Delean Daley
Indianapolis,IN
Summary
Experienced Quality Improvement Specialist offering 13-years of Healthcare history of successfully creating and implementing improvement plans for policies, plans and guidelines. Highly accurate, productive and goal-driven with excellent skills in verbal and written communication, decision making, problem solving and resource coordination.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Quality Improvement Specialist
Centene
09.2019 - Current
- Developed quality improvement plans, policies and operational guidelines.
- Documented and reported issues with compliance, standards of care and quality assurance requirements.
- Checked patient conditions and records to evaluate care.
- Compiled review data and produced detailed reports for use.
- Collected and analyzed data to measure effectiveness of quality control processes.
- Inspected items and compared against standards to meet regulatory requirements.
- Developed and implemented procedures to meet product quality standards.
- Completed Ambetter/Medicaid/Medicare denial letters
Program Coordinator II
Managed Health Services
08.2015 - Current
- Initiate, and processed authorization requests for inpatient and outpatient services.
- Training new employees.
- Assist with leading the denial process for non-clinical notification team.
- Completed Ambetter/Medicaid/Medicare denial letters and faxes.
- Monitoring member payments (Omni) and Verify eligibility and benefits.
- Managed and lead projects.
- Create and revise workflows for improving process.
Referral Specialist
Managed Health Services
09.2012 - Current
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
- Obtained prior authorization for inpatient, outpatient, DME etc. procedures.
- Processed referral requests from patients, doctors and other health care professionals.
- Partnered with other departments to provide top-notch service to clients.
- Verified insurance benefits and eligibility for Ambetter, Medicaid, procedures before referring clients.
Education
Master of Arts - Psychology
Indiana Wesleyan University
Marion, IN12.2019
Bachelor of Science -
Indiana Wesleyan University
Marion, IN12.2012
High School Diploma -
South Side Highschool
Jackson, TN05.2000
Skills
- Corporate Compliance
- Competency Evaluations
- Lean Manufacturing
- Cause and Effect Analysis
- Quality Improvement Activities
- Creative Thinking
- Six Sigma
- Utilization Management
- Standard Operating Procedure
- Process Updates
- Data Review
- Training Initiatives
- Audit Compliance
Certification
Managed Strategy Institute
(02/2022 - Present)
6 Sigma White Belt
Additional Information
INTERESTS
Psychology, Crafting, Designing, Poetry, Problem solving, and Tax preparation
Timeline
Quality Improvement Specialist
Centene
09.2019 - Current
Program Coordinator II
Managed Health Services
08.2015 - Current
Referral Specialist
Managed Health Services
09.2012 - Current
Master of Arts - Psychology
Indiana Wesleyan University
Bachelor of Science -
Indiana Wesleyan University
High School Diploma -
South Side Highschool
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