Manager Service

KATRINA HILL

**** ********** ***** ***** #*** l Tampa, FL 33619 813-***-**** *******.****@****.***

PROFESSIONAL SUMMARY

Multi-talented Healthcare Operations Leader with more than 15 years in depth knowledge consistently rewarded for success in planning and operational improvements. Experience in policy development and staff management procedures positively impacting overall morale and productivity with member and provider focus the highest priority. Proven success in leadership, operational excellence and organizational development with keen understanding of elements of Healthcare Operations.

SKILLS

Managed Care Leadership 15+ Years Medicaid/Waiver/Medicare/Commercial

Strategic Planning

Risk Management & Regulatory Compliance

10+ years Non-Profit Development & Management

Product/Program Development

Training & Development - Recruit, Hire, & Manage

Process Improvement & Procedure Development

Systems Implementation

Healthcare Operations

Provider Relations

Vulnerable Populations

Case Management

Claims Investigation and Research

Fiscal Accountability

Advanced Operating Systems

WORK HISTORY

AUGUST 2020 - PRESENT

Supervisor Claims Processing Chapters Health System Tampa, FL

• Supervises claim processing staff in the day-to-day performance of their jobs including assisting in: Paper claim data entry,

reviewing claims/invoices for payment processing, & Conducting billing research.

• Responds to telephone inquiries and customer escalations

• Ensures the Third Party Administrator timely loads and properly pays claims in accordance with vendor contracts.

• Responsible for daily, weekly, monthly reporting and trending.

• Trains staff on organizational policies and ensures procedures are followed at all times

• Provides guidance on more complex or high-value claims

• Ensures departmental KPIs are met

• Assists with the performance management

JUNE 2013 - JANUARY 2020

Manager of Provider Operations Sunshine Health (Centene) Tampa, FL

Led team of Provider Relations Representatives focused on internal customer and client satisfaction, compliance with internal, client, regulatory and accreditation standards, successful audits, and provider engagement

Offered data-driven recommendations aligned with overall company strategies and prioritized process improvement initiatives

Ensured day-to-day activities are performed effectively and support the larger network strategy, including meeting financial targets

Consistently striven to improve provider satisfaction by communicating with providers, identifying root cause of provider issues, developing and executing strategy to resolve provider issues

Engage operational business partners as necessary to track and resolve ongoing provider issues with care and urgency

Developed strong relationships with network providers & vendors. Provided timely and effective communication for problem resolution, training and education

Performed special projects, data analysis, develop specific action plans, and other duties as assigned by the department lead to successfully perform the role

AUGUST 2010 - JUNE 2013

Adult Services Manager Comprehensive Counseling Network Memphis, TN

Partnered with physicians, social workers, activity therapists, nutritionists and case managers to develop and implement individualized care plans and documented all patient interactions and interventions in electronic charting systems for over 60+ members

Reduced care costs without sacrificing quality through effective service coordination and multidisciplinary collaboration

Managed and directed fiscal operations, including planning budgets, authorizing expenditures, accounting, establishing service rates and coordinating financial reporting

Reviewed customer survey information to prioritize areas of improvement

SEPTEMBER 2009 - MAY 2013

Program Support Manager Orange Mound Development CDC Memphis, TN

Developed and implemented productivity initiatives, in addition to coordinating itinerary and scheduling appointments for HUD housing and community programs for over 300+ residents in targeted census

Devised, deployed and monitored processes to boost long-term business success and increase profit levels

Developed and implemented variety of innovative policies and strategies to promote client self-sufficiency

Referred clients to appropriate team members, community agencies and organizations to meet treatment needs

Conducted community workshops to promote different programs and educate public on available services

Conferred with representatives of local governments to assess and meet community needs

MAY 2008 - JULY 2009

Corporate Program Coordinator/Interim Executive Director RHD Memphis, TN

Coached leadership and offered actionable initiatives to increase knowledge of compliance-related issues for Special Needs population

Improved organizational filing systems for confidential employee records, resulting in improved accessibility and efficiency

Eliminated discrepancies in financial reporting and record-keeping through accurate preparation and management of Operational budget for 3 Tennessee locations

Reviewed job applications to identify, vet and recommend optimal candidates

Implemented process improvements to automate office operations, including record tracking and quality improvement of program

Improved project success rates with solid staff coaching, performance monitoring, quality assurance and effective problem resolution

Created, managed and executed business plan and communicated company vision and objectives to motivate teams with over 300+ employees

Modernized and improved operational procedures to increase efficiency and profitability while tightly controlling costs such as labor and preventing waste

JANUARY 2007 - MAY 2008

Project Director News Pathways, Inc. Memphis, TN

Planned and executed promotional activities to drive community engagement and increase occupancy numbers for grant funded program

Supervised facilities and services for 200+ residents of Public Housing within targeted census track

Hired, mentored and supervised instructors and volunteer staff to carry out program goals

Prepared, coordinated, and distributed information about yearly schedule of activities and classes for adults and youth

Established and maintained productive working relationships with staff to resolve operational difficulties and to promote interdisciplinary, collaborative approach to customer service provision

Analyzed current business plan, identified inefficiencies in existing processes, and tracked performance following implementation of improvements

Represented company at public service events and client registration

Managed quality assurance program including on site evaluations, internal audits and community surveys

Met deadlines by proactively managing month, quarterly, and yearly reports adhering to contractual requirements

MAY 2004 - JANUARY 2007

Program Manager CDC of Greater Memphis Memphis, TN

Developed short- and long term community development strategies to draw Community Development partners into network throughout Shelby County

Worked with governing board to turn mandates into real-world policies and advance program objectives for over 25+ programs

Educated families and community members about financial planning, predatory lending, and optimizing resources

Optimized operational systems to maintain effective budgets and accurate documentation for permanent records

Developed and created programs and monitored effectiveness against individual participant needs through technical support

Created support documentation that empowered and enabled user community to extend skills, leverage system features and find resolutions to questions without intervention from support team

Responsible for all program reporting to meet contractual & governing requirements

EDUCATION

2001

Bachelor of Arts: Rehabilitation Science & Psychology

Arkansas Tech University, Russellville, AR

ACCOMPLISHMENTS

Improved Provider Satisfaction Scores

Reduced, built, and sustained close relationship with all payer provider representatives to ensure proper claims processing

Reduced TAT in LTSS & Operations Authorization & Intake Functions adjacent to contractual obligations

Identified and resolved issues pertaining to contracts, improper billing procedures, & configuration migration

Designed and implemented programs to build and foster positive relationships between the health plan, provider, and AHCA

Supported internal business partners to achieve shared goals with multiple product lines including Commercial, Medicare, & Medicaid

Created critical KPI's to track and improve AHCA contractual obligations

Developed productivity metrics, dashboards, P&P, workflows, and reports

Recovered revenue through overpaid claims, risk adjustments, and provider billing errors

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