Barbara Camps-Sierra, PAHM
**** *.*. ** *******. Miami, FL 33165. ?786-***-**** ? abmrfj@r.postjobfree.com
Chief Operations Officer ? Vice President ? Managing Director
Delivering Business Development, Broad Technical and Business Acumen, Performance
Improvement
Dynamic and accomplished healthcare executive with more than 20 years of management,
operations, marketing, strategic planning, and budget administration experience in the
insurance and managed care arena with organizations ranging from over $200 million to
$87 billion in revenue. Expertise in integrating and improving processes to enhance
the total quality of the customer experience, while maximizing human and financial
resources. Exceptional cross-functional management background and demonstrated
performance in business and financial management, leveraging communications talents
and business acumen without compromising healthcare quality through effective
leadership, development and implementation of processes and procedures to dramatically
improve performance and streamline operations.
SELECTED ACCOMPLISHMENTS
Led corporate interdisciplinary teams for the systems conversions and operational
integration initiatives for VISTA Healthplan throughout the merger process of four
health plans (HIP of South Florida, Foundation Health, Beacon Healthplan, and
Healthplan Southeast)
Improved the Provider Service Call Center abandonment rate from 25% to less than 10%
within 120 days of direct management
Implemented paperless workflow system that resulted in a savings of $150,000 in
administrative costs
Developed and implemented a consolidated provider information system used for
credentialing and contractual data
Eliminated backlog in the Network Management and Credentialing Departments through
auditing procedures, incentivized production programs and flexible work schedules that
resulted in over $500,000 savings in labor costs
Developed a Financial Recovery Unit and implemented auditing procedures that resulted
in the identification of $11M in potential recoveries and the collection of $4M within
the first 120 days of the Unit's implementation
Completed successful AAAHC Credentialing survey to achieve a three year accreditation
for VISTA Healthplan
Developed a Claims Reconciliation Unit to resolve claims reimbursement contestations
that facilitated in the successful settlement and contract negotiation resulting in
over $5M million dollars of savings
AREAS OF EXPERTISE
Start-up Leadership Staff Development
System Conversions
Process Engineering Research & Analysis
Operations Systems Development
Communications/Negotiations Global Sourcing
Claims/Financial Recovery
Business/Strategic Planning Turnaround Management Training
/Development
PROFESSIONAL SUMMARY
UNITED HEALTH CARE Minneapolis, MN (May 2009 -January 2010)
Vice President of Network Data Management
Direct muti-site national operations for United Health Network Data Management
Department consisting of provider demographic, contract loading, delegated provider
roster management, and electronic provider data interface within 14 legacy platforms
and over 200 FTEs
Improved average turnaround time from 80% to 95% within 5 days through development of
inventory control reports and reduction of internal handoffs
Reduced production downtime from 20% to 12% by establishing staff management protocols
and policies
Team leader in the development of consolidated workflow tool to improve inventory
management and reporting
EMBLEMHEALTH HEALTH INSURANCE PLAN ADMINISTRATORS, HOLLYWOOD, FL (AUGUST 2007-May
2009)
Director of Claims Operations
Directed regional operations for the Claims Department consisting of OCR Claims
Validation, Claims Processing Operations, Claims Adjustments, Claims System
Management, Quality and Training, and Financial Recovery, with 140 employees that
support the national enterprise of HIP of New York, GHI, and affiliated companies with
an output of over 30M claims
Management expertise with Collective Bargaining staffing
Reduced the claims inventory backlog from 150,000 claims to a sustained inventory of
less than 50,000 claims
Created staffing model to increase productivity standards resulting in projected $1.4M
savings in labor costs for 2009 budget
P&L responsibility for a $14M departmental budget, $40M total operating budget
Established a new Financial Recovery Unit; YTD recovery of over $18M
Reduced cycle time from 25 day turn around time to 5 days in the claims adjustment
unit
Implemented performance metrics and a reporting database/program to monitor
productivity and quality standards resulting in a 20% savings in administrative costs
due to increased productivity
Created operations support for new Connecticare Medicare product
INDEPENDENT HEALTHCARE CONSULTANT (APRIL 2007-AUGUST 2007)
Developed auditing protocol and directed accreditation process that resulted in the
successful three year accreditation from the Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) for a national medical supply organization, MEDirect
Latino, Inc.
