Project Manager Quality Control

Erica J. Neises

** ********* **. ? Spring Lake, NC ? 28390 ?

703-***-**** ? *********@*****.***

EXPERIENCE:

BANK OF AMERICA

Charlotte, NC

*/** - **/** ******* Manager (Contract) - Quality Control & Development

Successfully managed Phase I - Enterprise Policy Framework, a company wide

initiative to re-template all Bank Policies; created high-level and low-

level Policy template to be implemented across all lines of business,

developed Procedure template

Utilized Six Sigma presentation methods developing PowerPoint and Word

presentations.

Facilitated mediation sessions with high-level Bank stakeholders in an

effort to formalize template requirements and information across all lines

of business and cross-functional project teams.

Consistently met project deadlines, completed required deliverables and

milestones.

Accurately calculated project phase push back date by assessing completed

and current projects and factoring in possible issues. Assigned a new end

date based on all information gathered while not affecting Phase II or

Phase III.

WELLCARE - 'OHANA HEALTH PLAN

Honolulu, HI

7/08 - 4/10 Senior Operations Supervisor

A Fortune 500 leading provider of managed care services dedicated to

government-sponsored health care programs,

focusing on Medicaid and Medicare.

*Associate of the Quarter, 2nd Quarter 2009; "You have gone far and

above your job description and responsibilities.

You're proactive, having taken a leadership role both by example and

by stepping up to take on sensitive and complex

projects."

Supervised team of 5 Provider Operation Coordinators and point of contact

for four Provider Relation Representatives for Medicaid/Medicare start up

program.

In charge f processing provider contracts, credentialing and auditing

approximately 5,200 providers for start-up Medicaid/Medicare network.

Relayed gaps to PR Reps to prioritize contracting efforts.

Monitored all department projects and activities to ensure deadlines met

and project accuracy; provide comprehensive project report upon completion.

Developed detailed weekly KPI report on PR Operations credentialing and

contract status as required in RFP; reported to Executive Team and state.

Successfully identify Configuration errors with largest client, 40% of plan

providers, resulting in reprocessing of claims and payout of over $250,000

in denied claims.

Monthly Excel Dashboard reporting on actual claims processing time, total

claims submitted,dollars paid out and member ER visits for Operations

Department in compliance with governing regulations and directives.

Audited team member's work to track progress and identify areas of

improvement while facilitating team growth.

Worked directly with Corporate Configuration Dept to create Step Action

Training (SATs) to minimize load error; trained PR Dept on Config SATs.

Created training documents to use for New Hires and Department refresher

trainings; trained New Hires and co-lead refresher trainings.

Lead transition of new credentialing process; designated Subject Matter

Expert (SME) on new process.

Utilized Access to manage contract status and use as basis for KPI Reports;

Access DB is used to report network status for regulatory reports to state.

Promoted from Operations Coordinator.

Erica J. Neises

28 Cottswold Ln. ? Spring Lake, NC ? 28390 ?

703-***-**** ? *********@*****.***

ALOHACARE HEALTH PLAN

Honolulu, HI

3/07 - 6/08 Provider Relations Project Coordinator

Created Excel project monitoring tool to track and manage 40+ projects and

reports for

Provider Relations Department to ensure deadlines were met. In charge of

editing project content before submitting for final approval.

Worked closely with PR Manager to edit/update PR Department and

Credentialing Department P&P's, assist in preparing both departments for

URAC accreditation/re accreditation as well as all necessary audits.

Submitted monthly PR Dept Utilization dashboard to Director of Operations

for submission to state.

Generated Network Provider Access Maps using MS Visio, monthly, to submit

to Director of Plan Operations.

Responsible for forecasting and procuring promotional items given out to

providers and members by PR Reps.

Created and maintain websites for both the PR Department as well as the

Credentialing Dept.

MANPOWER

Arlington, VA

8/05 - 12/06 HR Specialist

Assisted with the temporary, long-term, contract-to-hire and direct hire

staffing processes for the nation's largest staffing supplier, which

generates $16 billion in yearly revenue.

Conducted recruitment efforts for exempt and non-exempt positions;

scheduled interviews, coordinated temporary staffing for over 100 clients,

coordinated advertisements and position postings.

Lead employee trainings to improve employee placement, customer

satisfaction, employee retention and increase contract-to-hire

percentages.

Monitor employee schedules to ensure all open positions covered.

Completed benefit trainings, payroll and termination processes.

EDUCATION:

George Mason University

Fairfax, VA

BA, Advertising; Minor Business Administration

May 2005

SKILLS:

MS Office Excel Access

Dreamweaver MS Project

Sharepoint Oracle Outlook

Visio Clarity

Contact this candidate