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Mount Vernon, NY, US

United States

Strategic leadership and operational execution throughout the organization for Go-To-Market, regulatory changes, special projects, small to mid-scale projects, and ad-hoc projects for the enterprise.Liaison between product owners, clinical management and other areas to gather requirements and define the project scope to reach a 98% or higher timeliness for.

Performed oversight of vendors, including cultivating partnerships, Go-To-Market changes, developing detailed project plans, onboarding, maintenance activities, performance monitoring, audits, and deliverable tracking.Conducted product design analysis to provide product profitability of the OTC product and lead business cases for optimization. Evaluated.

New York, New York

Planned, implemented, and managed all operational and contractual business objectives for assigned hospital systems and providers on behalf of the organization.Strengthened hospital and physician business partnerships by refining health plan operations, updating documentation and creating bonds between external and internal stakeholders. Gathered provider.

Greater New York City Area

Assessed business requirements and project scope for health claims and benefit configuration projects to ensure compliance with the Schedule of Benefits (SOB) and vendor contracts. Actively participated in Kanban and Agile stand-up to provide status of implementation stories. Project managed the entire benefits team’s lifecycle of Go-To-Market updates.

Newark

• Support accuracy and quality of auditing processes by performing monthly audits on benefit coding, pricing, and reimbursements. Identify top error trends and improvement areas, communicate and institute corrective.
• Provided leadership in auditing auditors, and in providing ongoing training and coaching to new team members.
• Key contributor on enterprise-wide projects and in internal / external “best practice” sharing to continually streamline and improve audit processes

Newark, NJ

Ensured operational excellence by monitoring, evaluating, and providing quality training on workflows and procedures. Partnered with stakeholders in design and deployment of training on new work processes, systems, business initiatives, and product offerings—coordinating and / or delivering training at Horizon sites and remote vendor locations. Assessed.

Newark, NJ

Provided outstanding service to customers, answering questions, providing education, and resolving issues related to benefit coverage, claim payments, and appeals. Carefully investigated customer complaints to identify process deficiencies and institute corrective actions. Broadly communicated customer satisfaction goals to unify teams around common.

Cranbury NJ

Prudential Health Care/ Aetna Incorporated, Cranbury NJI was originally employed by Prudential Health Care which transitioned to Aetna Incorporated in the year of 1997. ♣ Sr. Claim Benefit Specialist (2000 – 2004)♣ Claim Benefit Specialist (1997-2000)