- Lead a team responsible for state filing and regulatory reporting, ensuring timely and accurate submission of 70+ reports to regulatory agencies.- Developed and implemented a Python-based automation system that improved reporting accuracy and reduced manual effort.- Used Oracle SQL and PL/SQL to mine, clean, and transform large datasets, optimizing data for reporting and improving the quality of insights delivered to stakeholders.- Collaborated with cross-functional teams to… Show more - Lead a team responsible for state filing and regulatory reporting, ensuring timely and accurate submission of 70+ reports to regulatory agencies.- Developed and implemented a Python-based automation system that improved reporting accuracy and reduced manual effort.- Used Oracle SQL and PL/SQL to mine, clean, and transform large datasets, optimizing data for reporting and improving the quality of insights delivered to stakeholders.- Collaborated with cross-functional teams to design and implement technical solutions that improved overall performance and productivity.- Conducted code reviews, established coding standards, and provided technical mentorship to team members to ensure consistent high-quality deliverables.- Managed project timelines and resources, ensuring that deliverables were completed on time and within budget. Show less

- Led cross-functional teams to support regulatory compliance reporting, ensuring adherence to healthcare industry regulations.- Utilized SQL to navigate and clean complex, large-scale datasets, improving data quality and supporting accurate decision-making.- Developed data reporting solutions using Google products, including dashboards that delivered actionable insights to stakeholders.- Leveraged DBT (Data Build Tool) to optimize data transformations on GCP BigQuery, improving… Show more - Led cross-functional teams to support regulatory compliance reporting, ensuring adherence to healthcare industry regulations.- Utilized SQL to navigate and clean complex, large-scale datasets, improving data quality and supporting accurate decision-making.- Developed data reporting solutions using Google products, including dashboards that delivered actionable insights to stakeholders.- Leveraged DBT (Data Build Tool) to optimize data transformations on GCP BigQuery, improving data accessibility and performance.- Collaborated with teams across the organization, using GitHub for version control and data pipeline management. Show less

- Managed a team of analysts responsible for monitoring and improving claims processing, including claims inventory, aging claims, and KPIs.- Utilized SQL and Python to automate claims routing and processing, eliminating manual intervention and increasing operational efficiency.- Implemented an automated Python program that saved 240 hours per week, ensuring accuracy in claims processing.- Worked with IT and business departments to automate contracting methodologies, resulting in… Show more - Managed a team of analysts responsible for monitoring and improving claims processing, including claims inventory, aging claims, and KPIs.- Utilized SQL and Python to automate claims routing and processing, eliminating manual intervention and increasing operational efficiency.- Implemented an automated Python program that saved 240 hours per week, ensuring accuracy in claims processing.- Worked with IT and business departments to automate contracting methodologies, resulting in the automation of high-dollar claims and reduced manual workload.- Conducted analysis and reengineering of workflows, which contributed to increased claims processing efficiency and a reduction in manual reviews. Show less

- Led key Oracle-based projects to support long-term strategies, demonstrating strong leadership in analytics and problem-solving.- Developed SQL queries to extract critical data from Oracle databases, aligning with department and company goals.- Designed business intelligence solutions and conducted advanced analytics to optimize decision-making and business outcomes.- Collaborated with network development leadership to implement system and reimbursement improvements, driving… Show more - Led key Oracle-based projects to support long-term strategies, demonstrating strong leadership in analytics and problem-solving.- Developed SQL queries to extract critical data from Oracle databases, aligning with department and company goals.- Designed business intelligence solutions and conducted advanced analytics to optimize decision-making and business outcomes.- Collaborated with network development leadership to implement system and reimbursement improvements, driving revenue growth.- Owned and maintained the Master Coding Grid, ensuring pricing accuracy for NetworX repricing activities.- Created and maintained 300+ technical processes on SharePoint, improving documentation and team knowledge sharing.- Applied best practices in NetworX Contract Configuration design, achieving high efficiency and automation in repricing.- Developed internal tools to optimize workflows and proactively addressed operational bottlenecks, enhancing team performance. Show less

