In my current job role, I thrive in project management environments where collaboration fuels efficiency and drives project success. I guide assistant project managers, fostering their development and helping them craft innovative implementation strategies to streamline processes and elevate project completion rates.I act as a bridge between departments, nurturing strong relationships with sales, consultants, clients, and internal teams. This ensures seamless communication and a unified approach to achieving project goals. I champion continuous improvement by overseeing workflow evaluations and implementing changes to enhance team performance. Maintaining adherence to service-level agreements, upholding quality standards, and maximizing productivity are my constant priorities.Anticipating and addressing critical issues proactively is a core value I instill in my team. This, coupled with exceeding client expectations through consistent proactive measures, is paramount to my success. I collaborate strategically with senior leaders across functions to tackle complex challenges and deliver exceptional client outcomes.I have a demonstrably successful record of gathering client requirements across diverse sectors (national accounts, public sectors, etc.) ensuring smooth integration and exceeding client satisfaction. My commitment to operational excellence is evident in my efforts to establish clear policies, maintain design standards, and spearhead process improvement initiatives, leading to continuous improvement.I leverage my strong analytical skills to advise businesses on strategic actions and alternatives aligned with organizational objectives. By leading a team of nine, I ensured the successful fulfillment of client pharmacy plan design needs (requirements, configuration, and deployment).

During this job tenure, I actively initiated engagement with key stakeholders to gather comprehensive requirements. This ensured a smooth installation process for pharmacy benefits. I meticulously crafted and executed implementation strategies that aligned perfectly with client expectations. These strategies adhered to established performance metrics and project timelines, ensuring a successful rollout. I closely monitored project milestones throughout the implementation process. Additionally, I proactively evaluated potential risks and provided regular status updates to both internal and external stakeholders. I implemented a proactive initiative to streamline rework reporting processes, further enhancing overall efficiency for the team. Pioneered the development of an implementation progress tracker. This innovative tool enabled real-time reporting capabilities for stakeholders, improving project visibility and communication.I championed thorough quality assessments and testing procedures to ensure superior products and services were consistently delivered to clients, exceeding their expectations. My deep knowledge in the field proved invaluable. I provided guidance, training, and mentorship to others on process improvements and workflow optimization, fostering a culture of continuous improvement within the team. In collaboration with internal stakeholders, I actively captured valuable insights gleaned from project experiences. These "lessons learned" were archived for future endeavors, ensuring continuous improvement across implementations.

At this position, my role involved safeguarding the accuracy of pharmacy benefit coding. Here's how I achieved this:I conducted routine quality audits to identify and rectify any coding discrepancies. This ensured strict adherence to client specifications, legal standards, and internal protocols. In collaboration with the Product team and the Aetna Pharmacy Management Benefit Coding team, I evaluated updates in pharmacy coding regulations. We worked together to align these updates with the overall benefit objectives.By leveraging my in-depth understanding of coding regulations and compliance standards, I effectively addressed coding inquiries from the coding team. This ensured consistent and accurate coding practices. I partnered with internal stakeholders to pinpoint weaknesses within the process for creating pharmacy benefit codes. Through collaborative efforts, we developed targeted action strategies to resolve these deficiencies.Data-Driven Decision Making: I analyzed coding inaccuracies to identify trends. These trends were then compiled into reports to facilitate informed decision-making among internal teams.Continuous Improvement: I actively participated in team discussions aimed at refining training materials for coders and crafting comprehensive work directives. This fostered continuous improvement in coding accuracy and efficiency.

Coded medical and pharmacy benefits in Aetna Systems for assuring compliance with state and federal legislative mandates for accuracy and adherence. Engaged with underwriting, sales, and implementation managers for collaboration on new business, revision activity, and plan designs. Conducted thorough analysis to assess the compatibility of customer requests with Aetna systems, while recommending alternative solutions to accommodate non-standard requests, thereby optimizing service delivery.Some of my key accomplishments include:• Conducted comprehensive research and provided timely alternatives to inquiries from internal stakeholders, exceeding expectations and facilitating effective decision-making.• Performed meticulous benefit reviews to ensure Aetna's compliance with State and Federal legislative mandates by mitigating risks and ensuring regulatory adherence.• Aligned products/services with client specifications, ensuring fulfillment of commitments and bolstering client satisfaction.

DESCRIPTIONIn this capacity, I played a key role in increasing participation rates for care management programs and health coaching services. Here's how I achieved this:I actively reached out to members on a daily basis to explain the benefits of enrolling in care management programs and health coaching services. This personalized approach significantly boosted participation rates. I fostered strong rapport with both patients and clinicians by coordinating effectively. I adeptly directed office flow procedures, demonstrating adaptability and a willingness to take on additional responsibilities when needed. This ensured smooth operations and efficient service delivery. I provided consultative advice to members and healthcare providers. This involved understanding individual member needs and then recommending the most suitable services to optimize their healthcare experience.I collaborated with members to evaluate their health assessments. I also addressed their inquiries regarding available products and services. This improved understanding and fostered greater engagement in their healthcare journey. I provided prompt helpdesk assistance to members encountering issues with their online health portal passwords. This ensured they could access the resources and support they needed.