Cecilia Coleman
Summary
Certified Case Manager with 25 years of experience in optimizing health care delivery and clinical operations. Expertise in developing and implementing policies and procedures to ensure adherence to industry standards and best practices. Proven leader with the ability to streamline clinical workflows and improve operational efficiency. Skilled in regulatory compliance, managed care, quality assurance, and identifying continuous improvement opportunities. Passionate about driving quality improvement and fostering a culture of excellence.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Business Implementation Lead
Cigna Healthcare
11.2022 - Current
- Provide expert content and professional leadership on complex Operations Management and Finance Operations assignments and projects to ensure regulatory compliance for Individual and Family Plans.
- Designed the workflow for the Business Implementation Lead role, which became the standard model for training all Business Implementation Leads across the organization.
- Designed training for new hire and mentored new staff.
- Recognized by leadership on quarterly town hall meeting for going above and beyond to successfully train and mentor a new team member with only six months experience in my new role.
- Leads the implementation planning of large programs through a collaborative approach, and regularly interfaces with senior management and legal counsel.
- Prepare and review key statements and documents related to business operations for Individual and Family Plans or key accounts.
- Consults on cross-functional teams as the subject matter expert to support business compliance with federal and state regulations.
- Coordinate and lead weekly meetings with key stakeholders from the Individual and Family Plans business teams to review new laws, assess impact, and initiate implementation planning.
- Awarded with multiple Cigna Standout recognitions from business partners across the organization for collaboration, getting results for issues that were stalled, and proactive support.
Senior Clinical Auditor
Blue Cross Blue Shield Association
03.2021 - 11.2022
- Developed clinical audit strategy and metrics to test internal controls for paid claims for health services requiring utilization review.
- Analyzed paid claims for health services identified through medical coding to verify whether local plans appropriately resolved claim system edits to accurately pay utilization management claims.
- Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
- Followed established auditing processes to meet internal and regulatory requirements.
- Presented best practices to the local plans from audit observations and continuous improvement opportunities to promote effective compliance programs.
- Identified $2.2 million dollars in overpaid health services claims through the clinical audit process.
Program Manager, Plan Liaison Utilization Management
Blue Cross Blue Shield Association
06.2016 - 03.2021
- Managed and supervised administrative and daily program operations for utilization management, complying with policies and regulations.
- Established strong relationships with key stakeholders, ensuring support for program initiatives.
- Reviewed, revised, and administered policies and procedures for utilization reviews as guidelines for local plans in compliance with the Office of Personnel Management contract requirements, federal laws, and national accreditation standards.
- Engaged and worked alongside cross-functional stakeholders to manage strategic initiatives.
- Reviewed local plan business plans and annual budget proposals to prepare the annual budget bulletin for utilization management.
- Provided clinical expertise on cross-functional teams, including support for special investigations and evaluation of pilot program proposals from the local plans.
- Mentored college interns, developed and managed their project activities, and completed performance evaluation for their learning institutions.
Business Change Manager, Clinical Programs
Anthem Blue Cross and Blue Shield
06.2013 - 05.2016
- Aligned change management initiatives with strategic goals, ensuring consistency across all medical management departments in support of organizational vision.
- Facilitated stakeholder buy-in through effective communication and engagement activities, promoting a unified approach to change initiatives.
- Led focus groups aimed at gathering input from various stakeholders, promoting collaborative decision-making in shaping change plans to migrate staff and workflow from Empire Blue Cross and Blue Shield to Anthem Blue Cross and Blue Shield.
- Championed a culture of continuous improvement, encouraging employees to identify and share innovative ideas for enhancing business performance.
- Managed cross-functional project teams, ensuring timely delivery of critical milestones and alignment with overall change objectives.
- Developed strategies for clinical operations, member correspondence, and staff training that resulted in full initial health plan accreditation.
Case Management Team Lead
Anthem Blue Cross and Blue Shield
01.2008 - 06.2013
- Analyzed trends in patient data to identify areas for improvement in care delivery and implemented improvements in the case management process.
- Enhanced patient care coordination by creating a structured system for managing and tracking case management referrals to balance the work across the team.
