Angelo Branch
Brooklyn,NY
Summary
Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success.
A collaborative leader with dedication to partnering with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings.
Overview
23
23
years of professional experience
Work History
Director Payment Integrity
VNS-Health
11.2018 - Current
- Oversee the accurate and timely load of provider contract terms into the payment system, ensuring seamless integration of updates and configurations
- Conduct pre and post load testing for all configuration updates to validate system accuracy and efficiency
- Develop and implement comprehensive audit plans for existing contract terms, ensuring appropriate payments by Choice and its vendors
- Identify and pursue recovery opportunities resulting from incorrect payment methodologies, minimizing financial losses
- Ensure the timely loading of changes to benchmark reimbursement rates mandated by regulatory agencies, accurately configuring all rate changes
- Coordinate with the VNS-Health IT department during systems implementation and integration to optimize data management processes
- Support legal and provider contracting teams in identifying areas of concern regarding contracting methodologies, ensuring compliance with industry standards
- Through the implementation of affordability initiatives, oversights identified a substantial $8.5 million in savings for the year
- These savings were attributed to diligent adherence to provider contractual obligations and the strategic application of configuration updates
Mgr. II Medicaid State Ops (IRU)
Empire-BlueCross
04.2018 - 11.2018
- Partners and supports leadership across the Health plan on assigned projects
- Participates in operational process improvement initiatives
- Facilitates collaborative effort between Health Plan and Corporate operations for implementation of State updates
- Serves as Primary contact to Health Plan leaders to ensure appropriate key operational indicators are in place for monitoring and analysis
- Resolves operational issues to include enrollment , benefit configuration, authorizations , high dollar claims, pended claims , appeals, adjustments, customer service and policy issues
- Assists Health Plan Provider Relations with Contracting interpretation and how it would affect claim processing
- Responsible for new Hires , training, coaching and evaluates performance of direct reports
- Responsible for weekly updates to CFO on current projects that have substantial financial impacts
- Responsible for all Healtp lan recoupment approvals, reviewing and assuring accurate recoupment
- Responsible for Operations policies, best practices and
- Identify Health plan opportunities for improvement in areas of efficiency and effectiveness
Program Manager
Empire-BlueCross,BlueShield, Provider Relations
01.2016 - 04.2018
- Responsible for updating Corporate Finance on OKL (Other Known Liability) projects, assuring liability funds are accrued and supported with documents for justification
- Assist in system research and issue resolution acting as a SME for management on claims and system configuration
- Responsible for ensuring benefit delivery and managing activities of assigned projects or inventory
- Assist in the development, process flows, and desk procedures for staffing required for effective project completions
- Interface with business of management and IT management to determine customer requirements and strategy are met and implemented timely and successfully
- Responsible for leading the project team to assure all projects are documented and resolved in a timely manner
- Effectively support the execution of the plans efforts to comply with state mandated updated rates by facilitating projects ensuring end to end completion
- Participation in meetings, and follow-ups on action items to ensure resolution and communication to team and stakeholders
- Instrumental in NextGen new workflows and updates to streamline processes and improvements for appeals
- Track and keep stake holders informed of status of all projects
- Diagnose and resolve problems and communicate effectively to other departments on progress
- Document and work on root cause analysis for resolution of global issues to reduce cost impacts of Health plan error.
Mgr. Medicaid Field Ops (IRU)
Health Plus/ Amerigroup
07.2013 - 01.2016
- Responsible for managing operations support team
- Implement operations issues through specific process and systems
- Resolves issue with cooperate business units such as Claims, Configuration, Call Center, Provider Relations etc
- Identify and monitor appeal trends to develop and implement resolutions
- Redesigned audit process for appeals reviewed by analyst
- Responsible for hiring , training , coaching and counseling direct reports
- Present weekly productivity reports to director to keep updated on team performance and goals
- Service pended claims queues to assure aged claims are less than 30 days
- Tabulate DOH complaints to assure all state regulations time frames are met.
