ARMENDINA DOMINGUEZ, CSM
CHICAGO,IL
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.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Process Improvement Director
Anthem Inc
Chicago , IL
05.2022 - Current
- Identify and develop plans to improve performance to be incorporated enterprise wide
- Responsible for large-scale project/program management for Medicare
- Develop metrics to track performance and goal achievement
- Compile and present summary reports for Executive level management and leadership Develop and manage efforts with significant operating budgets
- Monitor Medicare/Medicaid project implementation team performance by developing reports, measuring outcomes, and supporting department goals.
- Displayed advanced interpersonal skills and communicated with credibility across business and management levels.
- Set aggressive targets for employees to drive company success and strengthen motivation.
- Successfully managed budgets and allocated resources to maximize productivity and profitability.
- Planned, created, tested and deployed system life cycle methodology to produce high quality systems to meet and exceed customer expectations.
- Leveraged data and analytics to make informed decisions and drive business improvements.
Business Change Director
Anthem Inc
Milwaukee, WI
04.2019 - 05.2022
- Government Business Implementation Process Redesign, Transform healthcare management methodologies to support corporate projects, programs and initiatives
- Monitor Medicare/Medicaid project implementation team performance by developing reports, measuring outcomes, and supporting department goals
- Leading IT and healthcare business stakeholders on implementing, integrations, new products on nationwide existing or new Medicaid Markets, Medicare Advantage and Medicare Group Retiree Solutions programs, Duals, SNPs
- Mitigate potential issues, project charge, and scope
- Identifies impacted parties, business partners, and resources required
- Identify and align impacted business areas and resources on operational goals, needs and execution plans
- Lead efforts to identify best managed healthcare practices, project healthcare governance activities, NCQA, CMS,
- Conducted thorough reviews of operations to devise and deploy improvement strategies.
- Developed post-sale technical processes for installation and technical support.
- Compile and present summary reports for Executive level management and leadership Develop and manage efforts with significant operating budgets
- Manage timelines and deliverables to migrate Medicare/Medicare products onto different system platforms
- Identify, manage and mitigate potential issues
- Design, configuration system processes to support business needs
- Consulting with downstream areas including Encounters, Enrollment, Vendors, Regulatory Reporting, Utilization
- Management, Provider Data, Customer Care, Membership Data Design, IT, Delegated Risk, to provide guidance on operational government business division deliverables.
Business Change Manager
Anthem Inc
Milwaukee, WI
01.2018 - 04.2019
- Managed Healthcare, Government Business Implementation Process Redesign, Designed strategic execution plans for clinical cost and managed healthcare initiatives
- Acted as the pharmacy business integration led high profile integration efforts
- Detected workforce collaboration use cases and problems from employees and business partners through interviews, focus groups and surveys.
- Built support for change throughout business unit through direct outreach strategies.
- Played a key role in long- and short-term executive strategic planning workgroups
- Performed business analysis to identify requirements and impacts for organizational objectives
- Identified timelines and actions necessary to integrate services and solutions
- Develop, manage, and support timely submission of department’s regulatory deliverables
- Monitors Medicare/Medicaid implementation team performance by developing reports, measuring outcomes, and supporting department goals
- Identified potential issues, project charge, and scope
Network Relations Consultant Sr
Anthem Inc
Milwaukee, WI
08.2015 - 01.2018
- Develops and maintains positive relationships with the Medicaid/Medicare/Commercial provider community by periodic on-site visits, communicating administrative or program-related changes, and resolution of provider issues
- Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions, refund/recoupment inquires and other practices
- Coordinates communication process with all groups on issues related to administrative and medical policies, reimbursement, and provider utilization patterns
- Consult with Internal Resolution Unit and Business Analyst on overpayment recovery query requirements for WI Health
- Plan and Commercial Plans
- Conducts seminars to support the understanding of managed care and Blue Cross and Blue Shield policies and procedures
- Oversees activities related to the development and maintenance of the provider delivery system and portal interfaces
- Supervise processes for communication and complaint resolution between physicians, hospitals, members, and the public.