- Designed training and mentoring program for new hires, promoting professional development and maintaining high standards of care.
- Served as a key liaison between the case management team and other departments within the organization on cross-functional initiatives, facilitating collaboration and information-sharing to support optimal patient outcomes.
- Developed case management policies and procedures, ensuring alignment with best practices, Federal Employee Health Benefit Program requirements, and regulatory compliance.
- Improved case management processes by implementing new strategies and streamlining workflows, which increased team productivity by reducing enrollment time per case by 75%, improved quality scores to 98-100%, and increased customer satisfaction survey ratings to 9.5 or higher on a scale of 10.
- Established a positive work environment by fostering collaboration, open communication, and mutual respect among team members.
- Oversight of case management staff, social workers, and support staff in three office locations (Virginia, Georgia, and Indianapolis).
Education
Master of Public Administration - Health Care Management
Grand Canyon University
Phoenix, AZBachelor of Science - Nursing
Hampton University
Hampton, VASkills
- Friendly, positive attitude
- Leadership
- Teamwork and collaboration
- Customer service
- Critical thinking and analysis
- Strategic problem solving
- Program compliance
Certification
- Certified Case Manager
Timeline
Business Implementation Lead
Cigna Healthcare
11.2022 - Current
Senior Clinical Auditor
Blue Cross Blue Shield Association
03.2021 - 11.2022
Program Manager, Plan Liaison Utilization Management
Blue Cross Blue Shield Association
06.2016 - 03.2021
Business Change Manager, Clinical Programs
Anthem Blue Cross and Blue Shield
06.2013 - 05.2016
Case Management Team Lead
Anthem Blue Cross and Blue Shield
01.2008 - 06.2013
Master of Public Administration - Health Care Management
Grand Canyon University
Bachelor of Science - Nursing
Hampton University
Similar Profiles
Yannik BremsYannik Brems
Associate Director Client Management at Cigna HealthcareAssociate Director Client Management at Cigna Healthcare
Lindy M. HinmanLindy M. Hinman
Chief Strategy Officer, Medicare at Cigna HealthcareChief Strategy Officer, Medicare at Cigna Healthcare
Rashonda CalhounRashonda Calhoun
Senior Customer Service Representative at Cigna HealthcareSenior Customer Service Representative at Cigna Healthcare
Artia FogleArtia Fogle
Medical Claim Coordinator at Cigna HealthcareMedical Claim Coordinator at Cigna Healthcare
Prashant KumarPrashant Kumar
<ul><li>Roles and Responsibilities</li><li>Hiring and team building</li><li>Managing team’s career progression and performance reviews</li><li>Managing Performance improvement plan and firing</li><li>Mentoring</li><li>Product roadmap planning and execution</li><li>Accountability of the entire delivery execution including the risk mitigation planning.</li><li>Stakeholder management</li><li>Adhering to Apple Privacy and Security Guidelines for platform</li><li>Design and implementation of new architectures and solutions to manage all online services for AdXchange in Apple Ads.</li><li>Design and implementation of new architectures and solutions deliver Budget experimentation in Apple Ads</li><li>Design and implementation of new architectures and solutions to manage data for Ad Platform.</li><li>Creating and maintaining all the data and analytics and revenue pipelines for Ad Platforms</li><li>Driving the solution for data ingestions and data processing across Ad platform</li><li>Defining the Strategy for data governance and data access</li><li>Collaboration with business to deliver relevant data and insight for our strategy and decisions.</li><li>Managing storage, processing, copy/synchronization etc. appropriate to scale</li><li>Enabling machine learning and algorithm groups by proving them right frameworks and data</li><li>Advancing team’s design methodology and quality programming practices and evangelize those techniques across Ad platform.</li><li>Deliveries</li><li>Setup 8+ member team to design and deliver Budget Allocation and Budget experimentation.</li><li>Leading Ad Delivery services team, responsible for delivering various capabilities like query understanding, targeting, fraud etc.</li><li>Delivered and Lead Design for observability for budget, and data platform in Ad platform.