Manager Service

Del H. Allen, CCNA

Project /Operations Management

803-***-**** *****************.***@*****.*** linkedin.com/in/del-Allen Columbia, SC

Core Competencies Project Management Experience

•Project Planning & Management, Federal & State Contracting, Medicare, Medicaid

•Direct project management initiatives from conceptualization through development, implementation, and management

•Partner with key stakeholders to identify and execute cross-functional goals

•Define timelines, budgets, KPIs, deliverables, and milestones; allocate resources

•Draft and present project proposals, project scoping, business modeling

•Negotiate pricing, timelines, services, and terms with vendors

•Manage internal and external contractors and staff throughout project life cycle

•Change Management & Process Improvement, Resource Staffing, Budgeting & Cost Analysis

•Proven tactical skills, coupled with the ability to motivate and manage teams

•Create progress reports and monitor program data to assess efficiency

•20 + years of experience in Medical Claims, Operations, Medicaid and Medicare

•Skilled contract negotiator, Skilled in Marketing, and Project Management

•Build strong, lasting relationships and strategic partnerships through exceptional client service; serve as primary point of contact for client communications

Operations Project Manager

Exela Technologies

May 2019 – August 2020

Managed the operational performance of claims payment accuracy and monitors the C2P process.

Provided regular monitoring and reporting of Key Performance Indicators (KPIs) and establishes best practice claims payment methodology based on the latest CMS claims payment rules.

Design and implement various policies and procedures for the C2P processes.

Provided exceptional service to providers and proactively identifies issues and problems through regular monitoring of KPIs, Data Analysis, and review of the company roadmap

Assist SVP in developing a departmental budget to include annual projections, actual monthly spending, and variance justification.

Forecast all resource requirements and identify and resolve all issues effectively and schedule all employee attendance.

Implements and administers a robust configuration and claims quality and auditing program.

Coordinated project management activities and resources with vendors and customers

Assisted with setting project milestones, timelines, and budget

Liaised with stakeholders to identify and define requirements, timelines, scope, milestones and objectives

Created and maintained project documentation, plans, and progress reports

Conducted quality control assurance testing to ensure adherence to requirements

Key Achievements

Supported customer program implementation, training and onboarding 250+ users and achieving 100% adoption across 45 customers within one year

Drove product launch initiatives across website, social, and digital advertising platforms; managed $1M budget.

Senior Director Member & Provider Service & Marketing

Centene / Absolute Total Care

November 2008 – November 2018

Responsible for meeting all corporate State Medicaid/SCDHHS/CMS KPIs/guidelines for timeliness, quality, ASA, call quality. Successfully led the team to increase service levels to 98%

Manage interpret data models of the member and provider service areas and communicate standards with dashboards and reporting. Led in the design and development of large, multi-vendor system integration projects in Medicare/Medicaid, directly contributing to over $1 million to the company’s yearly revenue.

Develop, implement and monitor policies and procedures for Member and Provider Services Departments. Monitor and create dashboards and reporting procedures to ensure compliance with Federal & State Contracting Standards, including Medicaid and Medicare.

Developed tactical roadmap for reporting dashboards to align strategies and technologies with future needs. Effectively integrate new strategies and technologies. Created and developed State wide Medicare & Medicaid provider and member outreach programs.

Coordinates all aspects of the quarterly calendar and flyers from creation to production and distribution, both print and online versions. Evaluates opportunities and creates submissions, as appropriate, for new and existing free and paid advertising opportunities, including calendar entries, publications, web site links or listings.

Design, develop, and implementation of Medicare and Medicaid health per CMS/SCDHHS/SC Medicaid protocols.

Key Achievements

Executed implementation of $500K e-commerce feature, achieving key milestones on time and under budget, resulting in a 14% increase in annual revenue

Aligned existing e-commerce framework with expansion initiatives, increasing site traffic by 65% and generating $800K+ in new revenue in just nine months

Accounts Payable Manager

Performance Food Group

April 2008 – August 2008

Ensure timely resolution to customer issues/inquires (e.g., vendor invoice status, payment, remittance detail, etc.) received through email or phone calls and ensure that follow-up protocol for keeping customers updated is followed

Document procedures and FAQs to assist the CSRs in responding to customer’s inquiries

Monitor business processes related to assigned function to determine their efficiency and protective value, and assure integrity in records, information and in systems in compliance with Company policies and standards, government laws and regulations

Review ACD, CMS, AR, GL, agent reports for teams and identify areas of opportunity

Coordinate with other departments to resolve issues involving the customer service department

Provide input on recommended solution for customer complaints

Collected, compiled, analyzed, and interpreted data to assist in large project team of 25

Develop training programs and presentations

Develop and drafted technical manuals and create IVR and CMS system and User guides for IVR, CMS system.

Call Center Manager

Aetna Inc.

July 2005 – April 2008

Develops, motivates, evaluates and coaches staff on work procedures, proper call handling and teamwork delivering excellent customer service. Available to answers questions, monitor calls and give ongoing feedback to staff

Assesses individual and team performance on a regular basis and provide candid and timely feedback regarding developmental and training needs; includes completion of monthly and annual scorecards.

Monitors all performance measures such as daily stats and schedule adherence; allocates resources to meet volume and performance demands, with use of Crystal, SAP, IVR, ACD, and CMS systems. Develop training manuals for IVR, and CMS.

