DESIRAE LARA
Plainville,CT
Summary
Collaborative leader with dedication to partnering with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings.
Overview
9
9
years of professional experience
Work History
Manager, Product Implementation
CVS HEALTH CORPORATION
08.2022 - Current
- Accurately translated business requirements into technical specifications
- Onboarded new employees with training and new hire documentation.
- Focused on out-of-the-box management and integration solutions for various enterprise operations teams using Salesforce CRMs
- Created test strategies and documents, performed unit testing, guided business users with QA testing, and participated in multi-team deployments.
- Ensured post-deployment satisfaction and communicated changes to necessary stakeholders
- Collaborated with cross-functional business partners to increase productivity, efficiency, and speed to market deliverables
- Assessed risks, communicating dependencies, and executing alternative solutions in a timely manner that allows for mitigation or strategic reaction
- Reviewed billing problems, researched issues, and resolved concerns.
- Established internal audit procedures to validate and improve accuracy of financial reporting.
Implementation Project Manager
Equifax
03.2022 - 08.2022
- Outlined work plans, determined resources, wrote timelines, and generated initial budgets as part of project scope determination.
- Directed large-scale development and implementation of Affordable Care Act (ACA) Compliance Management Products to meet business needs and build client loyalty.
- Developed project plans identifying key issues, approaches and performance metrics.
- Managed project teams in Agile environment, realizing success through application of SDLC methodologies and exceptional leadership skills.
- Oversaw large portfolio of projects to support teams, report progress, and influence positive outcomes for key stakeholders.
- Communicated project updates to stakeholders at all levels.
- Monitored and tracked project progress to support timely completion.
- Led cross-functional teams to successfully complete IT projects.
Implementation Coordinator Lead
ANTHEM, INC.
06.2021 - 03.2022
- Project manages new case implementation activities and serves as a liaison between the Account Management team, Sales team, Sales Support and customers
- Ensures completion of all critical deliverables from multiple disciplines to assure timely and accurate implementation of our customers' benefit plans
- Accountable for the accuracy, timeliness, and completeness of the implementation process
- Develops effective relationships with existing new accounts and effectively collaborate with internal departments, such as Sales Support Services, Operations, Sales, and Underwriting
- Works with Director, Account Management Services on tracking, monitoring, and reporting progress of all functional areas throughout the implementation process
- Helps to develop tools and best practices necessary to improve installations
- Provides on-going root cause analysis; identifies opportunities for process improvement
- Acts as primary contact/liaison between customers to resolve issues related to implementation plan design and customer deliverables
- Supports Sales and Sales Support teams in developing prospects and responding to RFPs and actively participates in finalist meetings
- Leads corporate projects as assigned, develops and implements tracking mechanisms and tools for account implementation.
Implementation Coordinator
ANTHEM, INC.
06.2019 - 06.2021
- Verifies enrollment status, makes changes to records, researches and resolves enrollment system rejections
- Strong attention to detail to accurately enter data and research and resolve questions
- Assist in preparing plan materials including implementation welcome, overview and project plan
- Support cross functional implementation meetings to assess the organizations ability to meet the requirements of prospective accounts and to ensure completion of all critical deliverables
- Supports the Implementation Coordinator team in working directly with clients, consultants and brokers to define benefits, group structure, reporting and other client requirements.
Medicare Grievance Analyst I
12.2017 - 06.2019
- Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable language
- Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review
- The grievance and appeal work is subject to applicable accreditation and regulatory standards and requirements
- As such, the analyst will strictly follow department guidelines and tools to conduct their reviews
- The file review components of the URAC and NCQA accreditations are must-pass items to achieve the accreditation
- Analyzes and renders determinations on assigned non-complex grievance and appeal issues and completion of the respective written communication documents to convey the determination
- Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information
- The analyst may serve as a liaison between grievances & appeals and/or medical management, legal, and/or service operations and other internal departments.
Utilization Management Rep I
09.2016 - 12.2017
- Coordinated cases for precertification and prior authorization review for services related to Behavioral Health
- Determined contract and benefit eligibility; build authorization requests, outpatient precertification, and prior authorization
- Referred cases requiring clinical review to a Nurse reviewer
- Responds to telephone and faxed inquiries from clients, providers and in-house departments
- Developed and maintained positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
Customer Service Representative I
03.2015 - 09.2016
- Managed records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken
- Managed incoming calls related to benefits, billing, claims, and enrollment for Affordable Care Act (ACA) health plan members
- Ensured oversight that appropriate actions were taken to resolve customers' problems
- Routed unresolved customer grievances to designated departments for further investigation
- Contacted customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments.
Education
Bachelor of Arts Degree - Business Management
SOUTHERN NEW HAMPSHIRE UNIVERSITY
CONCORD, NH12.2021
Associate’s Degree - Culinary Arts
JOHNSON & WALES UNIVERSITY
PROVIDENCE, RI05.2010
High School Diploma -
JOHN F KENNEDY HIGH SCHOOL
WATERBURY, CT06.2008
Skills
- Strategic Planning
- Customer Relationship Management (CRM)
- Project Management
- Cross-functional Teamwork
- Product Management
- Process Improvement
- Effective Communication
- Organizational Skills
- Fiscal Management
- Project Implementation
- Issue Resolution
- Change Management
Timeline
Manager, Product Implementation
CVS HEALTH CORPORATION
08.2022 - Current
Implementation Project Manager
Equifax
03.2022 - 08.2022
Implementation Coordinator Lead
ANTHEM, INC.
06.2021 - 03.2022
Implementation Coordinator
ANTHEM, INC.
06.2019 - 06.2021
Medicare Grievance Analyst I
12.2017 - 06.2019
Utilization Management Rep I
09.2016 - 12.2017
Customer Service Representative I
03.2015 - 09.2016
Bachelor of Arts Degree - Business Management
SOUTHERN NEW HAMPSHIRE UNIVERSITY
Associate’s Degree - Culinary Arts
JOHNSON & WALES UNIVERSITY
High School Diploma -
JOHN F KENNEDY HIGH SCHOOL