Lisa Buchter Email & Phone Number

Brandenburg, Ky, Us

Kentucky, United States

• Work with business areas to determine inefficiencies within processes and complete necessary revisions• Thoroughly vet project intakes to determine impacts and type of work needed to complete• Complete monthly one-pager updates for various projects and ensure work is constantly moving and solving for blockers• Present to all levels of leadership on service improvement initiatives and other modernization projects • Completed training and obtained SAFe® Product Owner / Product Manager - Scaled Agile, Inc. Certification• Product Owner (PO) for Claims and Provider Payment Value Stream on Specialty Provider Agile Release Train (ART)• Work closely with scrum master (SM) and within scrum team to coordinate efforts to with our doers of work and impacted areas for EPICs, features and stories; also identify and work towards solving for impediments within the scrum team• Effectively write user stories, business hypothesis and acceptance criteria using Scaled Agile methodologies• Conduct stories refinement sessions, sprint planning, sprint review and retrospective and demos as per the Program Increment (PI) and in correlation with 2 weeks sprints• Go-to person for leadership with special projects or presentations are needed• Mentor to newly hired business analyst (BA)• Pioneer of Engagement

Louisville, Kentucky Area

• Created and maintained specific monthly reports for leadership and compliance• Provided regular Medicaid credentialing updates for new Medicaid business as it relates to provider network adequacy • Tracked turnaround time for all Medicaid states monthly to ensure service level agreements for tasks and end to end credentialing and re-credentialing• Identified gaps in reporting, such as the Medicaid contracted not credentialed report used to safeguard all providers who are contracted and require credentialing were not overlooked and were appropriately termed or credentialed• Developed and maintained a report and end-to-end process for reconciling and reporting on the departmental credit card (ghost card) for credentialing transactions which require payment; received a STAR award and recognition for this accomplishment• Completed various data analysis and data bumps to validate specific pieces of data for multiple audiences • Researched root causes of data integrity issues and developed resolutions• Developed and maintained various processes documentations to outline credentialing requirements for Medicaid credentialing and re-credentialing• Completed competitive analysis of credentialing resources readily available for providers, on an as needed basis• Researched, work and reported out monthly on the CMS preclusion list, applied sanctions and provided appropriate market notification as needed• Managed various projects on an ADHOC basis such as making credentialing forms available electronically to provider rather than fax or mail

Louisville, Ky

• Collaborated with market (IN & OH) on complex load, audits and other initiatives• Processed various monthly reports such as: turnaround time, quality, inventory, service level agreement, etc.• Hosted pre-load strategy calls as requested• Nominated by department director to be part of the Value Based Tool-Kit Team• Completed high-level reviews and tracked SLAs on tasks submitted for providers on the Navigator Top 20 list• Developed and maintained relationships with market personnel and other areas such as: CRED, SF, CIS• Worked within a Navigator peer group to enhance project management skills through the development and tracking of SMART (Specific – Measurable - Attainable / Action Oriented - Relevant / Realistic-Time Bound) goals, which involved root cause analysis, creating solutions (training, processes change or system enhancement), and data analysis and monitoring

Louisville, Kentucky Area

• Investigated and reported privacy breaches as they occurred and reported within established government timeframes• Processed various beneficiary Release of Information forms upon receipt • Organized and completed a large scale project to complete annual Privacy Risk Assessments and Attestations for all of HGB; met with various levels of leadership for each area and HGB collectively to assess and mitigate risks• Attended privacy training seminars and Health Information Privacy and Security (HIPS) training at Defense Health Headquarters (DHHQ) in Washington, DC to stay up-to-date on the latest privacy practices and breach reporting processes

• Managed multiple projects of various levels from initiation to completion for Privacy, Security and Records Management• Assisted Humana Government Business associates in obtaining Common Access Card (CAC) as well as collected and returned CACs to the government within the identified timeframe• Communicated with COR and DHA through CAC issuance and revocation processes• Cross trained and provided support to the Privacy team with breach reporting, processing forms and letters to beneficiaries in addition to other functions of security team such as terms, control numbers and eQIP• Lead initiative to move HGB to electronic fingerprinting, rather than paper fingerprinting and successfully worked with procurement and finance to secure a contract for services and equipment• Trained HGB security team how to appropriately complete electronic fingerprinting and submit for review• Under the same leadership, promoted to Consultant, Privacy (HGB) within one year

• Responsible for interviewing, onboarding and managing quality and production metrics for a team of 10 domestic associates • Effectively communicated with and managed a team of approximately 100 offshore associates• Monitored inventory levels daily in comparison to production levels creating a results-matter atmosphere• Provided broad analysis to identify trends and determine production forecasts

• Interviewed on boarded and managed performance of 18-22 call center representatives and 4-6 Team Leaders. Participated in co-managing up to 80 seasonal contractors• SME for leadership team on Privacy, Ethics and Compliance Office issues

Louisville, Kentucky Area

• Assisted sales agents with any pre-enrollment questions or concerns (i.e. product availability, plan details, certification, client/member eligibility, etc.)• Reviewed quality scores daily and strived to maintain a call quality of 98% or better• Maintained high level of knowledge on any changes in regards to Medicare enrollment, eligibility policies and procedures• Under the same leadership, promoted to Supervisor Agent Support Unit within one year