Develops and maintains strong collaborative relationships with constituents and internal business partners to maintain excellent lines of communication and share resources to meet common service center objectives.

Attracts, selects, and retains high caliber, diverse talent able to successfully achieve or exceed business goals. Builds a cohesive team that works well together.

Acts as liaison between staff and other areas, including management, all segments, provider relations teams, etc., communicating workflow results, ideas, and solutions.

Analyzes constituent data, identifies trends and issues using IVR, CMS, and ACD reports. Assess client issues and act on the need to improve the development and delivery of products and services. Clearly identifies what must be accomplished for successful completion of business objectives.

Effectively applies and enforces Aetna HR policies and practices, i.e., FML/EML, Attendance, Code of Conduct, Disciplinary Guidelines.

Customer Care Project Manager

ACS

January 2004 – July 2005

Supervised and guided UPS staff via the ACS Columbia data center Managed Client Care, NOC Operations/Call Center and Quality Control with an organization of over 60 people including all daily operations activities for 7X24 NOC.

Assist with deployment client integration projects including SAP, Crystal, GIGABYTE, SQL, DB4, 4GL, CHECKSHIPPER, IMAGEPRO, COMMPREP, equipment ordering and vendor negotiations, testing, troubleshooting, installation, and implementation of upgrades or configurations to of Kodak scanners.

Integrated PC’s, Servers, Cisco, LAN/WAN and telecommunications, LAN Switching systems and cabling systems.

Communicate global network status (RAPID) and provide quality documentation as well as generate any other reports requested or required by UPS and BPO management. Administering Microsoft Active Directory/Lotus User Accounts

Establish and maintain project milestones operating procedures as well as project priorities and schedule completion matrixes in coordination with UPS and management troubleshooting repairs and maintaining workstation hardware and software

Interact regularly with management, UPS and incumbents to constantly improve Network Engineering services.

Establishes and monitors operating standards and objectives to ensure accuracy and timeliness: reviews RAPID, SIR, SRB, ASD, Suspense, COD, GSD, accounts payable reports and verification activities.

Manage $5 million budget of site including salaries, equipment and all day-to-day activities.

10 years of experience providing customer support for Windows XP and MS Outlook in a networked environment, including experience performing computer hardware, software, break/fix, and troubleshooting.

15 years of experience supporting MS Office products (or other shrink-wrap software applications)

10 experience using a commercial trouble ticketing system (such as Remedy) and the ability to track and document actions taken.

Develops branded marketing campaigns for new and existing initiatives as needed, including comprehensive marketing plans, logos, taglines, branded print collateral, promotional items, and original marketing copy.

Assistant Manager Collections

Home Gold

May 2003 – December 2003

Maintain accurate records of accounts and make system corrections.

Review and identify critical problems related to the closed loan file.

Notify guarantor by phone and letter to ensure collection of delinquent accounts.

Follow up with Loan officers for resolution of problems.

Review mortgage information sheet for completeness.

Print settlement statements, collection of 90+ day delinquent mortgages.

Review of 90+ delinquent mortgages to insure all required inspections; letters, notices and calls are completed. Determine avenue of resolution of suspected problems.

Conduct financial analysis on all loans for possible loss mitigation options and discuss these potential options with borrowers.

Preparation of foreclosure recommendations for all accounts.

Manager Provider Services

Blue Cross Blue Shield, Columbia, SC

January 2002 – January 2003

Develop and deploy queries, SQL, COBOL to report provider data using large mainframe system structure.

Conduct impact assessment on the underlying causes of provider system Inquiries and initiating process improvement measures to avoid future inquiries.

Implementation and customized software and change/version control IVR, CMS, and ACD.

Management of provider information systems daily uses of SQL, DB2, DB4, and MS OS.

Managed high-level application design and integration with existing systems.

Developed, test and implemented new reporting strategies for the Managed Care, Medicare, and Medicaid areas.

Schedule and plan individual unit testing and support during user acceptance testing for JAVA, RACF, CICS systems.

Assisted in designing and customization of company Web site/Portal and CMS systems. Developed tech and training manuals for ALGS, WEB, and provider tech warehouse.

Writes, edits, and proofreads all copy for department promotions including printed materials, web pages, training manuals, print advertising, catalog/handbook ads, catalog/handbook descriptions, professional and trade association articles, calendar announcements, email notices.

Supervisor Provider Services

Blue Cross Blue Shield, Columbia, SC

January 1997 – December 2001

Customer Service Representative

Blue Cross Blue Shield, Columbia, SC

August 1994 – January 1997

Tax Analyst /Technical Support/ Field Services,

SC Department of Revenue, Columbia, SC

August 1993 - August 1994

Internal Auditor, Internal Revenue Service, Columbia, SC

January 1993 - August 1993

METHODOLOGIES & TECHNICAL SKILLS

Hands-on experience using Scrum, Agile, and Critical Path Method (CPM) to successfully execute 15+ complex projects

Expertise in, CRM, SharePoint, Google Docs, Google Sheets, MS Excel, and MS Project

Familiarity with additional PM programs and methodologies, CompTIA Project+ and Critical Chain Project Management (CCPM)

Education

A+, Network +, CCNA, Python

Training Concepts

Bachelor of Science: Degree Business Administration/Computer Information Science

Morris College, Sumter, South Carolina

Contact this candidate