Sara McElligott, CSM

Experience

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  CareFirst BlueCross BlueShield

  Jan 1991 - Jan 1994

  Quality Assurance Auditor

  Responsible for analyzing adjudicated claims for accuracy, identifying inconsistencies in processing guidelines and increasing the accuracy rate of claims examiners. Development of standard operating procedures and customized training.Initiation and development of the Full Service Representative position. Development of cross training program for claims examiners to handle Customer Service Calls. The average speed of answer was dramatically reduced, and service request turnaround time was reduced to an average of 2 days. Show less

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  Magellan Health

  Jan 1994 - Jan 1997

  Quality Analyst/Claims Recoveries Coordinator

  Development and operation of the Claims Quality Assurance Area, Claims Recoveries Area and Claims Training Program. Responsible for training new claims examiners, quality assurance auditors and recoveries specialists while assisting with the design and testing of Accounts Receivable software and developing auditing methodologies.Recovered 2.2 million cash within first three months; averaging 6.5 million in total recoveries, savings and avoidances on an annual basis.Design and testing of automated Quality Assurance Reporting software Show less

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  Magellan Health

  Jan 1998 - Jan 2001

  Responsible for the identification of cost reduction opportunities, development and implementation of cost reduction initiatives in addition to the development of reporting entities used to measure recoveries and savings. Also developed the claims grievance and appeals workflow and the problem resolution protocols for new business. Position requirements included understanding client needs to ensure strong relationships and customer satisfaction by offering creative solutions to address clients needs from a products and service perspective. Show less

  • Manager, Account Audits

    Jan 2000 - Jan 2001

  • Business Information Analyst

    Jan 1998 - Jan 2000
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  Antek Healthware, Inc

  Jan 2002 - Jan 2003

  Technical Support Specialist/Implementations

  Responsible for installation and onsite training of propriety Medical Practice Management and Billing software as well as providing Technical Support for existing customers. Other responsibilities include software design, testing and quality assurance.

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  Mamsi, Inc

  Jan 2003 - Jan 2004

  Business/Data Analyst

  Served as a member of the Data Analysis team employing the use of SQL Navigator and SQL Plus to access Oracle based data warehouse for the purpose of data analysis, the production of ad hoc reporting and the creation of data files for various business units within the corporation. Additional responsibilities included writing technical specifications for enhancements to the warehouse, testing, project management and management of the standard maintenance reporting process.

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  St. Agnes Hospital

  Jan 2004 - Mar 2006

  Financial Systems Analyst

  Responsibilities include the implementation, development, testing, documentation and general application support of Financial Information systems including Centricity Physician Practice Management System and Meditech Billing/Accounts Receivables System.Also responsible for the development of customized reporting employing SQL Enterprise Manager, SQL Query Analyzer and Crystal Reports to access relational databases housed on SQL 2000 servers.

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  Johns Hopkins HealthCare

  Mar 2006 - May 2015

  IT Project Lead

  Responsible for managing IT projects designed to deliver specified requirements to meet customer’s business needs. Responsibilities entail the development and maintenance of all documentation associated with assigned projects including project charters, scope documents, business requirements documentation and project plans. Responsible for identification of project resources and the development and leadership of integrated project teams critical to project completion and success. Provide analysis and issue resolution to ensure timely completion of project deliverables and communicate status updates to all stakeholders including executive staff and steering committees. Show less

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  Superior Vision Services

  May 2015 - Aug 2016

  EDI Manager

  Manager of EDI and Reporting for national vision benefit services company with a focus on the Medicaid and Medicare market place.• Manage a team of 7 EDI Analysts and Report Developers• Responsible for the daily production load and processing of inbound enrollment files, inbound claims data, outbound encounter data, out bound provider remittance files.• Report development for both internal and external customers – requirements, development and deployment to production. Also responsible for ad-hoc report requests. • Manage inbound traffic of service request tickets for the department, triage, prioritize and assign as appropriate. Show less

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  University of Maryland Medical System

  Aug 2016 - Sept 2017

  IT Project Manager

  Project Manager in large healthcare delivery system encompassing acute care hospitals, specialty treatment practices and outpatient community based practices. Responsible for identifying and tracking technology updates as mandated by federal regulations related to Meaningful Use and MACRA/MIPS Quality Payment Programs.

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  Populus Group

  Oct 2017 - Mar 2018

  Sr. Project Manager

  Contractor working on projects related to the Cost of Care.

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  Elevance Health

  Mar 2018 - now

  • Enterprise Cost of Care Director,

    Oct 2021 - now

  • Director, Cost of Care

    Apr 2021 - Oct 2021

  • Sr. Process Improvement Manager

    Mar 2018 - Apr 2021