Cortney Strzelczyk

Experience

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  Texas Roadhouse

  Jan 2007 - Mar 2009

  Server
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  UnitedHealth Group

  Jan 2009 - Oct 2010

  Health Advisor
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  TGI Fridays

  Oct 2010 - Jul 2012

  Server
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  Independent Health

  Mar 2011 - Nov 2015

  Responsible for working collaboratively with numerous departments and management to identify and troubleshoot issues within Independent Health's new core platform HealthRules. Successfully, established interim processes until permanent fixes could be implemented to ensure no breakdown of daily functions and claims processing. Successfully implemented training to various departments regarding Coordination of Benefits (COB) to ensure no negative impacts cross-departmentally. Ensured the entire COB team was trained and comfortable with the new operating systems for both Independent Health as well as our Self- Funded business Nova Healthcare. I was successful in creating and maintaining multiple savings reports to capture claims and members with identified issues until a resolution was able to be implemented. Through these created reports the COB department was able to acquire more than a half a million dollars in savings. Facilitated daily one on one training as well as classroom training to empower and educate all members of the COB team on their cross-functional roles. I performed daily tasks of fielding questions and escalations as well as maintaining departmental reports. As part of my Advocate position I was continuously on the lookout for ways to improve processes. Thinking outside of the box, not looking at the direct answer but looking for ways that would make the daily inventories easier to manage while maintaining quality and timeliness. Finding areas within the department that can be improved upon not only to assist the COB team but cross departmentally as well. In addition to the advocate daily duties I also maintained responsibilities for the work duties outlined in the COB Coordinator I position. Show less Responsible for accurately and efficiently maintaining files for workers compensation, no- fault cases, and other insurance. Developed and implemented a basic training program and materials for the COB department, to ensure future success of the new core system (HealthRules). Ensured that any questions raised by the team are fielded to the appropriate persons to receive a timely and accurate response. Consistently exceeded departmental metrics for quality and production. Produced Standard Operating Procedure Manuals as well as tip sheets to assist associates in learning and operating within HealthRules. Worked collaboratively with various departments and colleagues to ensure open communication and team work. Show less While working as a document processor I was responsible for accurately and efficiently entering all data for incoming/ internal correspondence, as well as facility and professional claims in accordance with Independent Health’s Business Rules. During this time I quickly became highly experienced in Independent Health’s core systems (Power, HealthRules, Siebel, Macess and Formworks applications). I was able to develop a strong working knowledge of processes and how to best service our internal and external customers within our contracted time frames, ensuring our business partners were satisfied and able to function without interruption. Daily collaboration with my peers to come up with more efficient and effective ways to enter documents into the system, as well as document storage for audits and internal needs. Daily date entry allowed me to gain the ability to accurately type more than 70 WPM. Following my time within the document processing department I was called on to assist with their backlog in inventories due to knowledge of systems and ability to key quickly and accurately. Show less

  • Advocate - Coordination of Benefits

    Jun 2014 - Nov 2015

  • Coordinator - Coordination of Benefits

    Sept 2012 - Jun 2014

  • Document Processor

    Mar 2011 - Sept 2012
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  Texas Roadhouse

  Mar 2014 - Nov 2014

  Server
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  Nova Healthcare Administrators, Inc.

  Nov 2015 - Jan 2017

  Cost Containment Analyst

  responsible for facilitating cost negotiations with providers who do not participate with Nova Networks to ensure lower costs for our clients. Reconciling with all vendors and brokers at month/year end to keep accurate and prompt revenues for all parties. Research and investigate cost saving measures internally as well as externally with our vendors. I currently manage two lines of business; along with their operating platforms for approximately 66 clients. Responsible for keeping organized and accessible records of all negotiations and reconciliations. In 2016 I have been able to acquire over $227,000.00 dollars in direct revenue through cost negotiations with providers and facilities. Show less

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  Independent Health

  Jan 2017 - now

  I manage 9 direct reports and an additional 21 indirect reports. These associates comprise 5 distinct teams. My current teams are responsible for the accurate and timely adjudication of medical claims, member initiated claims and daily reporting. We also manage any post payment adjustments that need to be made due to internal or external causes. Cost containment tracks and identifies opportunities for cost avoidance. Works on negotiating claims with non-participating providers or securing single case agreements with participating providers for services not included within the contract. Identifies areas of potential FWA to report to our SIU department. Tracks and monitors all Federal/ State NSA disputes. Manages invoicing and daily operations for numerous vendor relationships; including transplants and pricing networks. Touching almost 21 million dollars in cost avoidance for 2022. Recoveries identifies, researches, and pursues debts owed to Independent Health and it’s subsidiary companies, bringing in almost 2 million dollars in recoveries for 2022. Responsible for implementing process improvements to increase associate satisfaction, while also increasing quality, and production. Cross departmental collaboration to identify opportunities to cut down on member, provider, and internal disruptions. I also monitor and manage many aspects of monthly, quarterly, and annual compliance measures. -monthly and quarterly CMS universes - quarterly DFS submissions - annual policy review and sign offs - Representing the claims department in CMS, DFS, and other important audits. - providing documentation and support to other areas during their audits - Monitoring new guidance and ensuring we are processing claims, and providing correct correspondence based on the new guidelines. Show less I currently supervise three dynamic and distinct teams made up of thirteen unique individuals. One team who ensures all post-payment inquiries from both internal and external customers are handled appropriately. Cost Containment who negotiates to ensure the best rate and appropriate claim payment based on industry standards, for both non participating providers or services with no fee schedule. They also identify trends in provider billing and work closely with our leased networks- including our transplant network. Recoveries who work on collecting any over payments to both members and providers. Show less

  • Claims Operations Manager

    Oct 2021 - now

  • Program Manager - Claims Operations

    Feb 2021 - Oct 2021

  • Supervisor - Claims operations

    Jan 2017 - Feb 2021