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Click here or scroll down to respond to this candidateCandidate's Name , MSIO, CSSBBSt Louis, MO Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLELINKEDIN LINK AVAILABLEKnowledgeable and emotionally intelligent operations leader with 8 years of HR experience, 8 compliance, and 20 years of customer relations experience. Recognized for skilled process improvement program management with budgets of over $6.3 million; using well-honed servant leadership abilities. Skilled concept to implementation strategist with demonstrated success developing talent engagement and retention programs yielding 25% improvements while fostering interdepartmental relationships cutting acquisition time, and streamlining onboarding training for over 500 employees. Committed to defining, developing, and implementing programs and products that cultivate a community experience of excellence.SaaS: Microsoft, Jira, SalesforceCustomer Experience PlanningQuality Management PlanningProcess Redesign ExecutionHuman Resource ManagementOperations Budget ForecastingChange Management GuidanceTalent Acquisition InitiativesProject/Program ManagementExperienceAUTOMATED HEALTH SYSTEMS St. Louis, MO 7/2022 to 09\2023Manager of Quality Assurance/Workforce ManagementDeveloped and oversees the implementation of the Quality Assurance and Workforce Management plan of a 300-person Medicaid start-up program. Responsible for hiring, developing, and coaching six (6) QA Specialists two (2) Real-Time Workforce Analysts, and 15 product resource specialists in delivering and managing call center key performance metrics.Collaborates to optimize technological solutions, including Verint and Five-9 while leading a cross-functional team of Quality Assurance and Workforce Analysts to sustain a 7% Abandonment and 70% Agent Utilization RatesDeveloped and executed a Quality Assurance Management Plan driving Missouri Medicaid compliance adherence to 92% while overseeing risk management, agent evaluations, and planning QA metrics for 2nd phase contract launchPromotes operational excellence through the creation, implementation, and oversight of quality monitoring tools, controls, policies, and procedures supporting the call center and the mailroom and document processing center service level agreementsREDEEMED ARTS LLC St. Louis, MO 4/2019 to 7/2022Managing Director of Human Resources/OperationsControlled and oversaw the overall operations of Human Resources and Strategy as the key creative and operations leader of 65 team members leading community outreach programs and product development. Ensured work and resources aligned to maximize recruitment and retention to drive successful community events and new product launches.Consolidated expenditures by 35% by reconciling balance sheets, inventory, and payroll, while leveraging CRM platforms, increasing client engagement by 138% with a 65% conversion rateCreates and delivers over 50 annual leadership efficiency, employee engagement, and community impact workshops, including topics of communication, conflict resolution, negotiation, and emotional intelligenceCENTENE CORPORATION St. Louis, MO 4/2019 to 6/2020Senior Business AnalystDrove the analysis of large-scale business processes while providing strategies to improve operational efficiencies. Evaluated and recommended business solutions to support project managers, program developers, and executive leaders in assessing and understanding customer patterns, enrollment trends, and provider contract history.Unified three states health plan operation changes while leading project timeline, resulting in 99% health plan expenditures calculation accuracy & 97% contractual implementation accuracyAuthored training tools for business processes & continuous improvement initiatives while creating corporate Process Owner Standard Operating Procedures guideLead, Audit Operations 11/2017 to 4/2019Wellcare Health Plans St Louis, MOOversaw and directed 20 associates in proper Audits of Missouri provider contracts. Ensured proper credentialing requirements were obtained and applied to new contract holders before accepting claims for adjudication.Managed 20 internal contracting and credentialing agents on proper licensure, certifications, and accreditations processes and procedures, maintaining adherence to Medicaid regulatory, compliance, and policy requirements yielding $1.5mil first-year savingsConceptualized and delivered on process improvement strategies, gaining 45% in provider enrollment processing timeliness with 96% accuracy, lowering investigation errors by 64%Assessed operational trends and Salesforce CRM implementation errors, delivering process improvement directives increasing productivity by 38% and compliance adherence by 45%Team Lead of Customer Escalations 10/2016 to 11/2017Wellcare Health Plans Tampa, FLGuided 38 associates in proper management of Federal, State, and Executive