Cheryl D. Pelas
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Solution-oriented and driven with strengths in both self-management and leadership abilities. Experienced in team leadership, planning and organizational skills built during successful career. Smoothly equip employees to independently handle daily functions and meet customer needs. Diligent trainer and mentor with exceptional management abilities and results-driven approach.
Overview
20
20
years of professional experience
Work History
Business Systems Analyst
Change Healthcare
04.2019 - Current
- Trained business personnel in use of systems.
- Investigated and addressed system issues to enhance usability and improve functionality.
- Identified needed business improvements and determined appropriate systems required to implement solutions.
- Tracked feedback at all levels and researched resolutions for common concerns.
- Gathered, reviewed and reported on findings.
- Delivered client HRP software training, imparting knowledge of best practices for protecting data and minimizing errors.
- Coordinated data migration and consolidation efforts.
- Resolved malfunctions with systems and programs through troubleshooting.
- Collected, defined and analyzed business requirements.
- Helped deploy system enhancements to improve field operations.
- Meeting with client both directly and via electronic means to obtain their specific needs
- Writing business requirements that represent client business needs for System Developers and/or System Configuration Analysts.
- Monitoring development/configuration work and quality testing to ensure that client deadlines are met.
- Completes all client and CHC Management required documents and obtain approvals of said documents.
- Research and obtain knowledge of specific system functionality to help ensure proper recommendations are offered to client.
-
Health Services Supervisor
Change Healthcare
10.2016 - 04.2019
- Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
- Directly manage and supervise 10-15 Utilization Review non-medical staff members
- Assist HS Manager in management of 10-15 Utilization Review medical staff members.
- Fostered excellence by example by "setting pace" and being hands on mentor to clinical staff.
- Assist HS Manager to ensure all client Utilization Management SLA's were met
- Develop staff schedules to ensure adequate staffing needs to maintain client SLA's
- Including the approval of all PTO
- Develop and implement department policies and procedures
- Staff training
- Maintain staff training documents
- Weekly approval of employee time records
- Conduct weekly staff meetings and maintain documentation of staff meetings
- Assign duties to staff
- Directly communicate with client regarding urgent, sensitive and/or High-Priority UM cases
- Directly communicate with client Medical Directors regarding urgent, sensitive and/or
- High Priority UM cases
- Write Team and monitor staff OKR's
- Any other duties as directed by UM Manager and Director
- Page | 2
- Assisted with regulatory issues such as compliance.
- Provided in-depth support to executive staff in regards to healthcare programs and administration.
- Coordinated activities with HS Manager to align planning processes with targeted project outcomes.
-
Health Services Support Coordinator
Change Healthcare
Pensacola, FL
07.2012 - 10.2016
- Compile and distribute variety of daily, weekly and monthly reports
- Acted a liaison between client and UM Department
- Index all incoming faxes received with 1 hour of receipt
- Monitor BCBSAZ-UM proxy mailbox: Communicates with HP and various Med3000 departments through proxy email
- Respond to questions from HP, Claims, CS as necessary
- Forwards any received documents to PC7 for either UM or UM Claims review as appropriate
- Monitor BCBSAZ-After-Hours proxy mailbox: Communicates with HP Appeals/Grievances Dept, Complaint Department and various Med3000 through proxy email
- Respond to questions from, , Claims, CS as necessary
- Denial Letters: Attach letters to chart in PC7/Support Queue
- Print/mail letters to members
- Attached letters to members' PC7 Chart
- Monitor Nurse Review Queue for clinicals that have been uploaded from provider portal
- Correct the uploaded documents and corresponding authorizations in Facets as appropriate
- Monitor Support Review Queue and follow up as necessary
- Monitor the Pend for Info Queue and follow up as necessary
- Review and Send LOA requests to HP via proxy email to Client designated email
- Any other duties as directed by UM Supervisor, Manager and Director
- As Support Coordinator, I was able to establish and implement changes in getting cases requiring Medical Director review to go from a 100% manually completed process to 100% electronic and paperless process
- Implementation of new process, reduced the amount of time in getting cases to the client's Medical Director from 5-6 hours daily to 2 hours or less each day.
- Assisted with regulatory issues such as compliance.
- Provided in-depth support to executive staff in regards to healthcare programs and administration.
- Coordinated activities with HS Manager to align planning processes with targeted project outcomes.
Skills
- Software and Hardware Implementation
- Solution Testing and Implementation
- Business Rule Consolidation
- Production Support
- Business Processes and Procedures
- Training Personnel
- Problem Resolution
- Administration and Management
- Adaptability and Flexibility
- Employee Coaching and Motivation
- Managing Employee Relations
- Staff Management
Timeline
Business Systems Analyst
Change Healthcare
04.2019 - Current
Health Services Supervisor
Change Healthcare
10.2016 - 04.2019
Health Services Support Coordinator
Change Healthcare
07.2012 - 10.2016
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