Michele Phillips Email & Phone Number

Texas, United States

North Carolina

• Account Manager: Implements, builds and fosters productive relationships with participating physicians of all specialties and practices in (7) counties servicing a high volume (100’s) of accounts• Manages and optimizes work processes: prioritizes daily operations and administration of contractual provider relationships in a managed care environment, ensuring all relationships are positive and maintained• Drives Solutions / Action Oriented: Significant improvement made in state Medicaid cases from dozens of cases to (0)• Leads face to face & virtual monthly and quarterly meetings with providers (40+ a month) utilizing clear objectives and agendas• Initiated 400+ cases to provider data management team to improve efficiency, network adequacy and resolution to providers • Effective communicator: Impeccable follow up to providers 100% within 24 hrs of outreach to me, collaborates with internal teams to address any challenges• Oversees accurate and current databases, provide training and education to new and current providers• Researches, analyzes and resolves complex problems dealing with contract loading, division of financial responsibility interpretation, contract rate and language interpretation, appeals and eligibility• Experience with negotiating: Provide creative solutions for resolution• Operational Savings: Claims set up, resolution and contract issues worked or triaged, provide education to drive down costs to members while in our comprehensive care• Grievances/Escalations: Experience with customer escalation management, primary point of contact to teams, follow up and coach providers as needed• Leads collaborative quarterly JOC meetings with contracted PCPs and internal quality, risk management, contract and pharmacy teams

Raleigh, North Carolina, United States

• Implemented Medicaid LTSS Provider Relations program for the state servicing 19 specialties. Trained and educated new LTSS providers as liaison to the plan• Key point of contact for Care Management Team and NC providers: Provide ongoing support via routine scheduled visits, orientation presentations, educational training for claims/billing and clinical teams • Presented educational In Services presentations to providers throughout the state with Care Management: To strengthen partnerships & LTSS program throughout Eastern NC servicing 50 counties in 3 regions• Exceptional problem solver: Sourcing root causes with claims, care management and contract issues when complex provider issues need to be addressed • Ensure providers are well maintained and supported, while managing multiple provider relationships for the entire state since Medicaid transition of care • Provider Data Integrity and Credentialing: Conduct Director provider review on lines of business, initiate and communicate requests to add or terminate providers, liaison to contracting and provider data management

Raleigh-Durham-Chapel Hill Area

• Provided personal care services and companionship to several long term clients assisting with activities of daily living through various home health care agencies• Reported required information and communicated effectively with family members about daily changes / updates and patient needs• Identified risk factors and improved environments for optimum safety to reduce falls, choking, etc. • Specialized in Hospice care, Alzheimer disease, Dementia and Parkinson’s disease

Raleigh-Durham, North Carolina Area

• Trained department supervisor, new hires and nurses on PCS assessment scheduling new orientation to NC Medicaid PCS policies, procedures and protocols• Responsible for the largest volume region accounting for an average of 395 Medicaid patient assessments monthly and an independent assessment team of 6 registered nurses• Liaison to large and small home health providers and group homes for new admission and on-going annual PCS patient assessments for 3 large sub-regions within NC • Educated home health providers on Medicaid and PCS policies to ensure state compliance and provide necessary resources for access to various Medicaid programs • Processed formal provider and beneficiary complaints and escalations • Conducted avg of 76 outbound calls daily to schedule assessments, managed patient inquiries, answered and educated Medicaid beneficiaries, physicians and social workers on the PCS program, and researched eligibility requirements to meet revenue goals while providing excellent customer service• Project managed the completion of a high volume of assessments to ensure timely compliance with contractual standard performance agreements, achieving success over 95% • Ensured NC Medicaid contract compliance while following policy, procedures, and protocols for 100% Quality Assurance attainment while proactively anticipating and resolving issues related to services to ensure outstanding customer experience

• Coordinated public relations, branding, promotions, client relationships, event planning and content writing for various organizations • Developed and implemented a new internship for UNCG Communication Studies Department to promote the department’s presence and brand to the community• Recruited and trained new hires, created SOP manual for department internship • Planned, managed, marketed and executed ten successful events such as meet and greets, holiday parties and workshops for faculty and students to increase UNCG’s Communication department’s presence and branding to new & existing students• Worked to promote client relationships and promotional events, gallery showings, art competitions and gala to increase attendance and community awareness• Directed & managed volunteers and produced the grand opening gala event for ReStore of Apex, exceeding all sales and marketing targets to 160% of plan

Greensboro/Winston-Salem, North Carolina Area

Graduated magna cum laude with a BA in Communication and Media Studies. I went back to school part time then full time to finish my education.

Greensboro/Winston-Salem, North Carolina Area

Recruited to implement and develop an internship for UNCG's Communication Studies Department. - Planned, marketed, managed and executed ten (10) successful events to include: Meet & Greets, Fall Open House, Honor Society Induction and various workshops to build the department's brand and presence to attract transfer and new students to the community- Wrote a standard operations procedure manual for two positions: events marketing and social media promotions- Interviewed and trained two new interns for new internships in event planning and social media programs- Collaborated and created new department logo branding to be used on the department website and all promotional items

Raleigh-Durham, North Carolina Area

• Directed a team of volunteers, sourced sponsors and coordinated all of the catering and entertainment for the grand opening gala of Apex ReStore • Provided exposure to vendors on all radio and television advertising in the weeks leading up to the grand opening • Marketed and initiated partnerships within the community, chamber of commerce members and ReStore, accomplishing goal to spread Habitat’s mission and purpose to the community before opening day • Exceeded all sales and marketing targets to 160% of plan!!

Raleigh-Durham, North Carolina Area

- Developed an in-patient Hospitalist program from six (6) initial contracts to thirteen (13) hospital contracts in NC, SC, GA, KY, TX, AZ- Recruited and trained new hires for the department- Managed schedules for all physicians in each contracted state according to hospital guidelines for Hospitalist requirements to be met- Planned and promoted hospital meet and greet events to introduce new Directors to the hospital and community in preparation for their role as a Hospitalist- Coordinated all marketing efforts and followed up with key clientele and conference leads to connect with prospective customers- Prepared and planned reports, travel and conference coordination to Executives for each month end meeting, answered all inquiries regarding program contracts and current status of operations with contracted physicians and hospitals

Dallas, Texas, United States

- Managed 15 trade shows including exhibit presence, speaker opportunities, marketing media and public relations opportunities, advertising and sponsors, and followed up with key clientele- Targeted and researched national exhibition opportunities for OB/GYN conferences, women's expos and insurance forums to market treatment for uterine fibroids- Main contact for patient inquiries for a procedure using a medical device with Focused UltraSound called ExAblate- Managed federal employee national women's week initiative: cold called agencies in TX to promote sponsoring lunch and learn seminars for their employees with our physician teams- Exceeded quota- Supported Reimbursement Consultant, Public Relations Consultant, Director of Marketing / Reimbursement of N. America and VP of Sales and Marketing

Bachelor’S Degree, Communication And Media Studies

Activities and Societies: Alpha Lambda Delta Honor Society, Lambda Pi Eta Honor Society, University Marshal, Dean's List, Chancellor's.

Part Then Full Time, General Studies

Education record