Kristie M. Phillips **** Roman Street Metairie, La 70001

504-***-**** ad21b0@r.postjobfree.com

Proven record of managing and facilitating support services of the daily operations of fast paced medical offices and supervising staff to ensure efficient, functional running of healthcare facility and operative clinical activities. Advanced understanding of customer needs with diligent attention to detail resulting in superior customer service and high levels of client satisfaction. Special Skills

Over 15 Years of Supervisory, Leadership and Training experience

Over 20 Years of Healthcare experience

Highly analytic with the ability to work with minimal supervision

Provides excellent customer service in critical challenges, great use of critical thinking skills, and service recovery

Strong leadership talents, ability to work with a diversity of people and effective interpersonal skills

Sound knowledge of medical terminology, HIPAA regulations, CPT, and ICD coding

Excellent communication, time management, and multitasking skills

Solid understanding of medical insurance plans, benefits, and processes

Experienced in electronic medical records with proficiency in EPIC

Establish and monitor performance levels

Train, coach, motivate, develop, and guide employee performance through a variety of mechanisms

Ensures professional and courteous representatives provide customer service through quality assurance and evaluations

Responsible for the day-to-day application and implementation of organizational policies and procedures

Administer company policies that directly affect subordinate employees and responsible for achieving revenue and customer service objective

Coordinates work activities to achieve the volume expected to meet operational requirements; recognizes and recommends operational improvements based on performance, metrics and objectives set

Directs the flow of the operation and determine how to fix problems as they arise; responsible for training, evaluating, and managing performance evaluations of direct reports

Influences decisions regarding the hiring, firing, disciplinary action, promotional activity, and pay decisions for subordinates

Builds relationships and strategically collaborates across workgroups to achieve mutual outcome

Effective in making tough decisions to shape team dynamics

Set and achieve stretch goals

Develops high performing and diverse teams

Supports alignment of company goals within departments and outside of the company

Create focus groups and training material for performance management, customer service, and leadership

Serves as consultant regarding processes, desk top procedures, correct course of action and resolution

Kristie M. Phillips 3530 Roman Street Metairie, La 70001 504-***-**** ad21b0@r.postjobfree.com

Professional Experience

January 2022-Present

ADT Solar/Sunpro

Call Center Supervisor/Team Manager

Manage 4 Team Leads alongside 50 to 60 agents daily; leveraging metrics, KPI’s, and attendance to monitor, evaluate, and drive team performance

Effectively communicate expectations, coach, develop, and motivate Team Leads with weekly One-on-One coaching sessions and Team huddles

Participate in weekly side-by-side with agents to review overall performance, provide positive feedback, set expectations, and coach to areas of improvement

Work with leadership to improve customer service and team moral to ensure agents are meeting their individual potential

Partner with upper-level management in implementing new policies and procedures

Create an environment of continuous improvement to remove obstacles for agents to drive employee engagement and satisfaction

Oversee projects and special assignments

November 2020-January 2022

Cigna-Express Scripts

Prior Authorization/Eligibility Representative

Deliver administrative and basic business services in pharmacy eligibility.

Implement, update, and maintain benefit information for patients and plans.

Part of a dedicated team which helps our specialty pharmacy patients coordinate their medication needs and pharmacy insurance coverage for complex medical conditions such as HIV, PAH, and cancer.

Work with patients, providers, and insurance plans to provide guidance to patients about medication coverage.

Work to obtain prior authorizations and predeterminations for patients’ medication through multiple insurance plans and third-party administrators.

Coordinate and ensure services are covered under insurance coverage and talk with patients about their deductibles, co-payments, and authorizations. December 2015- June 2020

TriWest Healthcare Alliance

Supervisor, Escalations Team

Supervised and lead specially trained team of 12 Direct reports with expertise in resolving escalated and priority issues with the VA and Veterans.

Researched and resolved complex issues escalated by the Medical Center Director to minimize referral errors and returns to the VA.

Kristie M. Phillips 3530 Roman Street Metairie, La 70001 504-***-**** ad21b0@r.postjobfree.com

Serves as the primary liaison between the Veteran Affairs Medical Center (VAMC), Hub (site) Medical Management and Customer Service staff regarding escalated VAMC authorization, network adequacy/availability, and eligibility issues.

Established and maintained good relationships with Veteran’s, families, community providers, VA staff and leadership to expedite urgent situations, and overall delivery of quality patient care.

Provided leadership for advancing business practices that support patient care and delivery of health benefits.

Played a key role in developing internal review systems and standards within the Medical Administration Service and assures that the patient administrative activities which are interrelated with clinical services follow these standards.

Key management advisor reporting directly to senior management/Director of operations.

Primary driver of strategy in the Contact Center managing inventory, driving performance standards, as well as the execution of meeting the contractual business standards of the Veteran’s Choice Program.

Drive key patient experience initiatives and metrics.

Developed, in partnership with the Executive Leadership council, directs, and executes the vision and strategy of patient advocacy, timely scheduling and avoiding delay in healthcare.

