Jim Congleton Email & Phone Number

Duluth, Minnesota, United States

Duluth, Minnesota Area

Louisville, Kentucky, United States

Duluth, Minnesota Area

Worked with Pentaho application publishing Directory data to the Cloud.

Duluth, Minnesota Area

Accountable for a staff of more than 200 employees both domestically and globally. Our teams responsibilities includes timely and accurate loading of provider contracts for all government products including Medicare, Community and State, and TRICARE.In addition to this we have responsibility of Non-Par set-up for Facility records as well as preventing and correcting any provider contract defects. The key focus is improving accuracy and efficiency of our installation process. In addition, my role includes acting as the liaison between the Operations and our Business Segment Customers to assure strength in relationship and performance.

Duluth, Minnesota Area

Provided leadership and direction for Diamond to NDB provider data conversion that was previously unsuccessful.Developed proactive data clean-up reports which resulted in an 80% reduction of conversion fall-out.Effectively Implemented best practice sharing and lessons learned review from each data migration to improve future results.Created SQL reporting team that was able to build and automate weekly system sync reports as well as implement auto correction of certain errors.Successfully implemented the initial three NDB to CSP data conversions.

Duluth, Minnesota Area

Managed Provider loading into all United platforms. Responsible for a staff of more than 500 employeesImplemented AMS principals in managing NDM resulted in the elimination of 89 FTE’s saving 4.2 million YOY while maintaining TAT and improving quality from 4.3 sigma to 4.6 sigma. P&L responsibility for a $25M departmental operating budget.Implemented auto routing and Macro advancements to tech Team for all large work items resulting in Responsible for day to day operations and development of configuration protocols for the Provider Data Loading Departments (Network Data Management)Served as Security Officer for the NDBAdministered development of Department BCP plan and multiple successful implementations of the plan.

Duluth, Minnesota Area

Serve as Operations Director responsible for all fee schedule loading, par professional, facility, and ancillary demographic loading for central, western, and leased networks, par professional contract loading for the same, as well as technology development for the Fee Schedule loading application and the NDM queue management tool. Intricate role in development and growth of the Duluth NDM site expanding from 9 to over 100 employees and bringing on an additional 30 employees in the Long Beach and Fee schedule loading teams. Worked with network pricing & provider system on development of an automated update tool for quarterly market standard fee schedules saving over 4,800 hours of loading time per year Worked on a Six Sigma project to integrate maintenance of delegated providers into NDM improving quality and saving over 1.2 million in 2005. Improved department productivity by 30% by streamlining workflow systems, enhancing employee skill levels through comprehensive training programs, creative resource management, Flextime scheduling, employee incentive programs, and implementing strict production and quality standardsHeaded the Integration of the PacifiCare provider network on to UHC systems to take advantage of direct contracted rates verses a current leased arrangement. Developed a macro team responsible for loading the entire Pacificare network into NDB, 1.5 FTE Years’ worth of work completed by 1 FTE in 2 weeks.

Responsible for managing the Duluth PDI team including the loading of demographic and contract data for Facilities, ancillaries and professional providers.Integrated the data maintenance teams from the local markets into a centralized team. Standardizing and coordinating all the steps of the centralization project.

Managed the operations for a claims and customer service team handling Shell and Texaco oil customers who awarded us a best in class award in 1998. Designed and executed research methodologies to identify customer needs in order to improve provider satisfaction, resulting in increased provider service satisfaction by 10% from prior year.Implemented Auto Adjudication enhancements that resulted in a lift of 4% in auto adjudication.

Plano, Tx