Michelle H. Email & Phone Number

Minnapolis, Mn

Responsible for the management and measurement of Configuration and Claims Operations (CCO) department initiatives and improvements in alignment with department plans, goals and objectives. Manage the identification, planning and execution of process, product or functional analysis for the purposes of identifying root cause issues, mitigating risk and optimizing department performance. Ensure optimal subject matter expertise participation for cross functional projects, work-groups and… Show more Responsible for the management and measurement of Configuration and Claims Operations (CCO) department initiatives and improvements in alignment with department plans, goals and objectives. Manage the identification, planning and execution of process, product or functional analysis for the purposes of identifying root cause issues, mitigating risk and optimizing department performance. Ensure optimal subject matter expertise participation for cross functional projects, work-groups and committees. Manage, coach and mentor team of highly skilled analysts and project leads. Show less

Tampa/St. Petersburg, Florida Area

Captained the design and implementation of key Quality Solutions, developing strategic vision and oversight to ensure the continual improvement of critical applications, tools, and processes, empowering high-level Healthcare Quality service. Liaised with customers, internal staff, and product owners to drive solution projects including the implementation of HEDIS, STARS, Risk Adjustment, and Care Gaps systems. Established a culture of constructive, creative problem solving, leading accurate and… Show more Captained the design and implementation of key Quality Solutions, developing strategic vision and oversight to ensure the continual improvement of critical applications, tools, and processes, empowering high-level Healthcare Quality service. Liaised with customers, internal staff, and product owners to drive solution projects including the implementation of HEDIS, STARS, Risk Adjustment, and Care Gaps systems. Established a culture of constructive, creative problem solving, leading accurate and timely implementation of solutions to meet customer needs. ~ Delivered practical, user-friendly tools and applications developed through strategic assessment of client and operational needs.~Designed and led User Acceptance Testing (UAT) suites, ensuring optimal functionality of systems and tools. Show less

Eagan

Led an expert projects team, driving the improvement of care quality, processes, and cost effectiveness across MN Blue Cross Blue Shield Quality operations. Designed and created critical enhanced records management processes, instituting a data-driven approach to complex health care system and process evolutions. Designed strategic database, record tracking, and record retrieval methods and tools, assessing operations to identify critical needs. ~ Spearheaded the transition of an annual… Show more Led an expert projects team, driving the improvement of care quality, processes, and cost effectiveness across MN Blue Cross Blue Shield Quality operations. Designed and created critical enhanced records management processes, instituting a data-driven approach to complex health care system and process evolutions. Designed strategic database, record tracking, and record retrieval methods and tools, assessing operations to identify critical needs. ~ Spearheaded the transition of an annual HEDIS Medical Record Review project from vendor fulfilled to in-house execution, leading in-house operations design.~ Designed and integrated a Medical Record tracker, enabling record requests, retrieval, storage, and systematic filing of 30K+ medical records per HEDIS season and 100K Risk Adjustment medical records.~ Created strategic records management processes, securing a 98% retrieval rate, a 97% accuracy rate, and a 100% review and abstraction completion rate across roughly 28K medical records.~ Produced a key Provider Pursuit database application as well as implementing a Provider Relations role to ensure effectiveness in records and data retrieval and provider network relationship cultivation.~ Designed and created a HEDIS Strategy Dashboard to assess and uncover improvement needs.~ Other key Health Care Quality Improvement projects included a Member Incentive Program, Anti-depressant Adherence Outreach, and HEDIS supplemental data management. Show less

Eden Prairie, Mn

Captained a 5-person project management team, driving the delivery of exceptional customer service and customer experiences across nearly 40 client accounts and more than $10M in revenue. Mentored and guided team members in strategic client management and service, ensuring comprehensive knowledge of proprietary software and HEDIS project processes by leading onsite and online trainings. ~ Cultivated team capacity for critically analyzing client accounts to predict and determine needs… Show more Captained a 5-person project management team, driving the delivery of exceptional customer service and customer experiences across nearly 40 client accounts and more than $10M in revenue. Mentored and guided team members in strategic client management and service, ensuring comprehensive knowledge of proprietary software and HEDIS project processes by leading onsite and online trainings. ~ Cultivated team capacity for critically analyzing client accounts to predict and determine needs, enabling quick and effective resolution for a range of customer issues. Show less

Minnetonka, Mn

Leveraged robust Health Service and Solutions knowledge, Project Management expertise, and technological development capacity to create strategic consumer engagement and incentive programs. Utilized proprietary platforms to assess and review data accuracy and management. Established strong, communicative client relationships to support the continual evolution of platforms and processes. ~ Liaised between customers and IT to identify key data issues and discrepancies and design… Show more Leveraged robust Health Service and Solutions knowledge, Project Management expertise, and technological development capacity to create strategic consumer engagement and incentive programs. Utilized proprietary platforms to assess and review data accuracy and management. Established strong, communicative client relationships to support the continual evolution of platforms and processes. ~ Liaised between customers and IT to identify key data issues and discrepancies and design resolutions.~ Spearheaded a complex data validation project, uncovering and informing customers of vendor-based data errors and enabling accurate data processing through vendor data re-submission. Show less

Minnetonka, Minnesota, United States

Associate Director of Business Operations (2008 to 2011)Led value-based care delivery operations for a Senior Health Care Management Plan; guided and monitored a 14-person staff in complex enrollment and administrative assistance operations. Designed and implemented key tool and process improvements or innovations, improving data input, caseload management, and member data frameworks to noticeably enhance overall program function and success through strategic data management. ~… Show more Associate Director of Business Operations (2008 to 2011)Led value-based care delivery operations for a Senior Health Care Management Plan; guided and monitored a 14-person staff in complex enrollment and administrative assistance operations. Designed and implemented key tool and process improvements or innovations, improving data input, caseload management, and member data frameworks to noticeably enhance overall program function and success through strategic data management. ~ Designed analysis processes to prioritize encounter-based diagnosis codes and conducted ongoing scanning of the member population for missing and/or incomplete diagnosis codes, optimizing overall Risk Adjustment Factor (RAF) Scores.~ Analyzed member care trends to predict and meet new data stratification and management needs.~ Developed a strategic data input automation system, extracting input processes to reduce more than 120 monthly data entry hours to just 20 minutes and completely eliminating work duplication.~ Cultivated a team-wide culture of continuous improvement to drive process and tool enhancements. Show less

Provided key data based information for planning and executing business strategies and intiatives. Identified opportunities for process improvement based on analysis of business operations and emerging market trends. Systematically transitioned all departmental data collection systems from spreadsheets and other manual forms of data collection to a suite of dynamic database applications.

Mba Certificate, Business Essentials

Masters Of Science Degree, Information Technology With Specialty In Leadership & Project Management

Bachelor Of Science Degree, Advertising Communications