Amanda Tye

• Streamlined business processes by analyzing current procedures and implementing necessary improvements.
• Increased overall efficiency by automating repetitive tasks and optimizing workflow.
• Managed cross-functional teams for successful project completion and timely delivery of products or services.
• Developed strategic partnerships with key stakeholders, fostering collaboration and driving growth.
• Implemented cost-saving measures, reducing operational expenses without sacrificing quality or productivity.
• Designed comprehensive training programs to enhance employee skills and boost overall performance.
• Established performance metrics to evaluate team effectiveness and identify opportunities for improvement.
• Spearheaded change management initiatives to successfully integrate new processes or technologies into existing operations.
• Championed a continuous improvement culture by encouraging innovation and proactive problem-solving among team members.
• Implemented escalation procedures to effectively handle time-sensitive issues.
• Provides oversight and direction for the documentation and communication of the configuration criteria for CMS legislative mandates, benefit designs, and business policy decisions to enable ac curate implementation of the modifications.
• Plan for, develop, and manage the quality and productivity of the team, coordinate site wide issues with the Director, Claims.
• Support all departments within Health Plan Business Operations division in research and problem solving. This includes, but not limited to Claims (Medical/Dental), Enrollment, Cost Recovery and Appeals.
• Manage the vendor partnerships with the mailroom operations and third-party recovery.
• Reduce member appeals due to inaccurate payment/denial of claims by performing analysis of processed claims data.
• Ensure changes within the system are adequately tested using valid test case scenarios and accurate results are documented.
• Align with key business partners to serve the customer(s).
• Foster and maintain a collaborative relationship with internal and external customers to ensure customer satisfaction; work with business partners to identify ways to improve business processes.
• Partner with team to identify trends, efficiencies within processing, and improve auto-adjudication.

This role had the same responsibilities as above and also the following:

• Reporting to the Director of Claims, the Manager of Business Operations Support provides appropriate technical and managerial support ensuring key performance indicators mandated by the Office of Personnel Management (OPM), internal requirements and goals are met.

While under my tenure at GEHA, I was also the Supervised the Network Management Team. Responsibilities:

• Provides support and guidance to Network Management staff on daily responsibilities.
• Supports team members on development and performance.
• Set manageable team and individual goals that align with company values.
• Managing and overseeing leased network contracts, vendor contracts, client contracts, or provider contracts. Coordinates monthly file downloads and prepare weekly reports.
• Analyzes and oversees leased networks, vendors, clients, members or provider's service issues, workflow issues and contractual issues.
• Serves as a liaison between vendors, networks, members, providers, or clients and all other GEHA departments. Monitors and advises management of the status of network contractual performance.

• Increased team productivity by implementing streamlined processes and effective communication strategies.
• Achieved departmental goals by developing and executing strategic plans and performance metrics.
• Reduced operational costs through comprehensive process improvement initiatives and resource management.
• Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
• Enhanced financial accuracy by implementing streamlined accounting processes and procedures.
• Achieved timely financial reporting through diligent preparation and analysis of monthly, quarterly, and annual reports.
• Reduced discrepancies in financial data with thorough account reconciliations and adjustments.
• Managed successful audits by collaborating effectively with internal and external auditors.
• Ensured compliance with tax regulations by preparing accurate federal, state, and local tax filings on time.
• Implemented efficient budgeting processes to forecast expenses and monitor actual performance against projections.
• Optimized cash flow management through careful analysis of accounts receivable, accounts payable, inventory levels, and working capital requirements.

• Solely responsible for the medical recruitment and contract negotiations of all Hospitals and major Health Systems in seven states. This included onsite presentations to potential Clients.
• Responsible to achieve and maintain target savings for each contract market area.
• Developed and maintained Facility, Provider medical, and Dental fee schedules.