- Spearheaded two major database overhauls for ICD-9 to ICD-10 conversion, ensuring seamless backwards compatibility and operational support for both coding systems.- Collaborated with IT and business acceptance teams to automate complex NetworX contract configurations, enabling high-dollar claims automation and reducing manual intervention.- Authored and maintained over 80 documented processes in living documents, improving team efficiency and communication.- Mentored and led a… Show more - Spearheaded two major database overhauls for ICD-9 to ICD-10 conversion, ensuring seamless backwards compatibility and operational support for both coding systems.- Collaborated with IT and business acceptance teams to automate complex NetworX contract configurations, enabling high-dollar claims automation and reducing manual intervention.- Authored and maintained over 80 documented processes in living documents, improving team efficiency and communication.- Mentored and led a diverse team, ensuring on-time delivery of project objectives and high-quality output across contract configuration initiatives.- Resolved escalated issues from contract negotiators and external departments, showcasing advanced problem-solving and analytical skills.- Designed SQL queries for mining data from Oracle databases, providing ad-hoc support to team members and management.- Proactively recommended workflow, system, and process improvements to streamline contract implementation and operational effectiveness. Show less

- Automated new facility agreements and amendments for NetworX and PHCS’s primary PPO and MultiPlan’s complementary network, streamlining contract management.- Analyzed and supported repricing and contractual issues for NetworX, providing operational guidance to internal departments.- Updated NetworX and primary PPO rates for CPI and CMI projects, ensuring accurate rate adjustments across contracts.- Coordinated contract changes, including termination and reinstatement of rate… Show more - Automated new facility agreements and amendments for NetworX and PHCS’s primary PPO and MultiPlan’s complementary network, streamlining contract management.- Analyzed and supported repricing and contractual issues for NetworX, providing operational guidance to internal departments.- Updated NetworX and primary PPO rates for CPI and CMI projects, ensuring accurate rate adjustments across contracts.- Coordinated contract changes, including termination and reinstatement of rate sheets, ensuring smooth transitions in NetworX and facility agreements.- Performed detailed pre-implementation reviews of rate sheet exhibit language, ensuring accuracy in Healthcare Economics models and compliance with contract terms. Show less

- Researched and resolved claim appeals within a 5-business-day turnaround, addressing NetworX repricing discrepancies, balance billing disputes, and educating providers on contract terms.- Conducted thorough root cause analysis for provider and hospital claim disputes, driving first-time resolution and improving NetworX claim accuracy.- Handled complex pricing adjustments and facilitated client adjustments to resolve billing discrepancies efficiently.- Educated providers on NetworX… Show more - Researched and resolved claim appeals within a 5-business-day turnaround, addressing NetworX repricing discrepancies, balance billing disputes, and educating providers on contract terms.- Conducted thorough root cause analysis for provider and hospital claim disputes, driving first-time resolution and improving NetworX claim accuracy.- Handled complex pricing adjustments and facilitated client adjustments to resolve billing discrepancies efficiently.- Educated providers on NetworX contract rates and payment terms, enhancing provider understanding and fostering positive client relationships.- Proactively communicated claim resolutions to providers, including handling conference calls, to ensure transparency and accuracy in all case resolutions. Show less

- Collaborated with CIGNA and Principal Life on daily inquiries related to provider verifications, claims adjustments, balance billing issues, and data corrections, ensuring efficient issue resolution.- Delegated operational issues to internal departments, ensuring prompt resolution of NetworX-related matters and maintaining clear communication with clients.- Analyzed and categorized NetworX client issues to identify trends and recommend solutions, addressing root causes and improving… Show more - Collaborated with CIGNA and Principal Life on daily inquiries related to provider verifications, claims adjustments, balance billing issues, and data corrections, ensuring efficient issue resolution.- Delegated operational issues to internal departments, ensuring prompt resolution of NetworX-related matters and maintaining clear communication with clients.- Analyzed and categorized NetworX client issues to identify trends and recommend solutions, addressing root causes and improving client satisfaction.- Served as a key liaison between clients and internal claims teams, delivering guidance on NetworX contract interpretation and reimbursement procedures. Show less

