Shari DeBroux

**** ******* *** 920-***-****

Green Bay, WI 54313 ady6ow@r.postjobfree.com

Personal Statement

Leads influential, high-impact, multi-disciplinary teams by attracting and developing top talent who is focused on delivering a Risk-free business value, through accurate and detailed verifications and process creations. PROFESSIONAL EXPERIENCE

Humana Insurance DePere, WI Nov 1997-Present

Associate Director, Credentialing Operations (Jan 2018-present) Oversee the Medical Credentialing/Re-credentialing Operations for the entire United States, all Lines of Business

• Manage direct Humana Inc team of 8 direct team members and 93 indirect team members.

• Manage the relationship of 259 overseas team members.

• Responsible for creation and delivery of:

Corporate Policy and Procedures (Med Cred Ops, Recred, Delegation, and Dental) ALL state Medicaid Policy and Procedures

Audits preparations and presentations for Compliance/Accreditation (NCQA, URAC, AAHC) along with state and federal audits.

Closing gaps with between process and associate performance Assessing and following through with associate performance

• Partner with upstream and downstream business partners to ensure compliance needs are met including but not limited to SLA’s (Service Level Agreements), process improvements, process implementations.

• Associate Engagement scores well above corporate average Engagement plans were creatively crafted by team members to successfully grow and remove barriers.

• Leader of the Corporate Credentialing/Re-credentialing Committee Service Alignment Manager (SAM) (Aug 2016-present) Partner with market staff to proactively manage operational aspects of provider relationships. Understand market, providers, and connect within PPS to deliver service aligned with priorities.

• Managed the Provider Service Experience

• Collaborated with internal partners across PPS, PD, and MO to create an understanding of and execute on Humana’s providers service experience.

Provider Pend Group Manager (2009-Aug 2016)

Duties include Overseeing and balancing duties of the PPG specialists and the work queues to maintain inventory and issue resolution. This would prevent future claims pending to PPG for the same reason.

• Creation of Processes for Department

• Leading delivery of issue and correction

• Collaborate with Subject Matter Experts

regarding findings.

• Inventory control. Monitor SLA goals.

• Coach and Develop Front Line Leaders

• Meet with Market Associates to go over

Pended Claims and why they are Pended.

• Collaborate with key business partners to

identify opportunities to reduce pended

claims.

• Manage Offshore Vendor SLA

• Work with CPO to reduce the amount of

Pended Claims

• Manage staffing model

Account Executive Provider Services (2007-2009)

Duties included responsibility as Provider/Humana liaison. Traveled 50-70% of the time

• Issue resolution on complex claim issues

High Profile Provider/Hospital Groups that

threatened to leave if issues were not

taken care of,

• Review how contracts were loaded and how

claims were being submitted. Corrected issues

found

• Developed professional relationships with

Market Staff as well as customer relationships

• Prepared and presented presentations to large

groups of providers on how to resolve issues

they had with Humana.

• Oversaw claim review and reissue of payment

projects

• Hosted Joint Operation Calls with Key Groups,

Market Reps, Financial Recover, SIU, and any

party that was needed to correct issues at

hand.

• Attended Market Meetings so was kept up to

date with initiatives they had and aligned with

JOC meetings.

Skills

• Cross-Functional Communications

• Customer Follow-up

• Operational Functions

• Adaptability

• Focused

• Agile

• Alignment

Memberships

• National Association Medical Staff Services (NAMSS) 2019- present ADDITIONAL TRAINING

Humana Insurance:

-Understanding Your Communication Style as a

Manager

-Engaging Generational Differences

-Investment in Excellence

-Positive Leadership

-Business Acumen

-Inclusive Leadership

-Servant Leadership

-Leadership Concepts

-Leadership Skills Assessment

-Persuading Others

--Real Colors

-Crucial Conversations

-Essential Facilitation

**References available upon request

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