Evaluated current strategies, processes, and procedures for effectiveness across the organization.

Built cross- functional relationships to achieve business objectives timely and efficiently.

Partner with the VISN 16 Regional Director to resolve high priority, escalated issues – provider services issues, secondary authorization request, prevent delay in care, avoid congressional and/ or media threats, doing whatever it takes to resolve all outstanding issues

Promote and enforce TriWest/VA Business Standards and Contractual agreements Supervisor, Patient Services

Promotes the TriWest business standards and ensure authorizations are processed according to the VA/ TriWest contractual agreement

Coach and develop Patient Service Representatives on adhering to business standards and working with both a sense of urgency and accuracy to ensure quality of work

Share best practices with peers

Handles escalations involving congressional complaints with a sense of urgency, prevents further escalations, and salvages relationships with key providers all while remaining a strong manager, leader, and role model for my team

Conducts thorough research to identify root causes of escalated issues and provide feedback and resolution to director and regional director

Identifies coaching opportunities and develops processes to cure what may have caused the escalated issue and prevent it from happening again

Shares the above stated coaching opportunity with the employee's supervisor & send the supervisors in the HUB, including UM, CAS, Inbound and Outbound the process or the avenue that we should take to prevent additional escalated issues while consistently creating a positive outcome

Kristie M. Phillips 3530 Roman Street Metairie, La 70001 504-***-**** ad21b0@r.postjobfree.com

Prevents providers from submitting termination letters indicating that they are no longer doing business with TriWest

Resolves urgent requests from VA staff members, clinical supervisors, care coordinators and POCs

Communicates with healthcare professionals on all levels including the VA Deputy Chief of Staff

Works with clinical supervisors to obtain medical documentation required to proceed with urgent care of our Veterans

January 2015-November 2015

Comfort Keepers, Metairie, La

Sales/Client Care Coordinator

Prepare marketing plans and develop target lists within an assigned territory

Use skills to develop territories sales and marketing plan to achieve and exceed sales goals and quotas

Develop and maintain customer relationships to maximize revenues from existing accounts.

Manage intake calls, schedule, and conduct in home visits to assess clients’ needs and initialize client services

Call on Physicians, Hospitals, Nursing Facilities, Assisted Living Facilities, and other potential referral sources to develop new business relationships

Match caregiver with the client depending on their needs and likes and coordinate the introduction and training process

Worked with Long Term Care companies and Veterans Benefits to provide clinical information as related to patients in home care needs for payment processing and continued coverage

Maintain on call status and other duties as required Ochsner Medical Center, New Orleans, La

Clinical Services Supervisor, Outpatient Psychiatry 12/2008-11/2014

Managed and trained department call center staff of 12 direct reports, answering an average of 300 to 500 phone calls per day.

Provided excellent customer service in a medical institution and ensured all patients were well attended. Managed quality of care, patient satisfaction and service recovery.

Served as liaison between Psychiatry department and hospital/clinic departments, Human Resources, Patient Relations, and multiple other specialty areas.

Supervised and implemented policies and procedures as required by Ochsner Medical Center according to Joint Commission.

Lead/Supervised office operations, workflow, including but not limited to, all staff Psychiatrists, Psychologists, Social Workers and Resident physicians.

Provide support and perform regular QA reviews for client intake, registration, and scheduling functions.

Kristie M. Phillips 3530 Roman Street Metairie, La 70001 504-***-**** ad21b0@r.postjobfree.com

Manage facility procedures related to insurance and billing. Researched and proposed solutions to patients’ queries regarding their insurance renewal, benefits, authorizations, and balances.

Conduct annual performance evaluations and participate in the hiring and training process of new employees.

Performed daily operations and services such as: ensuring accurate and timely collections of data, charges and claims, and the receipts and processing of payments owed to Ochsner Medical Center.

Researched and resolved issues impacting the effectiveness of processing claims, denial of claims, customer service complaints.

Assured timeliness of all required paperwork submission, always implementing regulations and policies as decreed by state and hospital regulations.

Organized and managed child patient medical and immunization records, answered multi-line phones

Financial Coordinator

3/2008-12/2008

Special Services Coordinator/Referral Coordinator, Ochsner For Children Metairie 3/1999-3/2008

Worked in call center, answered multi-line phones, scheduled appointments, input insurance information, routed calls, etc.

Coordinated and monitored ongoing medical services for children requiring care in all sub- specialties, including but not limited to: mental health services, physical therapy, cardiology, gastroenterology, endocrinology, and pulmonary disease, etc. as well as urgent availability for critical need patients, emergencies, and hospital admissions processes.

Assisted families in identifying and obtaining available service providers, including insurance authorizations and pre-certifications.

Education

University of Phoenix, Metairie, La 8/2011-5/2013

Business Management

University of New Orleans 6/30/2009

Supervisory Management

Delgado Community College, New Orleans, La 12/1992-12/1994

Pre-Nursing

Riverdale High School, Jefferson, La 1989

High School Diploma

Riverdale High School, Jefferson, La 1989

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