Holly Ducommun
Chippewa Falls,WI
Summary
Hard working Associate Director that is a highly organized and self-motivated professional who is very experienced in project management, team development and process improvement. Skilled in developing and implementing strategies to increase efficiency and performance. Passionate about driving business growth and creating positive work environment.
Overview
21
21
years of professional experience
Work History
Associate Director – PCRL
UnitedHealth Care
12.2020 - Current
- I am currently an Associate Director over several teams: Contract Management Expert (Regional, National and FQHC/RHC), National Ancillary Roster Management, CAA Validation Team for FAC/ANC, FQHC/RHC Load, Audit and C2L, and finally the Demographic Management Experts (Regional, National Hospital and FQHC/RHC)
- My teams support the three primary books of business: E&I/M&R/C&S for all Facility and Ancillary provider types in all states
- I am responsible to hire/train/mentor managers in my department as well as ensuring all teams are meeting goals
- In addition to this, I ensure that our teams stay within budget, which a major part of that is understanding and adhering to the capacity plans
- Part of my responsibilities is to problem solve for any issues that come up for any of my given teams, engage with various departments (PROS, Tech Teams, Project Managers, Migrations, Network Management, Load teams…) and report status updates and progress to my leadership as well as others when applicable
- I am also responsible to continuously identify ways to improve and streamline our process along with quality by utilizing various data analytics and execute these improvements
- In my time as Associate Director I have stood up a whole new team (CAA), took on new teams (National Ancillary)
- Reorg’d my CME Team, supported globalization in various teams, transitioned platform tools and I’m currently supporting the transition of my FQHC/RHC Teams to better align with team structures within PDO
- I can handle high stress/ambiguous environments and I do very well leading a team through uncomfortable changes.
Contract Management Expert Team – Manager Central Region
UnitedHealth Care
04.2015 - 12.2020
- As the CME Manager I lead a team of 18
- I was responsible for Facility/Ancillary provider types for all three products (E&I, M&R, C&S) for the following states: IA, IL, IN, KS, MI, MO, MN, ND, NE, OH, SD and WI
- As part of my duties, I am accountable for managing the loading of provider demographic and contract data into the provider core systems NDB, Cosmos and CSP Facets as well as all legacy and line of business systems
- I was also responsible to assign and monitor inventory utilizing our standard reporting and ensuring we stay on track
- In addition to this, I must also ensure all performance targets are achieved (Turnaround time, Quality, Load by Effective Date metrics) for the installation of new providers and ongoing maintenance of demographic and contractual changes (rate changes, adds, and terms)
- Part of my responsibilities were to problem solve for any issues that came up, engage with various departments and report status updates and progress to my leadership as well as the Project Management teams when applicable
- Often, I collaborated with Regional Directors, VPs, and Market Leads
- I was also part of many innovation ideas such as creating new processes, assisting in the design of new application tools and creation of several macros – just to name a few.
P&P and Workflow Management Lead
UnitedHealth Care Military & Veterans
08.2012 - 04.2015
- I am the P&P and Workflow Management Lead for both the TRICARE CME and TRICARE GLO teams
- As part of my responsibilities, I created Load Mappings and Step Action Charts in Word and Excel to assist the TRICARE CMEs and GLO loaders
- As a team lead, I am also a subject matter expert in reviewing system platforms to ensure they are ready and accurate as well as steps on how to: execute, submit and audit contracts upon load completion including how to load and audit systems
- To ensure success from our teams, I work very closely with a third-party vender (PGBA), FRSP and Network Management to ensure we meet all TRICARE criteria and to ensure the intent of our contracts stayed in compliance
- From this duty I became knowledgeable in regards to Mental Health, Transplant and Free-Standing Skilled Nursing contracts
- During implementation of the TRICARE product, I also trained all 42 of the TRICARE CME contractors
- In addition, I assisted in the creation of the TRICARE CME and GLO SharePoint Site to house all the documentation
- I also continue to mentor and job coach both teams and I backup the TRICARE manager when she is out of the office
- Our team also works several special projects that I’ve taken the lead on which involved project management
- I’ve tracked, assigned, prioritized and reported on these projects.