Served as interim Compliance Officer for the company
Designed proprietary auditing tool for healthcare organization accreditation
Developed all corporate policies and procedures, including HIPAA compliance training
and Risk Management Programs
VISTA HEALTHPLAN, SUNRISE, FL (JUNE 2000-APRIL 2007)
Vice President of Network Management Services (2003-2007)
Responsible for day to day operations and development of systems and configuration
protocols for the Provider Contract Administration, Benefits Management, Provider Call
Center, and Credentialing Departments (Network Management Services)
Sponsored several plan wide initiatives in collaboration with Medical Operations and
Executive Management for the improvement of the financial performance of the Medicare
line of business through the development of the Extensivist Care Program and Specialty
Networks
Implemented system contract compliance improvements using various reimbursement
methodologies and financial impact analysis to enhance contract negotiation and
implementation
Maintained Medicare and Medicaid fee schedules in accordance with federal and
statutory policy and analyzed local payment trends
Resolved over 50,000 claims reimbursement contestations resulting in the successful
negotiation of contracts with several strategic healthcare partners in the major
hospital systems, i.e., HCA, Tenet, Baptist Health Systems as well as Sheridan
Healthcorp, Pediatrix, et al.
Created the Claims Reconciliation Unit to improve provider satisfaction with the
resolution of claims reimbursement issues, reduce pended claims, and enhance
operational processes and improve communications between Provider and Claims
Operations
Eliminated department pended claims backlog of 10,000 claims within first 90 days
after hire
Designed a proprietary claims resolution summary analysis to report claims review
findings and educate providers on billing trends
Director of Special Projects (2000-2003)
Responsible for managing the integration and systems conversion projects involving the
corporate operations teams. Worked closely with department leadership to ensure all
necessary resources from the enterprise and various external consultants worked
jointly to achieve effective and timely launch. Coordinated and enforced all the steps
of the project implementation process from inception until the implementation
occurred. Developed training documentation and workflow protocols in collaboration
with operational teams for operations management and maintenance
Analyzed and documented operational constraints and characteristics of each operations
area, including systems, pricing and data reporting structures in order to facilitate
new project launches
Maintained and developed close relationships with operations team members to ensure
consistent communication and smooth pre-implementation activities
Ensured that all Project Plan documents were kept up-to-date, and built other
operations resource documents pertaining to each new project
Organized project meetings and pre-launch activities in conjunction with the
conversion team and department Directors
Developed and maintained overall project pipeline documents
Supported department leadership efforts by coordinating project activities with rest
of the conversion team as needed
Communicated and worked effectively with conversion team to escalated risk factor
affecting project launch delivery when needed
Lead integration team meetings and participated in senior Joint Operations Committee
sessions
Demonstrated and documented 100% follow through in every commitment
AV-MED HEALTH PLAN, MIAMI, FL (1989-2000)
Director of Claims Service (1994-2000)
Directed operations for the Claims Service Department comprised of the Provider
Service Call Center, Claims Audit and Review, Financial Recovery, and Grievance and
Appeals, with a staff of over 100 FTEs
Designed and executed research methodologies to identify customer needs in order to
improve provider satisfaction, resulting in increased provider service satisfaction by
10% from prior year
Improved department productivity by 30% by streamlining workflow systems, enhancing
employee skill levels through comprehensive training programs, creative resource
management, Flextime scheduling, employee incentive programs, and implementing
production and quality standards
Decreased workflow backlog by 53% through aggressive auditing techniques to identify
root causes, while increasing staff production and decreasing the influx of duplicate
submissions
Provided leadership and direction for corporate reengineering projects, integrating
and planning objectives for multiple disciplines within the company for the Amisys and
MACESS systems conversions, and the development and implementation of EDI
Conducted external provider office staff educational programs to promote provider
education of managed care, improve billing practices, and expedite claims processing
in accordance with corporate claims guidelines
Assistant Director of Contracts, Product Development and Benefits (1993-1994)
Designed and implemented three new product lines within nine months of direct
management (CHPA, Small Group, and Individual)
Communicated with state and regulatory agencies to ensure that all product lines were
in compliance.
Managed daily operations of the Benefits Management Department that was responsible
for group benefits, and contract configuration and maintenance
Trained Marketing Department staff regarding new product designs and best practices
sales and service
Developed and conducted internal training seminars for new product implementation and
procedures
Manager of Enrollment (1989-1993)
Managed operations (enrollment, billing reconciliation, and system configuration and
maintenance) for multi-product membership
Eliminated the departmental workflow backlog in a six-month period through the
implementation of employee incentive programs and creative resource management
Recovered over $800,000 from CMS for ESRD members
Decreased administrative costs by $100,000 with the implementation of a flex schedule
and increased production by over 60% resulting in the elimination of enrollment
application backlog
Assisted in the development of and ongoing monitoring of Formal and Informal CAHPs
Facilitated action plan accomplishments for state and federal accreditation
COBRA administrator for the Plan's large employer groups
CREDENTIALS
Bachelor of Arts, Business Organizational Leadership, Magna Cum Laude, St. Thomas
University, Miami, FL
Certified designation of Professional with the Academy for Healthcare Management (PAHM)
Six Sigma Lean Leadership Certification
Healthcare accreditation expertise
Proficient knowledge of Power MHS, QCare, Amisys, and MACESS systems
COBRA Compliance Systems - COBRA administration training
Bilingual: English and Spanish