Experience

• 

  Cigna healthcare

  Nov 2003 - Dec 2005

  Senior customer service representative

  Answer phone calls from all lines of business and platforms. Completed simple adjustments for claims over the phone to increase provider satisfaction. Trained other agents on improving and maintaining job function skills while maintaining quality scores above 90%.

• 

  Molina healthcare

  Dec 2005 - now

  • Manage enrollment operations for 13 Managed Care Molina plans.• Manage the implementations for Enrollment Operations• Manage Regional Directors• Oversight of enrollment processes and IT jobs success/failures, to ensure each State’s enrollment is accurate and loaded timely according to regulations and compliance guidelines.• Provide detailed coaching and guidance to health plan enrollment leaders and staff, ensuring qualitative and quantitative goals and objectives are met. Develop, implement, and modify (when deficiencies are identified) productivity standards.• Ongoing work with other leadership partners to design and develop process improvements to continue to improve efficiencies across the Corporate Enrollment structure as Molina continues to grow Show less • Successfully implemented multiple States and products lines, including that of MMP (Duals) for Ohio, Illinois and Texas. Participating as both a leader and Subject-Matter-Expert for enrollment. Providing guidance, approvals, test scenarios and policies to ensure accurate go-live and production deployment.• Reduced the need for adding to staff with enrollment growth, by increasing the efficiencies and applying automation where possible. Specifically, redesigned multiple processes to increase productivity, automation as well as correcting ineffective enrollment load process builds for both Texas and Florida. • Oversee upwards of seven states simultaneously. Ensure my direct-reports; each State’s enrollment leader has satisfactory support and a clear understanding of their roles and responsibilities to meet and exceed the health plan’s expectations. Provide hand’s-on knowledge training whenever needed to create a strong leader that ensures we are meeting our set expectations.• Oversight of enrollment processes and IT jobs success/failures, to ensure each State’s enrollment is accurate and loaded timely according to regulations and compliance guidelines. • Provide detailed coaching and guidance to health plan enrollment leaders and staff, ensuring qualitative and quantitative goals and objectives are met. Develop, implement, and modify (when deficiencies are identified) productivity standards.• Ongoing work with other leadership partners to design and develop process improvements to continue to improve efficiencies across the Corporate Enrollment structure as Molina continues to grow. Show less • Directly managed nine (9) Enrollment and COB Representatives. Providing day-to-day oversight, direction, and coaching of the team to ensure production and compliance activities were met and maintained consistently. Delegate tasks and responsibilities to guarantee compliance with all regulatory agencies and NCQA standards.• Restructured and automated several enrollment processes to ensure the most efficiency with the available tools.• Worked directly with IT on a regular basis to confirm systems are configured correctly to meet health plan and business needs. Monitored daily and monthly eligibility files to confirm accuracy and timely loading of enrollment data into QNXT.• Ensure all ODJFS, OAC, and MHO requirements and timeframes were met for Newborn Notifications, Inpatient Deferment, ID card receipt timeliness and Membership reconciliation processes.o Worked with ODJFS on conversion to a new system to ensure minimal impact to members. Tested new files and identified potential issues, worked closely with IT to modify the MEG system to accommodate new information being received.• I was able to assist in a variety of corporate initiatives to provide Subject-Matter-Expertise in support of Enrollment for Molina. This included, but was not limited to Member and Provider portal redesign, MEG implementation, and COB application redesign.• Provided Subject-Matter-Expertise for enrollment in multiple state expansions for Molina. Played a primary role in the development of Texas Medicaid for Molina, developed from start enrollment team, SOPs, Policies. I played a key role as the direct interface with health plan enrollment and corporate entities to ensure guidelines and compliance standards were created and met consistently. Show less • Directly managed nine (9) Enrollment and COB Representatives. Providing day-to-day oversight, direction, and coaching of the team to ensure production and compliance activities were met and maintained consistently. Delegate tasks and responsibilities to guarantee compliance with all regulatory agencies and NCQA standards.• Restructured and automated several enrollment processes to ensure the most efficiency with the available tools.• Worked directly with IT on a regular basis to confirm systems are configured correctly to meet health plan and business needs. Monitored daily and monthly eligibility files to confirm accuracy and timely loading of enrollment data into QNXT.• Ensure all ODJFS, OAC, and MHO requirements and timeframes were met for Newborn Notifications, Inpatient Deferment, ID card receipt timeliness and Membership reconciliation processes.o Worked with ODJFS on conversion to a new system to ensure minimal impact to members. Tested new files and identified potential issues, worked closely with IT to modify the MEG system to accommodate new information being received.• I was able to assist in a variety of corporate initiatives to provide Subject-Matter-Expertise in support of Enrollment for Molina. This included, but was not limited to Member and Provider portal redesign, MEG implementation, and COB application redesign.• Provided Subject-Matter-Expertise for enrollment in multiple state expansions for Molina. Played a primary role in the development of Texas Medicaid for Molina, developed from start enrollment team, SOPs, Policies. I played a key role as the direct interface with health plan enrollment and corporate entities to ensure guidelines and compliance standards were created and met consistently. Show less

  • Program Director

    Jan 2018 - now

  • National Director

    Oct 2016 - Dec 2017

  • Regional Director, Enrollment

    Feb 2013 - Sept 2016

  • Manager, Enrollment

    Apr 2011 - Feb 2013

  • Supervisor, Appeals and Grievances and Enrollment

    Jul 2008 - Apr 2011

  • Supervisor, Member Services

    Sept 2007 - Jul 2008

  • Member Service Lead

    Dec 2005 - Sept 2007