- Delivered exceptional customer service by providing first-call resolution for NetworX providers, members, and clients, handling claim inquiries, provider verifications, and network participation requests.- Accurately assessed and routed NetworX inquiries, ensuring timely and effective resolution while maintaining comprehensive documentation of each contact.- Handled member referrals, re-credentialing inquiries, and fee schedule updates, demonstrating strong problem-solving and… Show more - Delivered exceptional customer service by providing first-call resolution for NetworX providers, members, and clients, handling claim inquiries, provider verifications, and network participation requests.- Accurately assessed and routed NetworX inquiries, ensuring timely and effective resolution while maintaining comprehensive documentation of each contact.- Handled member referrals, re-credentialing inquiries, and fee schedule updates, demonstrating strong problem-solving and multitasking abilities. Show less

- Developed an inventory receiving process that was rolled out nationwide and is still in practice today at all Barnes and Noble stores.- Optimized merchandise presentation and selection, increasing sale through effective product placement and selection.- Trained and directed sellers on merchandise guidelines, improving their knowledge and ability to provide exceptional customer service.- Coached and communicated with the store team about all products and services, enthusiastic… Show more - Developed an inventory receiving process that was rolled out nationwide and is still in practice today at all Barnes and Noble stores.- Optimized merchandise presentation and selection, increasing sale through effective product placement and selection.- Trained and directed sellers on merchandise guidelines, improving their knowledge and ability to provide exceptional customer service.- Coached and communicated with the store team about all products and services, enthusiastic model selling behavior, distributed technical knowledge, and provided recommendations about ways to connect customers with the right solutions and products.- Enforced loss prevention procedures for cashiering, book loans, and any other product entering or exiting the building, reducing shrink and preventing loss.- Resolved customer complaints in accordance with all operational guidelines, escalating issues when necessary to maintain customer satisfaction and loyalty.- Conducted interviews, reviewed applications, and recommended candidates to the Store Manager, ensuring a skilled and qualified team.- Coached and counseled booksellers on performance issues and took appropriate corrective action in partnership with the store manager, promoting accountability and continuous improvement.- Prepared and delivered performance reviews to booksellers in partnership with the store manager, setting clear expectations and goals for individual and team performance.- Oversaw general store operations as manager on duty, prioritizing and assigning tasks based on bookseller skills and current store needs, ensuring efficient and effective operation of the store.- Responded immediately to employee, customer, or store issues, and handled escalations to store management, maintaining a safe and comfortable environment for all.- Continuously sought out ways to optimize and improve operations, implementing best practices and utilizing customer and employee feedback to drive growth and success. Show less

- Trained all new booksellers on customer service, merchandising, and inventory management- Managed and scheduled staff, ensuring adequate coverage during peak periods and maintaining a positive and productive work environment- Learned all positions in the store, including cashier, customer service, and receiving, to provide support during busy periods and ensure smooth operations- Collaborated with store management to plan and execute promotional events and holiday displays… Show more - Trained all new booksellers on customer service, merchandising, and inventory management- Managed and scheduled staff, ensuring adequate coverage during peak periods and maintaining a positive and productive work environment- Learned all positions in the store, including cashier, customer service, and receiving, to provide support during busy periods and ensure smooth operations- Collaborated with store management to plan and execute promotional events and holiday displays, resulting in increased sales and customer engagement- Demonstrated expertise in multiple book genres, providing personalized recommendations to customers and contributing to the store's strong reputation for knowledge and customer service- Maintained accurate inventory levels and assisted with receiving and shelving new merchandise Show less

- Provided excellent customer service, resulting in high customer satisfaction ratings and repeat business- Maintained a visually appealing and organized display of books and merchandise- Demonstrated knowledge in multiple book genres and made personalized recommendations to customersProcessed customer transactions accurately and efficiently- Assisted with planning and executing in-store events and promotions