables are met within expected timeframes. Work closely with the account management team to ensure a smooth transfer of responsibilities, and that all issues/problems are efficiently resolved and that all contract and internal deliverables are met.· Served as Account Manager for HealthNow, BlueCross BlueShield LA, USFHP, Sentara, DC Charter · Specialize in and behavioral and medical health programs: disease management, utilization management, case management, behavioral integration, triage, physician review services, and network development and credentialing.· Project manager for the company’s various operational objectives, including a new clinical software program, and a telecommunication system with Avaya/NACR.

Oversee and manage new business implementations and business process improvement for medical and behavioral health products. Extensive interaction with clients and vendors, coordinate all interdepartmental efforts, including quality improvement, customer service, IT, telecommunication systems, sales and marketing, and clinical and non-clinical policy and procedure development. Actively designs and monitors project plans and workflows to ensure all deliverables are met within expected timeframes. Work closely with the account management team to ensure a smooth transfer of responsibilities, and that all issues/problems are efficiently resolved and that all contract and internal deliverables are met.Served as Account Manager for HealthNow, BlueCross BlueShield LA, USFHP, Sentara, DC Charter Specialize in and behavioral and medical health programs: disease management, utilization management, case management, behavioral integration, triage, physician review services, and network development and credentialing.Project manager for the company’s various operational objectives, including a new clinical software program, and a telecommunication system with Avaya/NACR.

Manage the delivery of member and provider services for a specialty managed care organization. Manage the customer service staff (over 60 employees), including the complaint and grievance process, provider and member service quality improvement programs, and the Claims Adjustment Unit. Managed seven large clients (BlueCross of Tennessee, BlueCross of Louisiana, BlueCross of Georgia, BlueCross of North Carolina, Aetna, Nissan Motor, and BellSouth) approximately 6 million covered lives and five clinical systems. Served as a technical resource and advisor for account management. Consistently met or exceeded goals of 30-second Average Speed of Answer and 5% Abandonment Rate for all clients. Designated as the project leader for a new clinical system interface, as it related to ERISA regulations, correspondence, member services, training, benefits, appeals and the complaint and grievance process. Completed within required timeframe and exceeded client expectations. Facilitated an outreach program (MAG) for members to discuss service issues, clinical concerns, and for our Company to share best practices. Designated as the project leader for a new clinical system interface, as it related to ERISA regulations, correspondence, member services, training, benefits, appeals and the complaint and grievance process. Completed within required timeframe and exceeded client expectations. Facilitated an outreach program (MAG) for members to discuss service issues, clinical concerns, and for our Company to share best practices. Designated as the Interim Vice President of Operations for the Chattanooga Regional Service Center.

Performed the technical support for the Quality Improvement department for a specialty managed care company. Responsibilities included, programming customized client reports, statistical analysis, and participated in client meetings. Extensive experience in several software programs (Impromtu, Venture, MEKA, Access, Microsoft Office). Designed and programmed multiple client reports that included utilization, care cost, geo access, claims paid/incurred data. Consistently met or exceeded monthly/quarterly/annual reporting requirements. Designated as the lead project manager for NCQA committees. Managed support staff and successfully received a three-year full accreditation. Updated and revised all policy and procedures to be compliant with corporate and client standards. Received recognition and 100% approval from the Executive staff and Regional Quality Improvement Committee.

Managed the provider network for a specialty managed care organization. Recruited providers, performed facilities reviews, negotiated fees, monitored credentialing status, and performed site reviews to ensure compliance with corporate policies and procedures. Monitored geographic access and membership for fifteen clients to ensure provider availability. Assigned project manager for all NCQA committees. Organized and completed a successful provider system reconfiguration.

First point of contact for callers requesting new and concurrent services, claim inquiries, authorization inquiries, provider relations, benefits, and general services. Responsibilities include problem-solving and educating callers on policies and procedures. Collected and entered patient intake information into the appropriate delivery system to initiate the services and management programs. Proven ability to perform superior quality customer service in a highly motivated, fast-paced, multi-tasked-oriented environment.