• Oversee multiple departments within the operations division, encompassing Expense Sharing, Clinical Review, Clinical Support, Member Support, Member Resolution, Correspondence, Enrollment, and Producer Support while ensuring seamless integration and alignment of strategies to drive operational excellence across the organization.• Efficiently manage the sharing of multimillion-dollar funds, ensuring optimal allocation of resources.• Spearheaded the company-wide initiative of updating… Show more • Oversee multiple departments within the operations division, encompassing Expense Sharing, Clinical Review, Clinical Support, Member Support, Member Resolution, Correspondence, Enrollment, and Producer Support while ensuring seamless integration and alignment of strategies to drive operational excellence across the organization.• Efficiently manage the sharing of multimillion-dollar funds, ensuring optimal allocation of resources.• Spearheaded the company-wide initiative of updating processes and procedures to enhance efficiency and effectiveness across all departments.• Identified critical gaps in processes within Sharing, leading to a comprehensive overhaul that resulted in a remarkable turnaround, streamlining operations, and significantly improving departmental performance.• Successfully cleared multiple company backlogs from a one-year turnaround model to real-time responsiveness by implementing efficient prioritization strategies and coordinating cross-departmental efforts, resulting in improved operations and workflow.• Implemented strategic workforce optimization initiatives, which included the elimination of redundant positions, resulting in significant six-figure cost savings for the company while maintaining operational efficiency.• Strategically placed adept leaders in appropriate positions within the organization, ensuring optimal alignment of skills and responsibilities, which contributed to enhanced team performance and overall organizational success.• Oversee the management of company processes and procedures, ensuring they are continuously optimized for efficiency and effectiveness. Additionally, I lead succession planning efforts to identify and develop talent within the organization, ensuring a seamless transition of key roles and maintaining organizational continuity. Show less

• Oversee the Medical Review Nurses, and Team Leads in their day-to-day activities including management of clinical review caseload, service levels, metrics, and other key quantitative/qualitative factors.• Developed, implemented, and maintained compliance, policies, and procedures regarding medical utilization management functions.• Promoted compliance with federal and state regulations and contractual agreements.• Reviewed analyses of activities, costs, operations, and forecast… Show more • Oversee the Medical Review Nurses, and Team Leads in their day-to-day activities including management of clinical review caseload, service levels, metrics, and other key quantitative/qualitative factors.• Developed, implemented, and maintained compliance, policies, and procedures regarding medical utilization management functions.• Promoted compliance with federal and state regulations and contractual agreements.• Reviewed analyses of activities, costs, operations, and forecast data to determine progress toward the stated goals and objectives.• Compiled and reviewed multiple reports on work function activities for statistical and financial tracking purposes to identify utilization trends and make recommendations to management.• Facilitated ongoing communication between utilization management staff and contracted providers.• Maintained member confidentiality per HIPAA and OSH standards.• Collaborated with other departments and leadership peers and supervisor(s) regarding member or provider interactions that require escalation.• Appropriately prioritized workload ensuring urgent member and/or provider needs get met promptly. Show less

• Accomplished call center objectives by training and coaching, scheduling, and enforcing policies and procedures.• Handled escalated participant calls requesting to speak with a supervisor.• Establish reporting and analytics for the Pre-Authorization Team.• Monitored operations through multiple queues.• Prepared performance reports by collecting, analyzing, and summarizing data and trends.• Point of contact for communication with other departments within OneShare… Show more • Accomplished call center objectives by training and coaching, scheduling, and enforcing policies and procedures.• Handled escalated participant calls requesting to speak with a supervisor.• Establish reporting and analytics for the Pre-Authorization Team.• Monitored operations through multiple queues.• Prepared performance reports by collecting, analyzing, and summarizing data and trends.• Point of contact for communication with other departments within OneShare Health.• Provide support to Specialists needing assistance in handling questions and further research to allow each Specialist to be ready for the next call.• Tracked emerging trends in call center operations.• Tracked agent's call quality then coached agents when necessary to improve performance.• Coordinated team schedules to ensure maximum coverage on the phones.• Become an expert on changes to systems/clients/policy to provide new instruction to their team. Show less

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• Administered all new hire training for the Genitourinary Center.• Consistently and accurately utilizes medical acceptance criteria to screen and schedule appointments for new patients in a way to ensures optimal efficiency in clinic operations.• Clearly and professionally communicates information during all patient communication. Follows established customer service guidelines and strives to meet all reasonable patient requests. • Supports successful implementation of… Show more • Administered all new hire training for the Genitourinary Center.• Consistently and accurately utilizes medical acceptance criteria to screen and schedule appointments for new patients in a way to ensures optimal efficiency in clinic operations.• Clearly and professionally communicates information during all patient communication. Follows established customer service guidelines and strives to meet all reasonable patient requests. • Supports successful implementation of department-wide new tools, support, and operational models to improve access to care and employee workflow.• Uses technical expertise to obtain insurance information when needed and electronically verifies eligibility when available.• Provides financial information to patients obtained during the verification process by financial clearance staff, including cost estimates, payment plans, discounts, and supplemental financial assistance. Show less

• Managed billing and collections.• Coordinated with other departments to ensure the accuracy of billing information.• Maintained and updated financial records.• Managed hundreds of client accounts.• Efficiently manage multiple hospital systems for billing• Reconciled account discrepancies.• Administer pre-certification of benefits for patients while adhering to insurance rules and patient confidentiality.• Responsible for updates to the employee training manual for… Show more • Managed billing and collections.• Coordinated with other departments to ensure the accuracy of billing information.• Maintained and updated financial records.• Managed hundreds of client accounts.• Efficiently manage multiple hospital systems for billing• Reconciled account discrepancies.• Administer pre-certification of benefits for patients while adhering to insurance rules and patient confidentiality.• Responsible for updates to the employee training manual for the operating system, insurance verification, and billing• Facilitated all new hire training for the verification department. Show less

• Managed multiple group homes throughout the northern Houston area.• Screened prospective residents to ensure the group residence can provide the appropriate care for their needs. • Ensured residents received quality professional care.• Supervised the preparation of regular medical reports on all residents.• Scheduled daily activities for residents.• Monitored operational costs to stay within budget.• Worked with the residential nurse to develop and maintain residents'… Show more • Managed multiple group homes throughout the northern Houston area.• Screened prospective residents to ensure the group residence can provide the appropriate care for their needs. • Ensured residents received quality professional care.• Supervised the preparation of regular medical reports on all residents.• Scheduled daily activities for residents.• Monitored operational costs to stay within budget.• Worked with the residential nurse to develop and maintain residents' treatment plans and monitor medications.• Maintained active involvement in professional and lay mental health organizations in the community. Show less