Experience

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  New horizons treatment center

  Aug 2016 - Sept 2016

  Administrative intern

  • Assisted clinical manager with daily operations, including but not limited to the following tasks: filing insurance claims, accounting for all cash transactions and medication inventory, and providing weekly evaluations to staff to ensure consistent execution of best medical practices.• Assisted financial clerk with patient check-in and processing payments and aided substance abuse counselors in maintaining patient records.

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  Wellcare health plans

  Sept 2016 - Oct 2021

  ● Trained 4 Operations Account Specialists and 3 new hire Operations Account Managers to provide insight on managing inventory and the day-to-day roles of their direct reports.● Served as an account lead and strategic partner with assigned providers and healthcare systems tomaximize the provider’s ability to interact with the health plan by researching, root causing, and resolving escalated claims, configuration, authorization, and payment issues for Medicaid and Medicare providers.● As an internal consultant, facilitated meetings with the Executive Leadership Team and key stakeholders to interpret complex data and information into an easy-to-understand format in order to propose solutions and obtain approval on implementing new policies and procedures, thereby reducing manual and system processing errors by 70%.● Investigated and reduced fraudulent, wasteful, and abusive billing practices by 50% by running quarterly reports to analyze provider billing trends and variances and using the report data to improve internal processes and educate providers on utilization and proper billing guidelines.● As a subject matter expert, served as a project manager by overseeing the implementation of newMedicaid programs and policies, by managing the full life cycle of multiple projects simultaneously, and by approving updates for internal processing documents for behavioral health and physical health claims.● Collaborated with internal cross-functional teams and the Georgia Department of Community Health to implement new business initiatives, policies, and programs to better serve Medicaid members. Show less • Served as the primary point of contact for the department for all provider issues and logged all provider inquiries to maintain the claim inquiry inventory for the Georgia market and improve provider interactions.• Researched and developed resolutions for Medicaid and Medicare claim inquiries regarding reimbursement issues, health plan payment methods, benefits coordination and business operations, thereby decreasing provider abrasion and billing errors.• Exceeded goal of resolving 90% of claim inquiries within 10 days by resolving 95% of claim inquiries.• Collaborated with 3 external vendors to conduct business case reviews of clinical policies and coding edits to help identify potential cost saving initiatives and reduce fraud, waste, and abuse exposure.• Received 2 WellCare Champion Awards for identifying system errors that caused over $97,000 in underpayments for a vocal provider and for training other Operation Account Specialists on maintaining the claim inquiry inventory in their respective states. Show less

  • Operations Account Representative

    Mar 2018 - Oct 2021

  • Operations Account Specialist

    Sept 2016 - Mar 2018
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  Optimity advisors

  Oct 2021 - Jun 2023

  Senior consultant

  ● Collaborates, consults, and builds relationships with clients to understand and remediate their challenges by developing solution-based deliverables based on the analysis of client data and working with business stakeholders to strengthen business development, engagement, and efficiency.● Creates presentations and facilitates meetings with internal and external stakeholders and clients todocument business processes and synthesize differing answers in order to identify client objectives,challenges, and needs, and deliver solutions, operational assessments, and strategic roadmaps.● Collaborates with cross-functional teams to compile client insights and requirements in order to develop project action plans and workflows, establish ongoing work streams for project status reporting and issue/risk management, and create streamlined processes to increase business engagement andefficiency.● Provides subject matter expertise and project management support for the procurement andimplementation of new initiatives, programs, vendors, and health plans across single and multi-stateentities and ensures projects adhere to state and federal guidelines and regulations.● Coordinates with executive leadership to provide status updates and triage and resolve project escalations, supports monitoring, and conducts working sessions with clients to refine and shape policies, procedures, and future operating models.● Manages, analyzes, and approves project timecards and invoicing to ensure the project is progressingtowards forecasted financial and operational metrics.● Seeks opportunities for business development and prepares responses for RFQs (Request forQualifications) and RFPs (Request for Proposals) to support the firm’s growth and increase revenue. Show less

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  Gold coast health plan

  Jul 2023 - now

  Operations manager