Customer Service Project Management

Shayla V. Picquet

Houston, TX ***** 504-***-**** *************@*****.***

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SKILLS • Customer Service • Revenue/Data Integrity

• Strategic Planning • Project Management

• Process Improvement • Data Visualization

• SQL • Analytical Thinking

• Network Relations • Problem Solving

• Skilled negotiator • Healthcare management

PROFESSIONAL

SUMMARY

Experienced Healthcare Contract Administrator with a proven track record in contract management and negotiations. Possesses strong problem-solving and critical-thinking skills, bringing a deep understanding of legal concepts and contract law to the table. Collaborative nature and dedication to delivering outstanding customer service enable the building of strong relationships with clients and stakeholders. Committed to ensuring successful execution of contracts and achieving mutually beneficial outcomes with a top-notch approach. WORK HISTORY MANAGED CARE CONTRACT MANAGER 10/2022 to CURRENT United Healthcare Remote

Engage directly with healthcare providers or their delegates to negotiate reimbursement amounts on behalf of consumers referred to Naviguard, including complex and/or specialty specific cases, achieving significant cost savings of over 750k dollars.

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Improve contract negotiation outcomes by conducting thorough research and analysis of managed care contracts.

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Provide expert guidance on contractual matters to project managers, facilitating smooth project execution.

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Resolve contractual disputes in a timely manner, minimizing potential risks and financial losses for the company.

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DATA INTEGRITY SPECIALIST 07/2022 to 11/2022

Fetch Rewards Remote

Conducted regular audits of datasets, identifying discrepancies and ensuring prompt resolution.

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Determined root cause of data quality errors and recommended long-term solutions.

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• Implemented best-practice methodologies that improved overall project S V

delivery timelines while maintaining quality standards. Interacted with internal customers to understand business needs and translate into requirements and project scope.

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PROVIDER RELATIONS ANALYST 08/2021 to 07/2022

Elemy Remote

Managed and collaborated with providers and clients to analyze and troubleshoot challenges with technology

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Served as primary contact for escalated provider inquiries, issues, and concerns while developing and maintaining strong relationships with providers

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Enhanced team collaboration by providing clear communication of complex findings through visualizations and reports.

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Collaborated with cross-functional teams to identify opportunities for process improvement and increased efficiency.

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Increased provider satisfaction scores 46% by collecting and credentialing demographic updates, investigating claims and inquiries and overseeing network integrity.

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PATIENT ACCESS COORDINATOR 07/2019 to 03/2020

Kroger Specialty Pharmacy Harvey, USA

Obtained prior authorizations; initiated request, tracked progress, and expedited responses from insurance carriers and other payers, and maintained contact with customers to keep them continuously informed

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Streamlined referral processes by establishing strong partnerships with healthcare providers, enabling more efficient transfers of patients between facilities.

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Provided compassionate service to patients and their families during difficult times, addressing concerns promptly and offering assistance as needed.

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Verified eligibility and compliance with authorization requirements for service providers.

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Fostered positive relationships with key stakeholders, utilizing exceptional interpersonal skills to address inquiries professionally and promptly.

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PATIENT ACCESS COORDINATOR 09/2018 to 03/2019

Our Lady of the Lake Baton Rouge, USA

Trained new hires on department procedures, policies, and software systems, ensuring consistent quality service delivery from all team members.

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Facilitated smooth billing processes by verifying insurance eligibility, obtaining authorizations, and accurately entering claim details into system.

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Facilitated smooth admissions process for patients by pre-registering them, providing clear instructions, and answering their inquiries promptly.

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Collaborated with clinical teams to coordinate bed assignments for incoming patients, optimizing hospital space utilization.

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COMMUNITY OUTREACH COORDINATOR 06/2016 to 07/2017

HAART Inc. Baton Rouge, USA

Provided outreach and education to diverse audiences through presentation, trainings, one-on-one meetings and networking, events, media outreach, and other outreach strategies

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Planned and managed logistics for events, ensured departmental engagement, and made sure we operated within budgetary guidelines

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Linked clients with community services and resources to help meet their needs while collaborating with outside agency personnel to obtain maximum results

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Evaluated success of outreach initiatives using data-driven metrics and made recommendations for future improvements.

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Developed educational materials to support community members in accessing available services and resources more efficiently.

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ACCOUNT ADVISOR 06/2014 to 06/2015

Blue Cross Blue Shield of LA Baton Rouge, USA

Conducted informal and formal site visits to assist in evaluating quality and effectiveness of contracted or prospective providers

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Reviewed and analyzed qualitative and quantitative information to assess provider performance, and make recommendations for plan action including corrective actions, contract terminations and other interventions

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Organized regular meetings with key stakeholders to review account progress and address any concerns proactively.

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Negotiated optimal contract terms and conditions to lessen business risk and maximize financial objectives.

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Ensured timely fulfillment of contractual requirements by closely monitoring progress and addressing potential issues proactively.

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Conducted thorough analyses of clients'' financial situations, presenting actionable insights for improvement.

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EDUCATION Bachelor's Degree Health Administration Our Lady of The Lake College, Baton Rouge, LA

Associate's Degree Applied Science Concentration Delgado Community College, New Orleans, LA

CERTIFICATIONS • Google Data Analytics Certification

• RBT 40-Hour Training Certification

• HIV Testing and Counseling Certification

• Lean Six Sigma (Yellow Belt)

• Basic Life Support (BLS) for Healthcare Providers

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