Delaney Heffner

• Program manager for the CHAMPVA healthcare benefit program, which provides health care benefits for over 800,000 beneficiaries nationwide, with a budget of $2.8B.
• Analyzed program performance data, identifying trends to drive strategic decision-making and operational efficiency.
• Led cross-functional teams to implement program improvements enhancing service delivery for veterans.
• Developed and monitored project plans, ensuring compliance with federal regulations and VA guidelines.
• Coordinated resources and timelines, facilitating successful execution of multiple concurrent initiatives.
• Fostered stakeholder engagement through effective communication strategies, improving collaboration across departments.
• Streamlined processes by implementing new tools or processes, reducing administrative burden on team members.
• Evaluated program outcomes, delivering actionable recommendations to enhance veteran services and support programs.
• Supported senior leadership decision-making by providing accurate reports detailing program status updates and key metrics.
• Applied change management principles to guide teams through adjustments in strategy or direction when necessary to meet evolving business needs.
• Managed cross-functional teams to drive projects towards completion, resolving conflicts while maintaining a positive working environment.
• Reduced risks and issues by proactively identifying potential roadblocks and developing mitigation strategies early on.

• Led Community Care Next Generation Network workstream, which is one of the core components of Veteran’s Community Care, to ensure an adequate network of providers achieving 95% of appointments within policy guidelines.
• Coordinated cross-departmental teams to implement strategic goals and improve service delivery, resulting in over 70% greater adherence to regulations in struggling regions.
• Analyzed Community Care Network program effectiveness through data evaluation, ensuring compliance with federal regulations and contracts.
• Managed stakeholder relationships to align program objectives with organizational priorities effectively.
• Implemented process improvements for intake of data from contractors that enhanced operational efficiency and reduced service delivery times.
• Facilitated regular team meetings to assess progress, address challenges, and promote collaborative problem-solving efforts.
• Championed organizational change by promoting new methodologies and approaches to program management, driving innovation and continuous improvement.

Two 120-Day Details

• Coordinated complex schedules for senior leadership, optimizing time management and resource allocation.
• Managed communication and correspondence, ensuring timely responses to internal and external stakeholders.
• Developed and maintained filing systems, enhancing document retrieval efficiency and organizational integrity.
• Facilitated meeting preparations, including agendas and materials, to support effective decision-making processes.
• Mentored junior administrative staff, fostering skill development and promoting a collaborative work environment.
• Led special projects that enhanced operational efficiency, resulting in improved service delivery for veterans' affairs.
• Maintained confidentiality with sensitive documents, ensuring proper storage and distribution as needed.
• Facilitated communication between departments, ensuring alignment on projects and timely information sharing.

• Led multidisciplinary project management to implement complex reimbursement methodologies and scalable AI business rules for both current and new claims processing systems.
• Led initiatives to assess existing policies, identifying areas for improvement and strategic enhancements.
• Presented findings and recommendations to senior management, influencing decision-making processes effectively.
• Mentored junior staff in policy analysis techniques, fostering a culture of continuous improvement within the team.
• Implemented process improvements that increased operational effectiveness within the department by 60%.
• Developed comprehensive policy recommendations based on research and stakeholder input.
• Facilitated cross-departmental collaboration to enhance policy understanding and implementation.
• Reviewed and revised policy documents for clarity, accuracy, and compliance with regulatory standards.
• Analyzed policy impacts on stakeholder communities, ensuring alignment with legislative requirements.
• Contributed to long-term planning efforts through participation in strategy development sessions focused on future policy priorities.

• Responsible for assigning medical codes (ICD9/10-CM & PCS, HCPCS, CPT, ADA/CDT, NDC, and POS) to the correct business rule.
• Determine if medical claims paid correctly according to Medicare, TRICARE, or CHAMPVA regulations or policies.
• Test rules and troubleshoot to maintain accurate claims processing.
• Conduct audits to maintain regulatory compliance.
• Monitored and executed changes in accordance with health care industry trends in both private and public healthcare sectors, including TRICARE and Medicare statutes, regulations, and policies, for impact on programs.
• Reviewed and/or prepared proposed legislation, and regulatory actions.
• Conduct benefit impact analyses and cost analyses to identify costs or cost savings (P&L) for regulatory or statutory changes.
• Served as Contract Officer Representative for Claim Auditing Software, $8M contract, and subscription evidence analysis and medical code research services.
• Implemented process improvements that streamlined claim processing timelines.
• Led initiatives to improve communication between departments, fostering a collaborative environment for resolving claims issues.
• Supported company objectives by maintaining compliance with all relevant federal regulations governing medical billing practices.
• Maintained comprehensive knowledge of healthcare billing practices, staying current on industry updates and changes in regulations.
• Led cross-functional meetings to address challenges and streamline reimbursement operations.
• Identified trends in reimbursement denials, recommending process improvements to minimize future occurrences.
• Analyzed payment discrepancies and resolved issues to improve overall accuracy.