I directed the diligent handling of over 16 million claims per month by managing a 66-member team and driving systematic resolution of 800+ client requests and 500+ rule updates per month. I was charged with strategic planning for operational excellence, product development in collaboration with product development team, and policy ownership of broad-sweeping initiatives. I served as go-to coach, mentor, and strategist responsible for spearheading strategic and continuous process improvements.During my time in this role, I championed systemic process improvements to achieve an average 94% first pass payment rate per month. I strategically reduced touches by 14% through product innovations, process re-engineering and pushing the boundary of automation. Additionally, I effectively increased efficiency by 20% by re-imagining alignment of stateside team around rule categories rather than client types.

As Senior Rules Manager, I led an international team and served as liaison to multimillion dollar vendor, focus group leader, and Federally Qualified Health Center expert. I supported creation of an institutional revenue cycle offering and 30+ hospital/clinic implementations in order to improve market penetration of hospital revenue cycle product. Moreover, I drove enterprise migration to ICD-10 with significant strategic responsibility including content design and communication with clients through conference presentations; presented rollout at conference and oversaw management of key analytics.

In my initial Rules Management position, I drove operations for a small team responsible for claims adjudication and managed technical/ad-hoc projects on an as-needed basis. Additionally, I provided strategic feedback throughout sales and system implementations.I was specially selected to lead vital client implementation; executed over 130 rules and worked directly with C-Level executives and senior leadership to scope and implement payer contracts. I also leveraged process and staffing changes to effectively increase complex client implementation capacity by 30%.

I directed vital electronic claims operations, cost reduction strategies, and fostering of key payer relationships as part of the design and implementation of electronic claim status inquiry transactions. I integrated claim status content into SaaS application, thereby reducing claim follow-up turnaround time by 50% for approximately 20% of claim volume.

I was responsible for electronic exchange of eligibility data through strategic analysis of trends and usage, fostering of payer connections, and design of eligibility transaction routing algorithm.I improved enumeration of patient data for over 20% of athena's patient population by designing and implementing a Blue Cross and Blue Shield eligibility transaction routing process. Furthermore, I prevented the loss of access to Medicare eligibility for over 22% of claim volume across 100% of providers on the network through continuous process improvements.