Kayla Marie Flowers, MBA, MSHI, BHA

** **** ******, *** ***** NM 87031

505-***-****, adegs2@r.postjobfree.com

SKILLS

5+ years' experience in Operations Management in a healthcare setting

6+ years’ knowledge and experience in Network Management at an MCO level

2+ years provider contracting skills, contract preparation/implementation, Value Based Contracting, extensive financial analysis

Detailed individual with a demonstrated history of problem solving through project management for providers, members, and internal business partners

High level of proficiency with MS Word, Excel and PowerPoint

Ability to generate reports from various databases and software systems

Experience with CMS Medicare and Medicaid Regulations

Experience in maintaining close working relationships with state-level leadership, network providers, and MCO partners

Energetic and Professional

Strong attention to detail and organization

Business & Medical administration

NCQA HEDIS and CAHPS experience

Medical Law and Ethics

Excellent customer service skills

Medical Terminology

Business Process Design

Proficient in various EHR systems

WORK EXPERIENCE

Western Sky Community Care, Albuquerque, NM

HEDIS Project Manager/ Value Based Specialist, 05/2019-Current

Plans, organizes, monitors and oversees projects utilizing cross functional teams

Deliver defined requirements to meet company strategic objectives

Manage the functions of the quality improvement program and team for HEDIS/CAHPS reporting

Incorporates incentives that encourage providers to improve the quality and effectiveness of the services they provide while simultaneously reducing their unnecessary use of delivery system resources.

Results in aggregate quality and financial outcomes that are consistent with the organization’s objectives.

BCBS of NM, Albuquerque, NM

Associate Project Delivery Specialist, 01/2018-05/2019

Serve as a liaison between business and key stakeholders

Provide technical solutions to meet user needs

Support delivery cycle and production change requests to meet enterprise initiatives BCBS of NM, Albuquerque, NM

Technical Support Specialist, 05/2017- 12/2017

Work directly with Network Contractors on pricing configurations for Providers

Run and maintain daily/weekly claims reports

Develop and maintain the Departments SharePoint site

Creation of new Statement of Understandings and Price Updates BCBS of NM, Albuquerque, NM

Project Analyst II, 12/2014-02/2017

Creating, Managing and reporting to the State to meet guidelines for Centennial Care

(HEDIS,CAHPS)

Maintain the projects assigned by Director, and PHP Staff

Supporting field staff, and production reports

Atrinea Health, Los Lunas NM

Referral Specialist, 06/2014- 12/2014

Scheduling high volume of patients for clinic setting

Maintain outbound referrals to various locations

Obtain Prior Authorizations

Maintain a professional working environment with Providers and clinic staff

Ensure HEDIS measures for clinic were met, gaps of care closed UNMH, Albuquerque, NM

OR Coordinator, 04/2013-06/2014

Coordinated OR block time for ENT, General Surgery, Plastics, Burn and Trauma.

Handled financial aide/Prior Authorization orderables/Insurance guidelines

Managed over 15 providers and 2 clerks with a high volume of cases

Worked closely with the General Surgery and ENT administration staff

Accommodated surgeons needs and chaotic schedules

Maintained a professional and organized work relationship with all providers

Served as a clinical staff backup

UNMH, Albuquerque,NM

DC & Charge Entry Clerk, 08/2012-04/2013

Receive hospital charges and enter into a Cerner database

Maintain independent clinics.

Use of ICD-9 and CPT codes on a daily basis.

Works independently, without direct supervision. Lovelace Medical Center, Albuquerque, NM

Materials Specialist 07/2011- 03/2012

Maintain the stock and supplies needed for the hospital and patients.

Use of computers for paperwork necessary for job

Complete order for the stock needed for hospital Universal Wellness Immunization Network, Albuquerque, NM Medical Assistant (Lead Admin) 03/2010 – 08/2016

Responsible for the administration and management of military healthcare clinics.

Perform phlebotomy services

Administer vaccinations and EKGs

Promark Research, Albuquerque, NM

Researcher, Call Center 07/2008 – 10/2008 & 10/2009-5/2011

New employee trainer

Perform market and political research for various clients nationwide.

Excellent phone etiquette and customer service skills

100% compliance with telephonic scripts

Appropriate language dialect depending on region

Continually exceeded performance metrics

EDUCATION

Grand Canyon University, Albuquerque, NM

Master’s Program- Health Care Informatics

Completed- May 2020

Grand Canyon University, Albuquerque NM

Master’s Program- Business Administration

Completed- July 2018

PIMA Medical Institute, Albuquerque NM

Associates & Bachelor’s Degree- Health Care Administration Completed- April 2012 & February 2015

PIMA Medical Institute, Albuquerque NM

Medical Assistant Certificate

Completed - June 2010

Los Lunas High School, Los Lunas NM

High School Diploma

Graduated - May 2008

References available upon request

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