Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Elizabeth Cooper

Rancho Cucamonga,CA

Summary

Experienced and enthusiastic Consultant with track record of success across wide range of industries. Possesses exceptional interpersonal, problem-solving and analytical skills to provide advice and expertise to client organizations improving business performance. Experienced in all aspects of operations, strategy and finance.

Overview

13
13
years of professional experience
1
1
Certification

Work History

Senior Process Improvement Professional, Consultant

Humana
04.2023 - Current
  • Implemented recommended business practices and procedures based on analyzed process data, resulting in improved safety measures, increased productivity levels, and significant cost savings.
  • Evaluates the potential benefits of integrating new information technologies in streamlining business operations.
  • Expertise in one or more of these areas: benchmarking, business process analysis and re-engineering, change management and measurement, or process-driven systems requirements.
  • Contributed to the development of the department's strategic plans.
  • Works without direction and handles moderately complex to complex issues regarding project components
  • Updates, maintains, and reviews fee scheduling and pricing structures
  • Possess a significant understanding of medical claims processing along with expertise in reimbursement methodologies. Additionally, I have extensive experience in editing ICD, CPT, and HCPCS Medical Codes.
  • Guaranteed accurate pricing and precise application of contracted rates and reimbursement policies
  • Identified reimbursement policy and process recommendations and ensured compliance with government regulations
  • Conducted analysis of provider reimbursement patterns and trends.
  • Experience presenting complex ideas to peers, stakeholders, leadership, and other partners Experience managing multiple, diverse projects
  • Mentored junior consultants, fostering a culture of continuous learning and professional development within the team.
  • Evaluated performance metrics to determine the effectiveness of implemented strategies, making necessary adjustments when needed.
  • Delivered high-quality presentations, effectively communicating complex concepts to clients and stakeholders.
  • Managed multiple projects simultaneously, ensuring timely completion and meeting clients'' expectations consistently.

Business Systems Analysis Professional, Analyst

Humana
08.2021 - 04.2023
  • Liaised effectively between Business and IT departments
  • Contributed to the successful facilitation of meetings
  • Analyzed project concepts and requests
  • Collaborated with cross-functional teams to identify opportunities for process improvement and increased efficiency.
  • Improved internal knowledge sharing by developing comprehensive documentation outlining standard operating procedures for various tasks.
  • Leveraged understanding of systems to identify potential areas for improvement
  • Collaborated with IT and Testing teams in various project stages such as design, coding, and testing by providing necessary assistance (answering inquiries, clarifying V&S or SRS intent ensuring data availability), along with performing unit tests.
  • Enhanced team collaboration by providing clear communication of complex findings through visualizations and reports.
  • Implemented predictive analytics techniques that enabled proactive adjustments to business strategies based on emerging trends.
  • Increased efficiency by streamlining data analysis processes and implementing automation tools.

Claims Processing Production Leader

Humana
01.2014 - 08.2021
  • Provided leadership and direction to a team of 11 Adjusters
  • Exercise oversight to ensure correct and timely claim processing
  • Evaluated significant claims as a peer reviewer
  • Facilitated team huddles to review changes and conduct training/cross-training sessions
  • Effectively managed and resolved any escalated issues within required timelines.
  • Provided recommendations on claim approvals or denials based on thorough research and documented findings; ensured accurate completion of claim correction/deletion correspondence documents.

Grievance & Appeals Specialist

Humana
07.2011 - 01.2014
  • Evaluated and analyzed appeals received from stakeholders throughout all divisions within the Medicare Business.
  • Promoted a culture of continuous learning and development within the Grievance Appeals team, encouraging skill growth and knowledge sharing.
  • Met compliance deadlines through case analysis and maintenance
  • Obtained SME Certification through successful completion of the Core Program, empowering me to provide guidance, establish clear expectations and responsibilities, and create an ideal learning atmosphere for associates.
  • Acted as a departmental resource on appeals matters.
  • Implemented quality control measures that ensured accuracy in case documentation and reduced instances of rework or errors in processing claims.

Education

Associate of Applied Science - Health Sciences

DeVry University
Pamona California
07.2021

Skills

  • Analytical Thinking
  • Quality Assurance
  • Cultural Awareness
  • Analysis & Evaluation
  • Business Analysis
  • Team Leadership & Development
  • Processes and procedures
  • Strategic Planning
  • MS Office
  • Continuous Improvement
  • Project Management

Certification

  • CCA certification
  • CPC certification

Timeline

Senior Process Improvement Professional, Consultant

Humana
04.2023 - Current

Business Systems Analysis Professional, Analyst

Humana
08.2021 - 04.2023

Claims Processing Production Leader

Humana
01.2014 - 08.2021

Grievance & Appeals Specialist

Humana
07.2011 - 01.2014

Associate of Applied Science - Health Sciences

DeVry University

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Elizabeth Cooper