Barbara A. Grijalva, PMP
Tucson,Arizona
Summary
Motivated and results-driven certified Project Manager with exceptional leadership skills seeking a Business Analyst or Project Manager position. Offering a strong foundation in business strategy, data analysis, and project management, with a proven ability to drive efficiency, deliver successful outcomes and collaborate within cross-functional teams. Focused Project Manager adept at planning, directing and maintaining continuous operations in various departments. Experienced in directing manufacturing employees and keeping efficient production in accordance with quality standards. Applying creative and analytical approach to operations for continuous process improvement. Skilled at identifying or anticipating problems and providing solutions. Excels through mentoring, training and empowering team to excel in performance.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Senior Organizational Change Manager
Centene Corporation
07.2022 - Current
- Manage business transition projects while balancing stakeholders, managing business changes, ensuring that new program benefits are obtained, monitoring Key Performance Indicators, and managing resources efficiently
- Oversaw change management efforts to support implementation of critical initiatives driving technology, process and culture changes.
- Designed processes and systems supporting business needs before, during and after transitions.
- Monitored project performance to identify areas of improvement and make adjustments
- Planned, designed, and scheduled phases for large projects
Claims Training Manager
Centene Corporation
07.2017 - 07.2022
- Responsible for the designs, implementation and evaluation of training programs
- Developed and maintained operational quality program which provides management with assurance that key service levels and policies are being adequately managed
- Led a high functional team of 12 trainers nation-wide to successfully execute multiple claims training projects to ensure analyst handled claims consistent with client and corporate policies, procedures, best practices and regulations.
- Expert in multiple areas of managed care including claims, training, auditing, provider networks, contracting, FWA (Fraud, Waste and Abuse), member and provider services, grievances and appeals
- Expert in local, state and federal regulations regarding Medicaid, Medicare and Marketplace
- Documented and communicated timely claims information while supporting accurate outcomes
Managed Care Specialist
Banner Health
03.2009 - 07.2017
- Served as subject matter expert by advising staff and customers and working directly with external agencies throughout audits or to remedy compliance issues
- Followed established auditing processes to meet internal and regulatory requirements.
- Analyzed data and findings to prepare reports detailing financial information
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Managed workload and priorities to meet claims processing meet deadlines
- Assisted in organizing and overseeing assignments to drive operational excellence
- Researched and resolved disputes, billing discrepancies and claims efficiently to maintain customer satisfaction, boosting satisfaction ratings 99%
- Monitored and reported trainee progress, introducing new learning tools to address individual needs
- Mentored new hires, resulting in stronger staff development and increased productivity
Education
BSBA Business Management -
Northern Arizona University
Graduate Project Management Certification -
University Of Phoenix
Skills
- Process Improvement
- Change Management
- Project Management
- Leadership
- SQL
- Report Writing and Presentations
- Critical Thinking
- Effective Communication
Certification
- PMP - Project Management Professional
Timeline
Senior Organizational Change Manager
Centene Corporation
07.2022 - Current
Claims Training Manager
Centene Corporation
07.2017 - 07.2022
Managed Care Specialist
Banner Health
03.2009 - 07.2017
BSBA Business Management -
Northern Arizona University
Graduate Project Management Certification -
University Of Phoenix
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