Dynamic Administrative Professional
Resume:
JAMENA BROWN
**** ********** ****, ******** ****, TX 77489
********@*******.***
PROFILE
Energetic, results-focused administrative professional offering 7 years experience providing full range support at the Sr. VP level in the health and insurance industry, with emphasis in human resource support, project coordination and management. Extensive background in operations is complemented by strengths in the claims, customer service and enrollment processes. Works well under pressure and is willing to go the extra mile to meet goals and objectives. Articulate communicator with strong interpersonal skills; excels in resolving conflicts/issues. Expertise and skills include:
-Operations Budgeting
-Billing/Payment Processing
-Project Management
-Policy/Procedure Development
-Workflow Analysis
-Data Collection
-CMS Auditing
-Process Improvement
-Vendor Relations
-Training and Development
-Quality Assurance
-Claims Auto Adjunction
-MS Word
-Excel
-PowerPoint
CAREER TRACK
UNIVERSAL AMERICAN FINANCIAL CORPORATION
PMO Project Analyst April 2006 – Present
Promoted to project analyst position. Plan and manage non-technical project assignments including processes, procedures, and tools designed to increase health plan productivity and accountability. Primary focus is tracking and monitoring staffing requisitions and staffing head counts. This involves strong data analysis skills and the ability to put together reports/presentations that are clear and concise.
•Document project charters, coordinate the maintenance of key weekly project metrics including "% complete" and "estimates to complete".
•Compile weekly data and status reporting including updated information in the following areas: task status aggregation, project management tool metrics, issues and risks, financials, milestone summary and detail, deliverables summary and detail.
•Schedule and coordinate project team meetings (some regularly occurring, some ad hoc). Includes coordination of meeting schedule, meeting location, and facilities (conference phone, hand outs, etc.).
•Coordinate periodic resource plan and/or work plan updates.
•Perform financial analysis as requested using budget, actual effort, and forecasted effort data.
•Develop methods and track project progress toward applicable deliverables.
•Compile data from teams as requested for cross team deliverables.
•Create and/or update documents required for managing the initiative as assigned.
•Assist project manager with development and maintenance of applicable Project Management deliverables including communications plan, configuration items list, issues list, risk list and roadmap.
HealthPlan Operations Coordinator
Oversaw HHSI’s day-to-day healthplan operations department functions, which supported the company’s provider relations, claims payments, customer service and billing and enrollment services. Scope of responsibility encompassed enrollment process activities, claim processing and recovery, and reporting system operations supporting 27 current HMO health plans. Ensured the timely and accurate printing, collating, and mailing of health insurance information to members, providers and vendors. Served as the primary liaison between IS&T and the user operations area. Directed the efforts of 8-15 employees.
•Code expenses for payment in accordance to AP guidelines, track expenses to budget and submit to AP department for payment
•Vendor relations coordinator for Enrollment and Billing, Claims, Call Center, and Provider Relations
•Update existing policies and procedures for various departments in accordance to CMS guidelines
•Assisted compliance with conducting mock quality assurance audits internally with various department and externally with vendors concentrating on CMS rules and quality improvement program
•Provided upper management with weekly and monthly audit results as well as improvement plans
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JAMENA BROWN ********@*******.***
•Provided departmental coaching/training based upon company needs
•Created claims, customer service, enrollment and billing and provider relations organization chart focusing on job definition and process, accountability for reporting, monitoring processes, internal controls, reconciliation, production standards and management of outsourced operations
•Performed and documented overall evaluation relative to functional integration of work flow and handoffs
•Oversaw the metrics of productivity standards, staffing levels and inventory control
•Developed a quality assurance program to ensure over 98% overall accuracy of enrollment, disenrollment, and reconciliation processes
•Created batching system to track enrollments that turned around a failed CMS audit and brought department into compliance within 3 months, receiving 100% audit rating
•Established procedures on Medicare enrollment and disenrollment submissions, reconciled Medicare membership, hired and trained staff on parts of Medicare HMO
•Facilitated weekly call calibration session
EDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATES (ECFMG)
Executive Assistant January 2001 – February 2006
Responsible for managing part time administrative and testing staff for a nonprofit organization. Oversaw clinical skills exam for Foreign and U.S. students seeking admission into the U.S. medical residency programs.
•Developed and implement administrative process improvement plan, which enhanced operational performance
•Served as the information and communication hub for the SVP staff and administrative support team to ensure they are aware of critical dates, events, etc.
•Consulted with management in recruiting, hiring, training, and supervision of the support staff, test administration and temporary personnel to ensure a quality staff
•Ensured that workflow is handled for maximum efficiency and proactively in anticipating needs of Senior Vice President (SVP) and staff.
•Arranged extensive domestic and international travel. Managed appointments, scheduled travel, created trip folders to ensuring that the department is organized and prepared for all business trips
•Coordinated details of onsite and offsite meetings and executive staff meetings
•Ensured office supplies, exam room and medical equipment/supplies were maintained at established par level
•Assisted human resources department with specific needs such as benefit policies and procedure updates
•Facilitated new hire orientation with all new hires to provide an overview of the company, job description, benefits, policies, and procedures
•Coached employees on administrative and operating policies and procedures to ensure compliance standards are met
•Coordinated maintenance of computer systems with MIS staff; ensured staff training on in-house computer applications
CREDENTIALS
Associates Degree in Arts, Houston Community College – In Progress
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