</li><li>Setup 11+ members high performing team to handle various business needs such as analytics and micro services for Display Advertising as well as Data Platform</li><li>Instrumental in driving Data Platform throughout the SDLC from inception, design, development, testing and deployment.</li><li>Instilled a strong team culture of high-quality delivery by constructive feedback, cross collaboration, focus and motivation.</li><li>Delivered Realtime and Batch Platform with various integrations</li><li>Delivered new DIP design for Data Platform</li><li>Delivered design of all the components of Data processing platform</li><li>Transitioned Display data work to India seamlessly and delivered many critical business impacting features and organizational security initiatives.</li><li>Closely worked with various stakeholders to understand the requirements which resulted into efficient remote work culture.</li><li>Seamless Display execution and set up best practices for 24X7 production on-call.</li><li>Tools and Technologies</li><li>AWS, S3, Kafka, Spark, Hadoop, EMR, Hive, Scoop, Flume, Cassandra, Airflow, Oozie, Gobblin, Schema Store, Icloud, Grafana, Kubernetes, Vertica, Alation, snowflake, druid, Iceberg, Java, Scala, IntelliJ, Oracle, MySql, Git, RIO, Spinnaker, Elastic cache, Grpc, Agile.</li></ul> at Apple - Adplatform<ul><li>Roles and Responsibilities</li><li>Hiring and team building</li><li>Managing team’s career progression and performance reviews</li><li>Managing Performance improvement plan and firing</li><li>Mentoring</li><li>Product roadmap planning and execution</li><li>Accountability of the entire delivery execution including the risk mitigation planning.</li><li>Stakeholder management</li><li>Adhering to Apple Privacy and Security Guidelines for platform</li><li>Design and implementation of new architectures and solutions to manage all online services for AdXchange in Apple Ads.</li><li>Design and implementation of new architectures and solutions deliver Budget experimentation in Apple Ads</li><li>Design and implementation of new architectures and solutions to manage data for Ad Platform.</li><li>Creating and maintaining all the data and analytics and revenue pipelines for Ad Platforms</li><li>Driving the solution for data ingestions and data processing across Ad platform</li><li>Defining the Strategy for data governance and data access</li><li>Collaboration with business to deliver relevant data and insight for our strategy and decisions.</li><li>Managing storage, processing, copy/synchronization etc. appropriate to scale</li><li>Enabling machine learning and algorithm groups by proving them right frameworks and data</li><li>Advancing team’s design methodology and quality programming practices and evangelize those techniques across Ad platform.</li><li>Deliveries</li><li>Setup 8+ member team to design and deliver Budget Allocation and Budget experimentation.</li><li>Leading Ad Delivery services team, responsible for delivering various capabilities like query understanding, targeting, fraud etc.</li><li>Delivered and Lead Design for observability for budget, and data platform in Ad platform.</li><li>Setup 11+ members high performing team to handle various business needs such as analytics and micro services for Display Advertising as well as Data Platform</li><li>Instrumental in driving Data Platform throughout the SDLC from inception, design, development, testing and deployment.</li><li>Instilled a strong team culture of high-quality delivery by constructive feedback, cross collaboration, focus and motivation.</li><li>Delivered Realtime and Batch Platform with various integrations</li><li>Delivered new DIP design for Data Platform</li><li>Delivered design of all the components of Data processing platform</li><li>Transitioned Display data work to India seamlessly and delivered many critical business impacting features and organizational security initiatives.</li><li>Closely worked with various stakeholders to understand the requirements which resulted into efficient remote work culture.</li><li>Seamless Display execution and set up best practices for 24X7 production on-call.</li><li>Tools and Technologies</li><li>AWS, S3, Kafka, Spark, Hadoop, EMR, Hive, Scoop, Flume, Cassandra, Airflow, Oozie, Gobblin, Schema Store, Icloud, Grafana, Kubernetes, Vertica, Alation, snowflake, druid, Iceberg, Java, Scala, IntelliJ, Oracle, MySql, Git, RIO, Spinnaker, Elastic cache, Grpc, Agile.</li></ul> at Apple - Adplatform