Customer Service Quality Assurance

LORI OSBORNE

( ***** Mountain Laurel Way ( Union, Kentucky 41091 ( phone 859-384-

**** ( ****.*******@*********.*** (

Profile

Results-driven, highly motivated healthcare professional with nearly 20

years successful leadership experience and documented annual results.

Excellent communication (written and oral), organizational, negotiating,

and closing skills.

Entrepreneurial approach to meeting deadlines and fulfilling budgetary

parameters.

Demonstrated ability to achieve results in challenging environments and

productively manage change.

Professional experience

Ingenix, a wholly owned subsidiary of UnitedHealth Group

6/09 -present

Market Outreach Consultant - West Chester, OH

Leverage health care information technology to provide practice management

support to physician offices with UnitedHealth Group Medicare Advantage

members

Consult with practices to code with specificity to accurately portray

patients with chronic conditions that risk adjust resulting in appropriate

funding from CMS to the client health plan.

Support contracting activities with client health plan by providing

analysis and reporting

Work with offices to pull through financial results by supporting

contracts and incentive programs

Johnson & Johnson, Ortho-McNeil Pharmaceutical

2000 - 6/09

Senior Professional Representative, Northern Kentucky territory

Promoted intravenous/oral anti-infective (LEVAQUIN ) and proton pump

inhibitor (ACIPHEX ) products to more than 250 physicians and community

hospitals within the Northern Kentucky market.

Recognized with multiple Representative of the Cycle awards for top

performance and leadership (1st Cycle 2001, 1st Cycle and 3rd Cycle 2002,

3rd Cycle 2003, 2nd Cycle 2004); District Representative of the Year

(2002, 2003, 2005)

Contributed to Cincinnati District team winning Region Business Director

Award for top sales results in the Midwest Region, 2005. Individually

named as Region Representative of the Year-2005

Appointed to Interim District Manager-7/05-12/05 Led team of 10

representatives during reorganization of company while successfully

managing my own territory which placed first in the region for all of

2005.

Honored with Johnson & Johnson Standards of Leadership Award, 2005

Mentored and trained 6 new sales associates with emphasis on product

education, selling skills, territory management, and managed care concepts

to prepare them to manage their own territories.

Appointed as advisor for in-house product and sales training for new

associates-over 40 new employees

Managed hospital contracting with GPO, as necessary; included negotiating

and implementing contracts

Adapted selling style and developed expertise to call on a wide variety of

health care professionals: Primary Care, Infectious Disease, Urology,

Critical Care Medicine, Pulmonology, Gastroenterology

Choice Care/Humana Health Plan

1991 - 2000

Provider Contractor 7/96-7/00

Recruited physicians, ancillary providers, and vendors for health plan

participation; managed all aspects of the contracting and operational

implementation and support.

Managed vendor contracting, including contract development and execution,

negotiation, performance standard measurement, day-to-day operations.

Vendors included: pharmacy benefit manager, subrogation, durable medical

equipment, imaging and other ancillary providers.

Participated on special project teams including product development and

NCQA site reviews.

Supported development and implementation of Medicare Risk plan for

physician and ancillary panels.

Senior Process Management Specialist 9/95-7/96

Led projects with multi-disciplinary teams with emphasis on process

improvement

Developed and implemented training programs for internal and external

customers-ranging from simple benefit changes to brand new products

Independently managed programs and projects sponsored by the health plan

Served as internal consultant to support team focus on plan customization

for large clients (500+ employees, union contracts and federal/state

programs)

Lori Osborne ( page 2

Professional Relations Representative 4/93-9/95

Maintained relationships with over 300 Northern Kentucky physician practices

Directed office staff orientation and training programs

Developed training and orientation reference tools (Office Manuals,

Customized Training materials), and delivered seminars to educate office

staff about health plan provider responsibilities and processes.

Conducted medical chart audits and environmental assessments in primary

care, dermatology, OB/Gyn, and Chiropractic offices in conjunction with

corporate quality assurance program.

Customer Service Representative 3/91-4/93

Researched and resolved customer inquiries regarding benefit coverage,

eligibility, and claim status

Maintained expert knowledge of all benefit plans and their provisions to

respond to client-specific questions

Averaged over 100 calls/day

EDUCATION

Northern Kentucky University, Highland Heights, KY

Bachelor of Science, Public Administration

Community Involvement/Affiliation

St. Paul Catholic Church Religious Education Program - Volunteer 2000-2003,

2005

Team Mom - Raider Youth Wrestling Team 2003-2005

Team Mom - Gray Middle School Wrestling Team 2004-2005

Team Mom - Ryle High School Wrestling Team 2007-present

Secretary - State of Kentucky Youth Wrestling Association 2007-2009

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