Kellie Malone Email & Phone Number

Katy, Tx, Us

Hampton Roads, Va, Us

DIRECTOR OF BUSINESS OPERATIONS: Manage system configuration, Provider configuration, enrollment and eligibility, Provider data integrity and quality teams. Led process improvement initiatives to realign the configuration process to eliminate waste and errors. Initiated a foundation for documentation, including Policy and Procedures along with Standard Operating Procedures, and process flows. KEY COMPETENCIES: TEAM COHESION, LEADERSHIP INFLUENCE, PRODUCT KNOWLEDGE, TESTING, DOCUMENTATION, WORKFLOW ANALYSISImplemented Epic Tapestry March 2020– Aug 2022● Completed Tapestry Certification AP Claims, and Contracts● Documented and streamlined previous QNXT processes, focused on system configuration for Benefits, Contracts, implemented Optum Easy Group as PPS pricer, and designed Triplets to encompass the MPF, and future state PEMS.● Created cross functional work groups to ensure robust, complete processesKEY COMPETENCIES: BUSINESS ANALYSIS, LEADERSHIP INFLUENCE, ORGANIZATIONAL CHANGE, PROCESS IMPROVEMENT, DOCUMENTATION Saved $145M between March 2020– Sept 2021 through redesign of Config. and Claims analysis against TMPPM● Increased claims editing efficiency to reduce Medical Loss Ratio (MLR), through Optum CES and improved Contract rebuilds● Created a robust testing/QA team to enhance the experience of our downstream partners, eliminating rework ● Implemented best practices, increasing oversight and controls

Tampa, Florida, Us

Manage business processes, approach, activity reports, reviews, and other performance data to measure productivity and goal achievement. Identify potential areas of cost reduction and program improvement. Supervise multiple teams while working as Director of Operations.KEY COMPETENCIES: BUSINESS ANALYSIS, LEADERSHIP INFLUENCE, ORGANIZATIONAL CHANGE, PROCESS IMPROVEMENT, DOCUMENTATION Saved $525M between Jan 2019 – March 2019 through revamping of Medical Claims processes● Influenced Executive Leadership to apply pre-go live testing approach to increase benefits testing● Created test strategy, test approach, and test plan ● Drove team, executed plan, and reported results during process KEY COMPETENCIES: CROSS-FUNCTIONAL LEADERSHIP, PROBLEM SOLVING, BUSINESS PROCESS, STRATEGIC PLANNING, MANAGEMENTIntegrated multiple teams in 3 separate locations to one shared goal● Implemented best practices and added value to organization● Facilitated consistency and strong leadership to ensure compliance during difficult times● Led with passion and integrity to deliver clear messageKEY COMPETENCIES: COLLABORATION, LEADERSHIP, BUSINESS REQUIREMENTS, PROCESS IMPROVEMENT, REPORTINGReduced member and provider complaints by 28% with creation of new system to manage change control which is now adopted as company SOP● Documented suggested approach, added value, and increased Return on Investment (ROI) ● Coordinated roadshow for each business area to gain buy-in and answer questions● Collaborated with IT teams, built vision for new system to manage change control

White Plains, Ny, Us

Spearheaded cross-functional team and provided leadership across organization for system upgrades, streamline processing. Analyzed business impact, created and executed test plan for system upgrade and implementation.KEY COMPETENCIES: STRATEGY, PROJECT MANAGEMENT, COST MANAGEMENT, DATA ANALYSIS, PROBLEM SOLVINGReduced re-work by $5.5M● Increased budget efficiency and eliminated budget waste● Researched, documented, and presented Executive Leadership with processes to eliminate re-work● Created training program for team and expanded responsibilities to reduce re-workKEY COMPETENCIES: WORKFLOW ANALYSIS, PROCESS IMPROVEMENT, ANALYTICAL THINKINGCreated and implemented all-inclusive tracker and work management application for appeals and grievances to ensure compliance● Partnered with A&G Leadership, processing staff, and QA teams to resolve workload issues, and increase oversight● Recommended several options to approach project● Streamlined manual processes and implemented needed phase approach with new technology KEY COMPETENCIES: COST MANAGEMENT, STRATEGY, BUSINESS ANALYSIS, QUALITY ASSURANCE, PROBLEM SOLVINGIncreased straight through processing of 89% of all Enrollment Applications and reduced staffing costs by 40%● Overhauled enrollment application to increase logic, added additional control points to ultimately minimize manual fallout, and maximize functionality● Built plan to increase efficiency, and accuracy for processing enrollment applications● Created automated logic to process enrollment application, ensuring accuracy and Compliance

White Plains, Ny, Us

Led Medicare Part D Operations Department. Managed data integrity and analysis at all levels within organization. Created and documented process flows, identifying control points, quality checks to ascertain sustainability and repeatability of all processes. KEY COMPETENCIES: MANAGEMENT, TRAINING, MENTORING, TEAM BUILDING, TROUBLESHOOTING, COMMUNICATIONOversaw creation of member-facing web portal● Generated requirements for member-facing portal to reduce call volume and increase IVR functionality● Researched competitors’ sites and solicited internal inputs to understand call center needs● Developed plan for phased approach to launch site KEY COMPETENCIES: SIX SIGMA, LEADERSHIP, PROCESS IMPROVEMENT, PROJECT MANAGEMENT, BUSINESS PROCESSIncreased transactions processing quality for CMS from 86% to 98%● Composed QA tool, performed initial quality checks to review accuracy of manual processing● Studied manual transactions, documented steps, and outputs for each transaction type● Documented SIPOC for manually processed transactions, developed code automate transactions and outputsKEY COMPETENCIES: ANALYTICAL SKILLS, PROCESS IMPROVEMENT, COLLABORATION, TRAININGEnvisioned and implemented central data repository and automated processor● Surveyed all functional requirement changes● Collaborated with IT developers to turn file into systemic transaction● Authored training material, and delivered the training to end users while creating process documents and process flows, to train and develop additional BA's and development staff to continue to grow application

White Plains, Ny, Us

Worked within the IT Department to monitor data integrity and identify trends and problems, and then create a suggested solution. Worked closely with the development team to fully understand the IT solutions and interacted with the business owners to ensure that all needs were being met. Performed quality assurance via an internal Change Management Application to ensure that the requirements are met and that the outcome is as requested by the business owner. Documented all CMS system requirement changes and document EDI processes. Used SQL to run database queries along with MS Access and Excel. Troubleshoot any and all system reported problems, including extracts, software and processes.

White Plains, Ny, Us

Overview of Medicare Supplements.Medicare Part D from 2005 - 2008Process and Improvements, both systems and business processesDeveloped and implemented performance and reporting metrics that led to higher productivity and lower labor costs by reducing staffing levels by 50% while maintaining quality performance.Developed and provided annual company-wide training on new benefit plans as well as refresher training on CMS rules for member eligibility and enrollment. Training materials used to educate physician and other healthcare provider groups contracted with the organization.

White Plains, Ny, Us

Contributed to the development of the organization’s annual business plan; provide reports on client feedback process including escalation, resolution and customer complaints. Develop, document and maintain efficient administrative policies, procedures and processes to be used in the leading the team to meet operational objectives and performance standards.

Created and delivered training materials for multiple accounts, including, Expedia.com, and USAirways.com, with multiple Computer Reservation Systems, Microsoft applications, scripted programs, and Customer Service Skills. Managed a team of CSR’s, created reporting and performance management tools to successfully monitor and report as needed by Account Executives.