I managed two operations teams. The Dispute Resolution team facilitates resolution of legal and state medical bill disputes for Coventry's auto, workers' compensation, and PPO-only business. The Priority Projects team works with internal and external PPO and out-of-network partners to coordinate adjustment projects.

Subject matter expert in workers' compensation medical fee schedule rules and regulations as well as working knowledge of ancillary topics such as utilization review and coding when there is an affect on medical fee schedule workflows. Expertise includes proactive tracking/monitoring of legislation followed by translation of rules and regulations to business impact through data analysis. In this role, I provide consultative services to internal and external clients as well as State regulatory agencies.

As Manager of the Bill Review Compliance team, I manage a team responsible for research, documentation, and publication of various items related to medical bill review in all states, to include workers' compensation, auto and federal claims. Specific duties include, but are not limited to:Tracking and documenting proposed and adopted fee schedule changesDocumenting relevant information regarding fee schedule rules and regulations for internal and external distributionExpert level understanding of fee schedule rules and regulations for all jurisdictionsWorking knowledge of ancillary rules and requirements related to products such as state reporting, networks, care management, and pharmacy benefit plansRegular interdepartmental interaction with teams including client development, account management, IT, product management and bill review operationsPosition relocated to Sacramento.

Customer Champion As Customer Champion, I worked with Account Management and Concentra Network Services (CNS) Operations to provide advisory and support services to one national third party administrator and two self-insured employers relative to the medical bill review product and several related products. Specific duties included, but were not limited to:Review of worker's compensation fee schedule changes to determine affect on client business and internal processesDocumentation of medical bill review workflow and related processes to ensure consistency in product deliveryParticipation in testing of claim and client EDI interface changesModeling and analysis of bill data at client request and for internal purposesResearch of internally and externally identified issues to determine cause and develop action plans to addressWorked closely with client program manager and account management to strengthen client relationship and build confidence in the CNS product

Director of Operations, Provider Bill Review Responsible for:Three bill review locations; Staffing consisted of approx. 85 indirect reports with 9 direct reports (managers, supervisors, regional trainer, and nurse reviewer)Operational oversight of 2 of Concentra's top 10 provider bill review customersOperational oversight of approximately 25 regionally based customersOversight of training programs for all indirect and direct reportsDedicated operations contact for one of Concentra's largest third party administrator clients

Provider Bill ReviewResponsible for:Office of approx. 45 indirect reports with 4 direct reports (bill review supervisors and subject matter expert)Operational oversight of 3 of Concentra's top 10 bill review customersOperational oversight of 10 regionally based customersOversight of training programs for all indirect and direct reports

Responsible for:25 direct reports (shared between two supervisors)90 day and annual reviewsAttendance and performance monitoringConsistent two to three day turn-around-time for all customersTraining - customer specifications, fee schedule guidelines, usual and customary guidelines, software applications, PPO application Human Resource functions - interviewing, new hire procedures, leave of absence monitoring, employee discipline and coaching, terminations