Quality and Compliance Specialist
Scion Dental Inc
Mequon, WI
12.2013 - 08.2015
- Developed a tracking system for dental Medicaid client services and quality/compliance on corrective action plans and audits
- Project-Managed the Office Inspector General Policy and Procedure workflow process throughout all of our companies
- Conducted IT Risk Assessments for all of our companies to identify, evaluate and estimate the levels of risk
- Composed a Quality Assurance process with the SQL Reporting Team on reporting grid templates for our clients
- Consulted with department managers and staff to address all quality related complaints, developed process improvement programs and quality improvement programs
- Researched and interpreted federal, state, local regulations, NCQA standards and requirements for all departments, created and managed operations policy and procedures
- Trained new hires on the HIPAA Compliance Guidelines, Coached and mentored Quality and Compliance staff on
- Audits, CAPs and Quality Assurance process
- Conducted auditing for all of our companies: Scion Dental, Vestica, ATA, Ocular Benefits and business associate Wonderbox Technologies.
Provider Relations Representative
Scion Dental Inc
Maquon, WI
09.2012 - 12.2013
- Outreach to providers for medical, vision & dental plans, and claim and authorization submission process
- Hosted in-person training sessions with providers, Optometric Association, and Dental Association nationwide
- Composed and revised Policies and Procedures and Workflow Processes for Providers Services
- Audited data for new lines of business on contracted/credentialed or termed providers
- Assisted manager and team members with provider services, duties, and client services by resolving provider and client concerns
- Maintained knowledge of current policies and procedures for proper implementation
- Trained newly hired dental and vision insurance market managers
- Customer Service Training
Customer Service Training Team Lead
Scion Dental Inc
Mequon, WI
07.2010 - 09.2012
- Prepare, schedule and perform training of new hires on dental insurance for Medicaid/Medicare as a 3rd party administrator
- Maintain knowledge of ongoing insurance product changes and system upgrade changes
- Offer on-going training to existing employees including system upgrades, Medicaid/Medicare policies and procedure updates, newly implemented insurance programs
- Coordinate and implement activities related to several training courses offered to new hires and existing staff
- Develop and prepare training material regarding new policies and procedures for administrative staff to review and approve
Bilingual Home Equity Department Loan Closer
JP Morgan Chase Bank
Milwaukee, WI
08.2005 - 02.2009
- Process customer applications and verify all application information, credit and lending requirements
- Exceeded monthly goals based on department policies and procedures to close home equity products for our clients
- Maintained positive relationship with customers and Chase banking centers in order to provide excellent service
Education
Bachelors of Healthcare Management -
Concordia University
Skills
- Excellent organizational, writing, and presentation skills
- Ability to coordinate multiple projects & tasks
- Leadership
- Team building
- Able to work under pressure to meet goals and objectives
- Microsoft office
- SQL
- JIRA
- Strategic business planning
- Project management
- Cross-functional team building
- Risk management
- Negotiations
- Strategic planning
- Research and analysis
- Financial modeling
- Business modeling
- Portfolio management
- Mergers and acquisitions
- Integrations
- Policies & Procedures
Certification
Certified Scrum Master
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Process Improvement Director
Anthem Inc
05.2022 - Current
Business Change Director
Anthem Inc
04.2019 - 05.2022
Business Change Manager
Anthem Inc
01.2018 - 04.2019
Network Relations Consultant Sr
Anthem Inc
08.2015 - 01.2018
Quality and Compliance Specialist
Scion Dental Inc
12.2013 - 08.2015
Provider Relations Representative
Scion Dental Inc
09.2012 - 12.2013
Customer Service Training Team Lead
Scion Dental Inc
07.2010 - 09.2012
Bilingual Home Equity Department Loan Closer
JP Morgan Chase Bank
08.2005 - 02.2009
Bachelors of Healthcare Management -
Concordia University