Senior Quality Assurance & Operations Leader
Resume:
Leslie F. Creely
Savannah Ga. 31419
********@****.***
OBJECTIVE
To move forward with UPMC Health Plan applying my knowledge, skills, education, and work experience within this excellent company.
SUMMARY OF SKILLS
●MC400/ Profound, HealthPlaNET, Genesys,OAS
●ADO, SharePoint, CCD, KIP
●MED HOK, Right Fax, File Net
●eCIS, People Soft, Kronos, Nice Engage
●Microsoft Word, Microsoft Excel, Microsoft Outlook, Power Point, Canva
PROFESSIONAL EXPERIENCE
UPMC Health Plan
Senior Manager Quality Assurance & Operational Integrity November 2012- Present
●Ability to maintain designated production standards and manage multiple projects and task.
●Knowledge of medical insurance for all lines of business.
●Detailed oriented individual with excellent organizational skills.
●High level of oral and written communication skills.
●Supervise and monitor ongoing performance of team members.
●Monitor, examine, and report team performance against department standards.
●Work to ensure call center standards are met or exceed the standard.
●Intermediate to advanced proficiency with MS Office products and extensive PC skills.
●Strengths in sampling methodology.
●Able to demonstrate excellent organizational, interpersonal, and communication skills.
●Previous experience with compliance.
●Analytical skills.
●Knowledge of Call Center technologies including, IVR, NICE, CCD, MC4OO/PROFOUND
●Excellent written and verbal communication skills.
●Strong conflict management, teambuilding and motivational skills.
●Strong leadership skills, role model.
●Excellent interpersonal, organization, and time management skills.
Supervisor of Clinical Operations October 2008 – November 2012
●Comply with federal, and all company policies, procedures, and regulations.
●Supervise and monitor ongoing performance of team members.
●Monitor, examine, and report team performance against department and call center standards.
●Work to ensure call center standards are met or exceed the standard.
●Prepare and hold employee performance reviews.
●Complete interviewing, hiring, and scheduling training of team members.
●Work cooperatively with internal departments and the Clinical Management staff.
●Perform duties as assigned meeting deadlines and turnaround times set by Manager and Director.
●Worked with the Claims department on authorizations and claim issues.
●Completed SOX monthly.
●Manage escalated issues and ensure excellent customer service is provided.
●Mentoring and coaching team members creating a positive work environment.
●Training team members individually or in a classroom environment.
●Identify trends in call data making business plans to improve operational performance.
●Schedule, create an agenda and hold monthly staff meetings.
●Prepare staff schedules.
●Schedule staffing for special events.
UPMC
Provider Services Team Leader November 2004 – October 2008
●Worked to attain phone quality to meet and exceed set goals.
●Mentor and coach team members to attain excellent customer service.
●Meet weekly with team members
● one on one.
●I assisted the Supervisor with annual reviews.
●Monitored and managed phone queue volumes to ensure call center standards were achieved.
●Provided support to other departments.
●Processed and adjusted claims.
●Worked several claims projects, over and under payment.
●I managed escalated issues.
●I assumed supervisory responsibility in the absence of the supervisor.
●I maintained and created reports to assist with monitoring team quality.
●Tracked and trended call issues providing solutions to ensure optimal outcomes.
●Performed duties as assigned including special projects for the claims department.
CCP South Hills Pediatrics July 2002 – November 2004
●Telephone Triage 180 calls per day
●I was a liaison between patients, physicians, and facilities.
●ICD10 training
●Billing
●Patient Chart documentation
●Processed all incoming faxes, test results
●Administration of immunizations to patients.
●Performing clinical patient contact including vital signs, urin and throat culture testing.
AMG Sign Company October 1999 – July 2002
●Administrative assistant to the Controller
●Accounts receivable/payable
●Answering tall incoming phone calls
●Sales
●Customer Service
Emergency Medical Services Prism and Brentwood EMS November 1989 – September 2001
●Paramedic
●Supply Officer
●CPR Instructor (American Heart Assoc.)
●First Responder Instructor (American Heart Assoc.)
Education
Quality Process Improvement November 2011
Team Building February 2012
ICD-10 Coding March 2012
Excel Refresher Course March 2012
DISC Training April 2012- Sep.2023
Advanced Business Writing May 2012-July 2023
UPMC Management Training June 2012
UPMC HEALTH PLAN FOUNDATIONAL SUCCESS SERIES April 2007
UPMC HEALTH PLAN MANAGEMENT TRAINING May 2007
Baldwin High School Graduated 1976
Slippery Rock University 1976- 1979
Pittsburgh Beauty Academy 1979 -1980 PA Cosmetology Managers License/ number CM-005301-L
CCAC EMT 1989 -1996 PA Emergency Medical Technician Certification 080907
CCAC Paramedic Certification 1996 to present Pennsylvania Certification 058489
Contact this candidate