Resume

***** ******

**** ***** **** **. #** Cincinnati, Ohio 45247

T: 513-***-**** / ***********@*******.***

qualifications

EXPERIENCED OPERATIONS MANAGER

Twenty four years of leadership experience with high-volume

claims and call centers and financial management roles.

Exceptional level of professionalism.

Strong and inspirational leader with a talent for motivating and

recruiting exceptional talent. Passionate about associate

engagement and customer service and tenacious in the pursuit of

"Perfect Service". Equally adept in strategic planning and

process improvement execution. History of quantifiable success.

AREAS OF EXPERTISE

? Team leadership ? Project Management

? Analytical

? Customer Service ? Budget Management

? Organization

? Six Sigma ? Recruiting

? Process Improvement

? Lean Sigma ? Relationship Building

? Microsoft Applications

PROFESSIONAL EXPERIENCE

Manager of Operations 2007-2010

Humana, Cincinnati, Ohio

Recruited to execute start up of pharmacy mail-order and drug

authorization call centers utilizing Avaya phone systems.

Recruited a team of 12 exceptional supervisors and 250 associates

and created efficient processes that ensured "Perfect Service"

for customers.

Directed and managed an incoming call center doing over 8M

scripts by phone per year and 4,000 drug authorizations

Administered Humana's Perfect Service Vision and Model within

department

Responsible for building and maintaining positive morale of the

team

Partnered with Workforce Management to ensure appropriate

staffing

Analyzed all processes and identified process enhancements using

Six Sigma and Lean Sigma tools.

Claims/Correspondence/Grievance 2003-2006

and Appeals Manager

Responsible for developing frontline staff and coaching and

mentoring supervisors.

Managed all aspects of the Grievance &Appeals and

Correspondence/Claims Rework units for all platforms serviced by

the Cincinnati Service Center

Developed strong relationships between service centers to ensure

consistency in processes and excellent customer service

Developed Tracking and trending model for all operational metrics

as it applies to Grievance &Appeals, claims and correspondence

Performed route cause analysis and develop action plans to

correct claims operational issues

Administered process for external review of appeals

Worked directly with providers and the contracting area to

troubleshoot claims issues

Continuously monitoring processes and procedures to ensure

maximum production and quality

Managed platform migration strategy as it relates to

Correspondence and Claims rework units

Responsible for staffing models and budgets

Headed oversight and completion of the ChoiceCare platform

shutdown

***** ****** RESUME - PAGE 2

PROFESSIONAL EXPERIENCE - Continuation

Market Relations Manager 2002-2003

Developed relationships between market offices and service center

to ensure customer and member satisfaction

Integrate and improve processes within corporate, market office

and service center

Drove excellent service delivery to complex customers

Managed cross -functional teams including Humana's service center

realignment

Provider Reimbursement Manager 1999-2002

and Manager of Financial

Recovery and Claims

Managed all aspects of claims review and payments and a staff of

65

Headed the Provider reimbursement area which included development

of fee schedules including capitation rates for hospitals and

provider offices

Coordinated efforts with the Network area to contract with

hospitals and provider offices

Maintained all data used to develop fee schedules

Worked directly with IT to ensure proper loading of all fee

schedules, DRG multipliers and weights and all current CPT codes,

ICD9 and HCPCs

Established financial recovery area which audited and collected

overpayments made to providers

Senior Reimbursement Analyst

1990-1999

Helped develop fee schedules that were used in negotiations of

hospital and physician contracting

Ensured all rates were loaded correctly

Junior Accountant

1985-1990

Responsible for accounts payable and receivables

Managed payroll for Cincinnati based associates

Education

Pursuing Degree in Business Management and Finance at Mt. St.

Joseph College

Contact this candidate