Recognizes people as the most important asset to any business/call center unit; Advocates nurturing and developing individuals for maximum potential
Increased average speed of answer rate from 85% to 97% by redesigning more efficient workflow procedures
Increased call resolution rate on initial contact from 75% to 98%
Developed and implemented professional call center procedures, which provided stellar customer service
Quality Assurance Analyst, LASHGROUP, October 2017 to Present
Complete a full audit of a minimum of three incoming/outgoing for a team of Reimbursement Counselors to ensure team is in full compliance and is meeting service level agreements.
Complete and publish monthly quality reports for management team.
Complete all monthly coaching efforts with Reimbursement Counselors.
Assistant Manager, Reimbursement, LASHGROUP, April 2015 to October, 2017 Rockville, MD Ensured a minimum of 98% compliance of all Service Level Agreements for Client
Maintained less than a one day turnaround time for all Client service requests to include but not limited to benefit investigations, prior authorizations and appeals.
Managed a team of 15-23 Agents, Patient Care Coordinators and Team Leads.
Developed all department metrics, SOP’s and training materials.
Responsible for hiring, training and evaluating all team associates.
Identifies client issues and provides timely resolution.
Attends regular client meetings by phone and quarterly in person.
SR Reimbursement Consultant, LASHGROUP, Rockville, MD December 2011 to April, 2015
Completes a full, extensive medical and pharmaceutical insurance investigation for complex therapies for all commercial, public and government plans.
Collaborate with insurance companies, third party payers and client Case Managers to determine the most appropriate care for patients with special needs. Provide continuous support to Case Manager managing the patient and follow up with all parties to ensure no interruption in therapy arises.
Receive, triage and place orders to distributor as needed for fulfillment.
Execute wholesale agreements with customers who wish to purchase wholesale products. Determine proposal as per policy and execute with Legal Department’s guidance. Follow through until full execution.
SR Reimbursement Specialist, Cystic Fibrosis Services, Bethesda Md, March 2011-September 2011
Provide excellent Customer Service to internal and external customers by servicing pharmacy referrals faxed to call center within a two-day turnaround time.
Completed a thorough insurance verification prior to submitting prescriptions to the pharmacy for fulfillment
Collaborates with four specialty pharmacies to provide ultimate customer satisfaction
Provide courteous and empathetic solutions to patient with special health needs
Claims Billing Manager, Financial Health Strategies, Gaithersburg, MD, May 2010-October 2010
Provided a host of comprehensive services for three key accounts within a portfolio that generated over $50M in annual revenues
Collaborated directly with the Vice President of Billing and Outsourcing Options with bottom line responsibility for the monitoring and reviewing billing issues for Healthcare clients
Reviewed client accounts to determine that accurate insurance was assigned and corrected accounts with erroneous information for medical/professional dental practices
Oversaw recurring reconciliations activities; updated financial spreadsheets; balanced AR/AP Ledgers/Reports and forwards report of financial gain/losses to clients
Claims Manager, Bravo Health, Baltimore MD, May 2008-Feburary 2010
Effectively collaborated with key departments to ensure hospital claims were paid within ten days for Medicare Advantage Plan in Baltimore, MD
Resolved escalated claim issues immediately to preserve customer relationships
Key member of project team for development and implementation of new healthcare system
Developed policies and procedures in accordance with CMS regulations
Manager of Business Operations, the Trizetto Group, Linthicum, MD, April 2007-April 2008
Developed a strategy to correct system configuration issues that improved client relations
Provided training to remote employees in India via the internet
Reduced the Provider Database Inventory by 60%
Served as part of the auditing team that was voted "Best Team" in the entire company based upon the delivery of consistently significant and "Out of The Box" work
Manager of Claims and Client Services, Wellpoint Health Network, Springfield, VA, October 2000-January 2007
Effectively motivated and developed Customer Service Reps to achieve Administration Corporate goals
Educated provider population in appropriate billing practices and procedures
Liaison between employee groups and providers for complex issue resolutions
To promote excellent service, developed and implemented service incentive awards
Developed and implemented QA program that improved overall quality of the department.
Associate Director, Claims Administration DC Chartered Health Plan Washington, DC September, 1996 – August, 2000
Responsible for overall operations of Claims and Customer Service operations for DC Medicaid HMO(
Authored and implemented all department SOPs and training materials
Recruited and trained all new personnel
Successfully implemented new claims payment system
Supervisor, Claims Department GWU Health Plan, Bethesda, MD April, 1995- September, 1996
Responsible for the overall operation of the Claims Department for Metro DC area HMO
Developed policies and procedures pertaining to the processing of managed care claims for DC Medicaid and commercial contracts.
Hired, trained and coached new personnel
Supervisor, Claims Administration Corporation, Rockville, MD August 1984- April, 1995
Supervised unit of 15 Claims Examiners and Auditor for government contract PPO plan
Responsible for the overall daily operation of the claims processing unit and inventory management
Developed and implemented stellar training program named “Model Office” Hired, trained and coached
Full MS Office Suite, FACETS, QNXT,Oracle, CSC, EClinical Works, Medical Manager, Patient Plus Claims Examiners and Auditors
Education and Specialized Training
Montgomery College, Medical Terminology I &II; Rockville, Md 1981-1982; 4.0 GPA
Interpersonal skills training, Winning in Customer Service, Change Management, Resolving conflict, Behavioral Interviewing, Salesforce, TheraCall, Power Index, Peoplesafe