career objective

results-driven program director eager to contribute superior leadership, team-building, and analytical skills toward supporting the employer in optimizing operational and financial performance

profile

ø  numerous years of progressive project management experience in the health insurance arena, with expertise in implementations, process improvements, and team leadership 

ø  extensive hands-on experience in billing, customer service, claims, provider database, marketing, membership  and administrative services, facilities, provider credentialing, network contracting, accounts receivable, and claims supervision

ø  facilitate client-focused, service-oriented environment vital to maximizing customer satisfaction and retention

ø  define requirements, delineate project scope, determine schedule and budget guidelines, allocate resources and institute cost controls, plan and oversee implementations, and provide progress reports throughout entire process to ensure alignment with business and technical objectives

ø  conduct detailed business assessments, identify gaps and inconsistencies, and develop and execute solutions that result in increased efficiency, productivity, and overall corporate profitability

ø  solid record of building, training, and managing top-performing support teams; strategically plan and coordinate workflow and human resources for optimal coverage while containing labor costs

ø  consistently achieve critical deadlines while maintaining high quality standards

ø  dynamic communication, presentation, negotiation, and relationship management skills

professional experience

licensed realtor, insert geographic area                                                                                                2008 c present

 

wellpoint, inc., thousand oaks, ca                                                                                                             1983 c 2008

director, network data operations (2004 c 2008)

         in recognition of outstanding performance, steadily progressed within the nation's leading health benefits company to attain ultimate position as business project director for the enterprise provider database solution

         expertly developed and secured executive approval of project charter and capital acquisition request package; delivered ongoing status reports to steering committee and program sponsors

         diligently identified and documented business requirements, redirected workflow, established web-based training, coordinated user acceptance testing, and oversaw governance review process

         trained and supervised project managers to ensure timely and accurate completion of special projects and day-to-day activity

director, provider database operations (2001 c 2004)

• cost-effectively planned and administered $8m+ annual budget for the provider operations division and its multiple lines of business; oversaw all day-to-day activity for national and corporate provider databases for the enterprise
• successfully oversaw six provider operations division managers responsible for a 115-member team; provided staff direction and leadership across multiple locations
• collaborated with executive team to strategically outsource select functions of the provider database and provider credentialing areas

manager, provider database (2000 c 2001)

• relocated to southern california to support national provider database by pioneering quality, process improvement, and business process redesign initiatives
• launched audit and review process to increase overall data quality and procedural efficiency, standardized sops, and created highly successful training program for newly hired and veteran staff; results from the audits were tracked at the associate level and used as quality indicators for performance evaluations

 

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manager, provider credentialing and database (1998 c 2000)

• served on team responsible for designing and implementing new idx version of the provider database; managed 15 associates in verifying and updating all transferred data, including provider tax id, office locations, medical group affiliations, contract details, and services offered
• achieved 96% accuracy rate for completed database; personally responsible for developing review and approval processes for data updates and negotiated for and installed vendor-owned provider credentialing database

~ prior positions ~

manager, provider credentialing (1995 c 1998)

manager, facilities management (1993 c 1995)

facilities and expense management consultant (1991 c 1993)

project management / business process development roles (1983 c 1991)

education

general studies, triton college, franklin park, il

 

~ credentials ~

accelerated implementation methodology (aim) for project management certification                                          2004
licensed realtor, state of nevada                                                                                                          2008 c present
member, realty executives of nevada