Vice President operational Customer Service
Resume:
Anthony M. Werner
MBA, LSSMBB, CPHT
Buford, GA *0519 973-***-**** *******@***.***
Operations & Customer Service Executive
Analytical and detail-oriented call center executive with extensive experience managing operations for a variety of entities, including large call centers. Equipped with broad skillset and training as a Master BlackBelt in Six Sigma, able to lead teams of 200+. Proficient in revenue cycle management and technologically sophisticated, with competence in the implementation of new systems. Proven track record of improving customer satisfaction and the user experience. Many years as an adjunct professor teaching classes for medical billing and coding and medical office administration. Excellent executive leader, who will take time to coach and mentor team members for career growth and optimal performance.
Areas of Expertise & Technical Skills
Strategic Planning & Execution
Customer Experience
Project & Program Management
Call Center Management
Profit, Loss, and budgeting
Technical System Integration
Medical/Pharmacy Policy Development
Business Process Redesign
Six Sigma Methodologies
Data Tracking & Trending
Business Intelligence
Staff Training & Leadership
Professional Experience
PROCARE RX, Gainesville. GA May 2017 - Present
Vice President Pharmaceutical Manufacturing Patient Contact Center
Lead staff of 100+ in the delivery of excellent customer service to more than 1M patients enrolled in international pharmaceutical manufacturing pharmacy programs, with contracts in excess of $1B. Ensure quality and timely patient enrollment and meet all patient medical and financial needs. Manage budget of $1M, with a profit of $12M, annually.
Key Accomplishments:
Ensure call center, with more than 750K inbound/outbound calls, maintains 95% compliance with call center key performance indications, as outlined in accreditation standards through URAC accreditation organization.
Maintain enrollment refill rates of more than 90% across all lines of business.
Meet/exceed customer/provider satisfaction metrics.
Improve prior authorization process, with a focus on SMART prior authorizations. Decrease costs, and increase efficiencies and approval rates.
Conducted client audit and led initiatives on patient satisfaction, client quarterly meetings, and URAC.
Created new lines of business for population health business, including Medication Therapy Management and Opioid Abuse and Reduction programs.
Executed medical and pharmacy coding integration for population health.
EMPIRE BLUE CROSS BLUE SHIELD OF NEW YORK/ANTHEM, New York, NY May 2016 – February 2017
Senior Director Medical Management Call Center Operations
Drove results for medical management, leading call center staff of 22 employees, serving as single point of contact for all New York inpatient, outpatient, and long-term care services for 650K members. Liaised with state and federal agencies in New York and complied with New York Health and Medicaid Regulations.
Key Accomplishments:
Led utilization management team and maintain 95% compliance.
Collaborated on reduction of reauthorization of members with case management, providers, and hospital systems.
Monitored call center operations with more than 400,000 annual calls, meeting all KPI requirements and customer/provider satisfaction.
Improved prior authorization, with a focus on SMART prior authorizations.
Led corporate initiatives on Medicare Stars, CAHPS, HEDIS, and Patient Satisfaction.
HEALTH REPUBLIC OF NEW YORK, New York, NY August 2015 – November 2015
ICD-10 Project Program Director
Led project for enterprise-wide transition to ICD-10. Used Six Sigma methodologies to document and validate current and future state business process flows. Developed and executed business requirements. Conducted User Acceptance Testing (UAT) for projects, implementations, system fixes, and enhancements. Served as corporate consultant for physicians, hospital groups, and internal clients. Partnered with consultant forms to assist providers with ICD-10 Roadmap.
Key Accomplishments:
Led complete implementation of ICD 10 in two months with no post-implementation claims issues, delivering it on budget, and in compliance with regulatory requirements.
Ensured all 10 impacted internal departments, and eight vendors, met project-team deliverables and certified readiness with ICD 10.
Delivered high-impact presentations on ICD-10 implementation for healthcare plans, providers, and TPAs at multiple vendor conferences and seminars.
Used project management methodologies, including resources, and budgeting, to facilitate smooth transition to ICD-10.
HEALTHFIRST, New York, NY July 2011 – December 2014
Pharmacy Customer Experience Manager
Complied with Medicare and Medicaid regulations and provided cost-efficient quality care through management of pharmacy-related projects. Prepared for internal and external audits and reviewed audit findings. Acted as single point of contact for health plan and Pharmacy Benefit Management (PBM) communications. Established audit criteria for PBM and corporate member services, focused on the delivery of world-class customer service, while meeting federal and state guidelines.
Key Accomplishments:
Transitioned 600K-member system from fee-for-service to managed care integrated pharmacy and medical plan.
Integrated 500K-member acquired company into the culture and systems of the parent corporation.
Interacted with multiple members and advocacy groups to ensure satisfaction and 96.7% retention for all lines of business, including Medicare, Medicaid, Commercial, and Exchange.
Led corporate initiatives on Medicare Stars, CAHPS, HEDIS, and Patient Satisfaction
HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY, Newark, NJ June 2010 – July 2011
Business Analyst, ICD-10 Project
Worked with ICD 10 enterprise project team to ensure compliance with ICD 10 mandate. Led organization operations, primarily related to clinical areas, including medical, case, and disease management.
Key Accomplishments:
Reviewed operations and provided recommendations and solutions, resulting in a company savings over $500,000.
Partnered with departments impacted to meet project-team deliverables Through the coordination of communications and utilization of project management methodologies.
Presented at conferences and seminars on ICD-10 implementation for Healthcare plans and providers.
Conducted User Acceptance Testing (UAT) for projects, implementations, system fixes, and enhancements.
Assumed lead role as corporate consultant for physicians, hospital groups, and internal clients. Assisted partner providers with ICD-10 Roadmap by collaborating with KPMG consultants.
Developed and executed business requirement documentation for enterprise-wide information technology tool (COMET) for medical coding system integration.
Additional professional experience with Horizon Blue Cross Blue Shield of New Jersey as Supervisor Pharmacy Operations, Pharmacy Utilization Management Coordinator, and Utilization Management Clinical Appeals Coordinator, and experience at Great West/One Health Plan as Customer Service Representative/Pre-Certification Representative. Teaching experience as Professor for medical billing and coding, medical assistant, pharmacy assistant, and medical office administration.
Education & Certifications
Master of Business Administration (MBA), Healthcare Administration, 2009
DeVry University Keller School of Graduate Studies, New York, NY
Bachelor of Science, Healthcare Management and Administration, 2007
University of Phoenix, Phoenix, AZ
Six Sigma Green Belt 2010, Black Belt 2012, Zenith Process Management Group
Certified Pharmacy Technician (CphT), 2009 - Present
New Jersey Life, Health, and Accident Insurance License, 2010-Present
Certified Professional Coder, American Academy of Professional Coders (AAPC)
AAPC ICD-10 Bootcamp, 2010
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