Process Improvement Customer Service

RAMONE HAYDEN

*************@*****.*** ٠-502-***-**** ٠ Louisville, KY

www.linkedin.com/in/ramonehayden

An experienced professional with a strong background in customer service based operational leadership and business process improvement. I’m passionate about building relationships and energized by innovation. Seeking a position within an organization that allows me to utilize my experience in healthcare, client management and leadership.

• Operational Leadership

• Process Improvement

• Multi – Level Interaction

• Client/Account Management

• Talent Management

• Analytical Reasoning

• Financial Services

• Quantitative Analysis

• Project Management

PROFESSIONAL EXPERIENCE

PharmaCord; Louisville, KY August 2022 – Present

A leading provider in patient support of pharmaceutical specialty drug services. Committed to enhancing the patient experience on therapy by providing them with support throughout their journey to better health. Program Manager

● Launch program initiatives for assigned pharmaceutical client and establish operational workflow procedures to ensure efficiency

● Manage on-site and remote team of Oncology Nurse Advocates that provide case management, patient adherence, and eligibility determination of the Patient Assistance Program

● Conduct weekly meetings with clients and business partners to provide data and program operations insight utilizing PowerPoint slide decks

● Engage business clients to provide education and guidance in accordance with organizational policy and best practices

● Demonstrate experience with process improvement, workflow, benchmarking, and evaluation of business processes

● Prioritize issues identified by business partners, internal team members and collaborate to monitor progress and ensure timely resolution

● Perform root cause analysis of issues and develop solution alternatives

● Anticipate internal/external customers’ needs and proactively develop solutions

● Apply comprehensive knowledge of billing guidelines and regulatory requirements within the healthcare industry to establish criteria, standards, and levels for quality objectives, utilizing effective management methods and ensuring compliance

● Maintain records of all business rule modifications, standard operating procedure updates, and training activities to provide a solid foundation for adherence to regulations and guidelines

● Demonstrate knowledge of Pharmacy Benefit coordination, billing requirements for commercial health plans, Medicare plans, and Managed Care Medicaid prescription coverage guidelines PharmaCord; Louisville, KY January 2020 – August 2022 Senior Program Operations Supervisor

● Responsible for the training and onboarding of new associates assigned to client/program

● Acted as client-facing resource with direct client contact for assigned program

● Partnered with HR to ensure program staffing levels are achieved by identifying, conducting phone screenings, and interviews of potential candidates

● Strategically executed initiatives to achieve KPI’s, corporate goals, and objectives

● Demonstrated knowledge of Pharmacy Benefit coordination, billing requirements for commercial health plans, Medicare plans, and Managed Care Medicaid prescription coverage guidelines

● Developed and maintained monthly scorecards/dashboards to provide detailed metrics to monitor employee performance

RAMONE HAYDEN Page 2

Description Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve life long well-being and be a part of an organization that is growing and poised to make an impact on the fut ure of healthcare, Humana has the right opportunity for you. Responsibilities The Director, Strategy Advancement supports the Medicare & Medicaid segment strategy by effectively and intentionally collaborating with best-in-class strategic partners to advance our clinical and experience objectives. The role would be asked to support business partners in a variety of ways, including to analyze/synthesize complex business problems, develop analytical frameworks and issues evaluate potential vendors/part ners using data from internal and external sources; The Director, Strategy Advancement provides data-driven strategic direction to identify and advance business priorities and opportunities. This role provides business intelligence and vendor evaluation / strategic partnership development support for the Medicare & Medicaid, Clinical Strategy & Analytics segment and potentially the company at large. In this role you will: engage in problem solving and strategy setting – e.g., taking an ambiguous request, defining a hypothesis, requirements, and framework for evaluation use data, analytics, and insight from experts to identify the greatest opportunities in clinical outcomes, quality, cost, and experience lead cross-functional teams to define discrete opportunities that are both impactful and achievable work directly with cross-functional partners across the enterprise to deve lop recommendations for vendors/part ners required to capture prioritized opportunities The successful associate: establishes trusted relationships with senior leaders and internal stakeholders as thought partner for meeting their vendor/partner-led needs Serves as player-coach – rolls up his/her sleeves to do analysis, develop presentations, etc. and also manages junior team members on related assignments brings expertise or identifies subject matter experts in support of multi-functional efforts to identify, interpret, and produce recommendations and plans based on company and external data analysis Required Qua lifications Bachelor's degree 5+ years of consulting, strategy development, commercial and/or strategic planning or business strategy experience Healthcare experience 2+ years of direct supervisory leadership experience Prior professional experience in analyzing and translating ambiguity into structured framework and/or processes for analysis Prior analytical experience; being able to synthesize data; develop a methodology to help bring strategies together and present on those strategies; Ability to conduct, interpret, and leverage data and analytics to improve strategy and make recommendations Prior experience in Microsoft Excel modeling & PowerPoint presentations Experience leading cross-functional group of leaders/teams Preferred Qualifications Master’s Degree Computershare; Louisville, KY December 2015 – January 2020 A world leader in financial administration and transfer agency; offering employee equity plans, mortgage servicing, proxy solicitation, stakeholder communicationns, and other diversified financial services. Operations Supervisor-Special Issuance Group

● Managed team of 20 Special Issuance Transaction Processors to ensure production goals support timely completion of broker-initiated stock transactions in accordance with regulatory standards, contractual obligations, and organizational Service Level Agreements

● Monitored workforce queues to anticipate barriers, forecast volumes, and established production standards using daily workforce queue inventory volume

● Demonstrated strong operational focus with project management, change management, and execution skills

Joerns Healthcare; Louisville, KY January 2015 - December 2015 Premier supplier and service provider in post-acute care; revolutionizing healthcare through a suite of advanced injury/wound prevention, patient care and handling products, and professional services programs. Business Consultant

• Lead business operations staff and successfully driving delivery of owner defined business goals

• Demonstrated knowledge of Medicare Part D benefits, guidelines, and polices

• Collected, analyzed, and maintained financial forecast and budget information (e.g., work effort, training, data integration), using input from applicable sources Humana; Louisville, KY November 2007 – June 2013

One of the largest publicly traded health benefits companies. Offering a diversified portfolio of health insurance products and services such as – traditional, consumer choice, employer group, and government sponsored plans focused on improving consumer well-being. Production Team Lead (Humana Veterans Healthcare Services)

● Provided supervisory direction/support to 25-person cross-functional team specializing in complex member issues, provider referrals and benefit/eligibility updates and verification

● Exhibited working knowledge of claims, medical billing guidelines, HMO and PPO plan requirements and coordination of benefits

● Established, developed, and maintained effective relationships with applicable project stakeholders including but not limited to project team members, leadership, delegated entity teams, internal customers, functional SMEs, and business partners

Humana; Louisville, KY November 2004 – November 2007 Beneficiary Services Representative (Humana Military Healthcare Services - TRICARE)

● Received incoming calls from TRICARE beneficiaries, medical providers, Military Treatment Facilities, and other internal service representatives

● Provided information regarding the TRICARE program, eligibility, authorizations, and benefits

● Assisted providers with obtaining medical referrals and updated status of existing referrals EDUCATION

Spalding University; Louisville, KY August 1999 - June 2000 SKILLS

• 10+ years of operations leadership • 10+ years of health care/managed care experience

• 10+ years managing project initiatives • 10+ years Microsoft Word, Outlook, PowerPoint, Visio, Excel

• 5+ years Power BI experience • 5+ years financial services experience

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