Contract Management Expert
UnitedHealth Care
04.2010 - 08.2012
- I assisted Network Management in the contracting, loading and maintenance of Facility and Ancillary agreements
- I reviewed system platforms to ensure they are ready and accurate
- I then submitted to applicable departments to have the various platforms updated
- I then performed a post audit review to double check accuracy and report my findings back to Network Management
- I also did various special projects relating to state mandated updates
- I am knowledgeable in Commercial, Medicare and Medicaid products
- I am also familiar with several platforms used for these products.
Business Analyst for Institutional/NYU Lead
UnitedHealth Care - AmeriChoice
05.2008 - 04.2010
- Configured new contracts in Diamond as well as updating old ones
- I fixed configurations that were not accurate
- I worked very closely with FRSP on coding to ensure loading accuracy
- I built Operating Instructions when needed
- I attended Command Center Calls for collaboration with other departments when new P&P’s were created
- I also worked closely with many people from different departments
- I was a lead of a team of 5, not counting myself
- I managed, tracked and coordinated the entire workload for NYU
- I also helped to ensure my team had all tools and knowledge to complete their work successfully.
Contract Coordinator for Institutional
UnitedHealth Care - AmeriChoice
11.2006 - 05.2008
- Configured new contracts in Diamond as well as updating old ones
- I fixed configurations that were not accurate
- I built Operating Instructions when needed
- I attended Command Center Calls for collaboration with other departments when new P&P’s were needed
- I became knowledgeable in several different Medicaid states
- I also worked closely with many people from different departments.
Contract Coordinator for Physician
UnitedHealth Care
09.2006 - 11.2006
- Updated fee schedules and viewed claims for payment inaccuracies
- Trained new people and helped with many high priority projects.
Settlement Analyst for AmeriChoice
UnitedHealth Care
09.2005 - 09.2006
- My primary duty was to review a large number of claims to determine if a provider was eligible for reimbursements
- I worked extensively on excel
- I learned how to do pivot tables and other such functions.
Claims Processor for APIPA
UnitedHealth Care - AmeriChoice
10.2003 - 09.2005
- Processed physician claims for the state of Arizona, Medicaid
- I acted as pend coordinator and I was the “Go To” for any pricing questions.
Education
High School Diploma -
Chippewa Falls Senior High
Chippewa Falls, WISkills
- Project Management
- Strategic leadership
- Analytical Thinking
- Coaching and Mentoring
- Relationship Building
- Team Collaboration and Leadership
- Process Improvement
- Operations Management
- Budget Management
Business Objective
My objective is to be an active & excellent employee within UnitedHealth Care and to express and develop my professional skills in order to give my best. I want to bring novel and noble things to the table, for I believe in how much I can give to the organization rather than how much the organization can give me.
References
- Susan Galzerano, Director – PCRL, 870-934-8996
- Cassidy Hinz, Manager - Contract Management Expert, 952-202-7825
- Julie Newman, Network Program Manager, 360-620-2009
Timeline
Associate Director – PCRL
UnitedHealth Care
12.2020 - Current
Contract Management Expert Team – Manager Central Region
UnitedHealth Care
04.2015 - 12.2020
P&P and Workflow Management Lead
UnitedHealth Care Military & Veterans
08.2012 - 04.2015
Contract Management Expert
UnitedHealth Care
04.2010 - 08.2012
Business Analyst for Institutional/NYU Lead
UnitedHealth Care - AmeriChoice
05.2008 - 04.2010
Contract Coordinator for Institutional
UnitedHealth Care - AmeriChoice
11.2006 - 05.2008
Contract Coordinator for Physician
UnitedHealth Care
09.2006 - 11.2006
Settlement Analyst for AmeriChoice
UnitedHealth Care
09.2005 - 09.2006
Claims Processor for APIPA
UnitedHealth Care - AmeriChoice
10.2003 - 09.2005
High School Diploma -
Chippewa Falls Senior High