Manager- Call Center
Health Plus/Amerigroup, NCC
01.2010 - 07.2013
- Establish and implement goals for the center
- Ensure department goals are being met as outlined by senior leadership
- Consult extra-departmental entities such as Claims, Finance, Provider Relations, etc., regarding various issues
- Ensure staff regulatory, quality, and schedule adherence
- Report directly to VP in absence of director
- Analyze and interpret data from WFM for reporting to VP
- Develop associates by coaching through 1:1 trainings as well as team meetings
- Augment systemic processes in order to increase staff claims review productivity by 10%
- Audit all work prepared by new employees
- Centralize claims review process to remove internal roadblocks
- Delegate all incoming tasks and projects to staff daily
- Forecast monthly production quotas in order to remain ahead of the work curve
- Reconcile large dollar projects for Senior management
Supervisor
Health Plus, Medical Management Call Center
01.2008 - 01.2010
- Review and resolve complex issues brought by senior representatives
- Consult extra-departmental entities such as Claims, Finance, Provider Relations, etc., regarding various issues
- Monitor, track, log, and analyze call monitoring reports
- Primary liaison between staff and management
- Organize staff training
- Report operating conditions, and issues that need to be addressed to management
- Utilize resources to efficiently run the operations of the MMCC
- Responsible for Customer focus reporting while maintaining the goal for aged cases
- Responsible for managing Info-plus assuring providers access to the system
- Assist Health Service reps with understanding provider networks before authorizations
- Created Data base to track all Void, and reissued checks requested from the Call Center
Senior Provider Service Analyst
Health Plus, Provider Relations
11.2006 - 01.2008
- Review and resolve system generated errors for Provider Relations
- Maintain member primary care physician log for accuracy of member to PCP assignment
- Identify Provider Contract configuration discrepancies and recommend resolutions
- Provide claim adjudication and system support for Claims, Member Services and Health Services Department
- Schedule Managerial meetings to discuss payment and reimbursement issues due to facets configuration
- Assist managers with system reports as requested
- Created pend code tracking log for claims submitted to Provider Relations for review
- Maintain the Provider Claims Analysis Log for complaint resolutions
Configuration Specialist
Health Plus, Model Office
09.2004 - 11.2006
- Maintaining and configuring Trizetto/ Facets 4.1 to 4.31
- Troubleshooting of system claim error reports (N026- MOD)
- Verified testing of new and amended Hospital and Practitioner contracts
- Analyze and test system applications of facets 4.31
- Provide technical system support to Claims, Provider Relations, and Member Services Depts
- Update procedure code/rates to facilitate yearly Medicare and updated Medicaid pricing
- Pioneered Configuration Log for tracking of system updates and changes
- Remodeled Correspondence Data Base for Correspondence tracking in Access
Senior Provider Service Representative
Health Plus, Provider Relations
12.2003 - 09.2004
- Responsible for call center phone monitoring of staff to assure professionalism of incoming calls
- Assist in Facets system training for Provider Service Representatives
- Handle complex provider calls and Customer Focus Cases
- Auditing of Provider records created by Data Specialist staff of 5
- Responsible for review of NO26 Provider Relations claims error report
- Review claims for Provider Relations claims project to create, and update provider records
- Redesigned workflow for Provider update process
- Created Desk Level Manual for Provider Service Representatives
- Assess Customer Focus cases created by Service Representatives staff of 10 or more
Provider Service Representative
Health Plus, Provider Relations
07.2003 - 12.2003
- Responsible for resolution of provider inquires
- Provide claim inquires and credentialing status to providers
- Handle special Projects assigned by Provider Relations Manager
- Create Customer Focus cases for tracking of provider inquires
- Research and update provider records for claim processing
Claims Processor to Claims Analyst
Health Plus
09.2000 - 07.2003
- Analyze and adjudicated claims from facets report
- Handle provider calls , providing status of claim inquires
- Responsible for incoming Correspondence from provider
- Reviewed appeals sent by providers
- Accountable for the adjudication of complex claims for various types of services
- Pinpointed and resolved claims that error in facets for accuracy and processing
Education
High School Diploma -
Abraham Lincoln High School
Skills
- Quality Assurance Controls
- Project Implementation
- Organizational Goal Development
- Project Oversight
- Facets & Configuration
Timeline
Director Payment Integrity
VNS-Health
11.2018 - Current
Mgr. II Medicaid State Ops (IRU)
Empire-BlueCross
04.2018 - 11.2018
Program Manager
Empire-BlueCross,BlueShield, Provider Relations
01.2016 - 04.2018
Mgr. Medicaid Field Ops (IRU)
Health Plus/ Amerigroup
07.2013 - 01.2016
Manager- Call Center
Health Plus/Amerigroup, NCC
01.2010 - 07.2013
Supervisor
Health Plus, Medical Management Call Center
01.2008 - 01.2010
Senior Provider Service Analyst
Health Plus, Provider Relations
11.2006 - 01.2008
Configuration Specialist
Health Plus, Model Office
09.2004 - 11.2006
Senior Provider Service Representative
Health Plus, Provider Relations
12.2003 - 09.2004
Provider Service Representative
Health Plus, Provider Relations
07.2003 - 12.2003
Claims Processor to Claims Analyst
Health Plus
09.2000 - 07.2003
High School Diploma -
Abraham Lincoln High School