escalations. Responsible for escalations of 19 jurisdictions for Medicare and Medicaid claims, Pharmacy claims, and all state contracting inquiriesBuilt and managed a cross-functional team of 18 executive escalation experts in performing collaborative root cause analysis, system error triaging, billing and adjudication investigation, and resolving state and federal complaints and grievancesAssembled and directed 20 Florida Medicaid Escalations analysts to investigate internal claims, provider credentialing, and system configuration errors, producing $425k first-year savings and reducing AHCA fraud, waste, and abuse filings by 28%Created and integrated 24 Standard Operating Procedures and overhauled internal quality control indicators, reducing complaints by 42% and increasing provider contract renewals and member re-enrollments by 40%Senior Account Resolution 10/2015 to 10/2016Wellcare Health Plans Tampa, FLAssisted in the direction of training, certification, and disciplinary actions for 85 team members as related complaints or inquiries for 19 jurisdictions related to billing configuration, contract language, and claim adjudication. Also partnered in the development of an internal Provider Chat program streamlining communication between Provers and health plan.Recommended strategy for an overhaul of operational metrics in determining billing, configurations, and claims adjudication efficiencies, supporting the training, coaching, and development of 85 employeesDeterred $875,000 in regulatory fines by investigating billing and contract configuration errors and collaborating in the development of a Provider Chat Platform pilot resource servicing over 15,000 usersCollaborated on the cross-functional creation of a 4-week escalations training program and Critical Systems Users Guide for case management efficiency, supporting 525 internal usersProject Controls Specialist 11/2012 to 12/2014Wellcare Health Plans Tampa, FLManaged claim command center projects totaling $6 million ensuring each of 19 contract holders was adjudicating claims correctly, saving health plans up to $1 billion in liquidated damages per each state guidelineCoordinated Medicaid and Medicare projects through requirement gathering, milestone creation, process implementation trend analysis, and systems integration success rate reporting in support of over 350 claim specialists across 18 marketsModified data integrations of Salesforce, SharePoint, and PEGA, yielding 38% process optimization and 18% savings on a $3.6mil to $5.4mil project budgetEngineered internal tracking tools for streamlined systems user performance and critical error resolution timeline adherence, resulting in a 35% performance improvementHead of Human Resources and Operations (Co-Founder) 4/2010 to 9/2016Kings Entertainment and Productions, Inc Tampa, FLDirected and guided up to 440 employees in effective community outreach and partnership management. Responsible for live community programming reaching an audience of 500 per event and 50 per workshop. Increased company margins through strategic branding and program placement.Orchestrated cumulative expansion to 40 FTE and 400 seasonal agents through collaborative strategies creating 50+ job descriptions and forming new benefits and compensation plans, optimizing Kronos and QuickBooksDrove market footprint across three (3) states, reaching a $700k annual budget; while reducing operational costs by 30% with renegotiated contracts and better-aligned community partnershipsCultivated community relations, executing over 500 live events and workshops dedicated to mental health, social equity, employee engagement, and youth delinquency preventionSupervisor of Call Center Operations 2/2008 to 8/2010Vangent Inc Riverview, FLDeveloped operational metric for 750-person call center while directly managing 30 team leaders through a talent management plan to effectively grow team leaders and senior representatives in their respective succession plansHired and developed 30 team leaders to manage 720 agents on maximizing call center efficiency based on collaborative analysis of key performance indicators, service level agreements, workforce forecasting, and contractual obligationsCollaboratively steadied employee retention to 91% through onboarding trend assessments, employee journey mapping, execution of customer experience surveys, consistent exit interviews, and employee satisfaction surveysEnacted call center quality and performance measures reducing costs by 18% while improving member engagement by 53% through detailed audits of 140 Medicare Advantage Plan customer engagement campaignsEducationDECEMBER 2021Master of Science/Industrial and Organization Psychology / Capella University / Minneapolis, MNOCTOBER 2020Bachelor of Science/Management and Leadership / Capella University / Minneapolis, MNNOVEMBER 2019Certified Six Sigma Black Belt / Council for Six Sigma Certification / New York, NY |
