Christina M. Foultz
Lewisberry,PA
Summary
Dedicated, self-driven leader with over 15 years of federal health insurance operational and program management. Passionately leads teams to encourage high-performance, personal development, and contribution to exceed company goals. Influences growth by using data-driven decision making.
Overview
17
17
years of professional experience
Work History
Manager II Network Data
National Government Services
Harrisburg, PA
09.2021 - Current
- Leads, provides direction to and encourages twenty six direct reports to meet and exceed CMS regulations; collaborates effectively with peers and senior leadership establish SOPs, desk references and cross functional efficiencies
- Hires, trains and completes performance management responsibility with team on a consistent basis; including workforce management planning; including creating schedules, analyzing incoming workloads and staffing
- Maintains compliant processes to safeguard program integrity overseeing the gateway for providers into the Medicare Program with access to the Medicare Trust Fund
- Manages the accurate, timely maintenance of critical provider information on all claims and provider databases
- Ensures the synchronization of data among multiple claims systems and application of business rules as they apply to each database
- Ensures the data to be housed on provider databases is in adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.
Performance Enhancement Manager II
08.2018 - 09.2021
- Developed, coordinated and managed quality management and regulatory compliance functions for all operational areas
- Monitored performance of the QA program to evaluate and ensure quality, effectiveness, and efficiency, and making appropriate adjustments to meet organizational goals and objectives
- Managed multiple teams in a matrix organization that supported each operational area to ensure clear, concise, accurate and complete feedback is provided to front line associates.
Quality Team Lead
08.2014 - 08.2018
- Managed the Quality Program for the Small Business Health Options Program (SHOP) Call Center, reviewing incoming calls, outbound calls, and written communication
- Developed detailed analysis and executive communication to highlight error trends for the team and individuals
- Managed the prep for any audits including ISO audits – Quality Management System (QMS)
- Accomplishment and Skills
- Inspirational leader with high annual associate satisfaction scores
- Feedback includes: (1) “My manager is constantly reminding me how valued I am…”, (2) “I also have a manager who lets me know that I am valued as an employee…”, (3) “She is an awesome leader
- She is always willing to listen and provide constructive feedback to any questions/concerns.”
- Built meaningful collaborative relationships across the enterprise to align to each departments goals
- Created reports to provide the most data driven information for each operational area to exceed standards
- Recommended changes that improved quality, efficiency and reduced cost
- Established workflows and roadmaps to increase operational excellence through partnership and collaboration across a matrixed organization
- Played an integral role in transition to the Salesforce platform
Quality Analyst
Customer Value Partners
Harrisburg, PA
04.2013 - 08.2014
- Evaluated and examined Medicare Part A and Part B telephone calls and written inquiries to verify quality assurance
- Supported management as a SME to assist peers, provide directional training to front line staff and facilitate calibration sessions
- Acted as a consultant to the prime contractor to facilitate collaborative dialog adhere to the Statement of Work (SOW) and sharing best practices
- Accomplishments and Skills
- Leveraged analytics to make data driven decisions and recommendations to client point of contacts, including Learning & Development resulting in increased quality and training assessment scores
- Actively provided feedback, guidance and support on Standard Operating Procedures (SOPs) based on federal regulations and SOW expectations
Customer Service Representative
Diversified Service Options, Inc, Highmark Medicare Services
Camp Hill, PA
12.2008 - 04.2013
- Answered Medicare Part A and Part B telephone calls and written correspondence inquiries; acted as a mentor to new associates to increase AHT and/or quality scores
- Completed in classroom customer service training, on-the-job experience and development courses via SoftSkills to establish subject matter expertise to support stakeholders, peers and providers
- Production Reviewer I:
- Provide quality assurance, auditing, and data analysis by reviewing and researching various samples from all departments to ensure quality standards are met
- Delivered feedback to operations increasing performance, suggesting best practices and identifying training opportunities
- Accomplishments and Skills
- Supported the development, coordination and facilitation of associate training sessions to increase performance
- Identified as a top CSR with opportunity to mentor others CSRs, providing leadership and feedback in the Contact Center
- Review and interpret federal regulations provided by the Centers for Medicare and Medicaid Services (CMS) to ensure compliancy and understanding across operations
Customer Service Representative
Express Scripts
Harrisburg, Pennsylvania
01.2007 - 12.2008
- Completed Patient Care Advocate training to provide quality customer service
- Provided white glove, face to face guidance to patients at Health Benefit Fairs across the United States
- Participated in executive level meetings and conferences to establish training strategies and programs for the contact center.
Education
Lower Dauphin High School
01.2005
Several Business Related Courses Completed -
Southern New Hampshire University
Several Business Related Courses Completed -
Harrisburg Area Community College
Skills
- Operations Management
- Strategic Planning
- Cross-Functional Team Management
- Staff Development
- Performance Management
- Business Development
Timeline
Manager II Network Data
National Government Services
09.2021 - Current
Performance Enhancement Manager II
08.2018 - 09.2021
Quality Team Lead
08.2014 - 08.2018
Quality Analyst
Customer Value Partners
04.2013 - 08.2014
Customer Service Representative
Diversified Service Options, Inc, Highmark Medicare Services
12.2008 - 04.2013
Customer Service Representative
Express Scripts
01.2007 - 12.2008
Lower Dauphin High School
Several Business Related Courses Completed -
Southern New Hampshire University
Several Business Related Courses Completed -
Harrisburg Area Community College
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