Ariana Prophete
Palm Bay,FL
Summary
Healthcare operations leader with 8+ years of experience in provider and member services, centralized support, and call center supervision. Skilled in leading cross-functional teams to manage provider inquiries, claims resolution, credentialing, and compliance within Medicaid and Medicare frameworks. Adept in EMR/EHR platforms (Epic, Athena), CRM systems, and provider operations tools. Recognized for driving service excellence, optimizing workflows, and ensuring adherence to CMS and HIPAA guidelines.
Program management professional with history of driving projects to successful completion. Known for fostering team collaboration and delivering results in dynamic environments. Proven expertise in risk management and resource allocation.
Overview
29
29
years of professional experience
14
14
Certification
Work History
Program Manager
AssistRx
09.2025 - Current
- Key responsibilities include managing client relationships, ensuring day-to-day operations run smoothly, monitoring program metrics, collaborating with internal teams to optimize processes, Assisting with reports from upper leadership
- Other duties include staff supervision and development, creating client-facing content, and implementing data-driven initiatives.
- Creating easier Processes
Centralized Operations Manager
Oak Street Health
05.2023 - 08.2025
- Lead centralized service teams handling provider and patient inquiries, appointment scheduling, authorizations, and referral management.
- Partner with provider relations and credentialing departments to streamline access and reduce provider onboarding delays.
- Conduct QA audits, performance reviews, and compliance checks to meet CMS and HIPAA standards.
- Utilize Epic and Athena platforms for documentation, ICD-10 coding, and utilization review processes.
- Co-Pay oversee
Clinic Manager
OMNI Healthcare
01.2020 - 05.2023
- Supervised clinic operations, including front/back office staff and provider support teams across call scheduling, insurance verification, and claims preparation.
- Resolved provider escalations related to claim denials, coverage disputes, and referral issues.
- Trained staff in medical documentation best practices, EHR use, and patient-provider communication.
- Ensured compliance with HEDIS and pandemic regulatory requirements.
- Multiple Practice .
Eligibility Coordinator 3
Health First Health Plans
08.2015 - 11.2019
- Served as a primary contact for Medicaid/Medicare provider and member eligibility inquiries.
- Verified demographic and financial data to support accurate provider reimbursement and claims processing.
- Collaborated with providers to educate on plan benefits and resolve case discrepancies.
Education
Associate of Applied Science - Human and Health Services
Herzing University
Dearborn, MI03-2026
Diploma - Human and Health Service
Herzing
08.2025
Diploma - Medical Billing & Coding
Herzing University
12.2022
Diploma - Medical Administration
Everest University
02.2017
Associate - Business Management
Briarcliffe College
01.2007
Skills
- Provider Services & Relations
- Claims Resolution & Denial Management
- Medicaid/Medicare Operations
- Call Center Leadership & Escalation Support
- Credentialing & Prior Authorization Oversight
- Provider Education & Onboarding
- CMS/HIPAA/NCQA Compliance
- EMR/EHR Systems (Epic, Athena)
- CRM Tools (Salesforce, Oracle)
- QA Auditing & Performance Coaching
- Epic
- Athena
- Salesforce
- Oracle
- SAP
- ICD-10
- HEDIS
- ADP
- Workday
- Credentialing Platforms
- Microsoft Office
- Google Workspace
- Call Center Telephony (Avaya, Cloud-based)
- Program management
- Client relationship management
- Data-driven initiatives
- Process optimization
- Performance audits
- Compliance checks
- EHR documentation
- Appointment scheduling
- Claims processing
- ICD-10 coding
- Quality assurance processes
- Team collaboration
- Regulatory compliance (CMS, HIPAA)
- Reporting and analytics
- Training and development
- Eligibility verification
- Problem-solving
- Project management
- Detail-oriented
- Process improvement
- Team leadership and direction
- Decision-making
- Project coordination
- MS office applications
- Policy and procedure improvements
- Critical thinking
- Interpersonal skills
- Program leadership
- Work Planning and Prioritization
- Data collection & research
- Team management
- Flexible and adaptable
- Team training and development
- Attention to detail
- Operations management
- Stakeholder communications
- Customer service
- Relationship building
- Public speaking
- Good judgment
- Scheduling and planning
- Budgeting and resource management
- Cross functional team builder
- Partnership development
- Program reviews
- Team development
- Stakeholder management
- Quality assurance
- Performance monitoring
- Data analysis
- Change management
- Multi-operations management
- Community outreach
- Business development
- Project lifecycle
- Documentation proficiency
- Influencing skills
- Scope management
- Cost management
- Remote team management
- Personnel management
- Revenue growth
- Cultural sensitivity
- Resource management
- Strategic direction
- Event planning and execution
- Agile projects
- Presentation creation and delivery
- Proficient in [software]
- Risk analysis and management
- Budget preparation
- Budget development
- Professional writing
- Vendor management
- Quality assurance evaluation
- Regulatory compliance
- Profitability optimization
- Organizational performance
- Individual instruction
- Onsite customer support
- Contract development
- Partnerships and resource mobilization
- Cost estimates & budgets
- Google workspace
- Financial leadership
- Vendor relationship management
- Proposal development
- Work delegation
- Life cycle management
- Utilization management
- OSHA compliance
- Quality control
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Documented and resolved Escalation which led to 85% turn around.
- Supervised team of 108 staff members.
- Collaborated with team of 50in the development of Duplication.
- Resolved product issue through consumer testing.
Certification
- Certified in Medical Billing
- HIPAA Compliance (Knowledgeable)
Timeline
Program Manager
AssistRx
09.2025 - Current
Centralized Operations Manager
Oak Street Health
05.2023 - 08.2025
Clinic Manager
OMNI Healthcare
01.2020 - 05.2023
Eligibility Coordinator 3
Health First Health Plans
08.2015 - 11.2019
Diploma - Human and Health Service
Herzing
Diploma - Medical Billing & Coding
Herzing University
Diploma - Medical Administration
Everest University
Associate - Business Management
Briarcliffe College
Associate of Applied Science - Human and Health Services
Herzing University