Jennifer Korzyk
Schenectady,NY
Summary
To get started right away, just tap any placeholder text (such as this) and start typing to replace it with your own. Forward-thinking Operations Specialist bringing [Number] years of expertise in [Area of expertise] for [Industry] sector businesses. Cultivates rapport with individuals to optimize project goals and output, resolve complex problems and deliver innovative improvement strategies. Proficient in [Software] and [Software]. Highly organized and self-motivated professional 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. Hardworking Associate Director knowledgeable about business practices in the [Description] industry. Adept at supporting and enhancing operations with a decisive leadership style and strategic approach to decision making. Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success.
Overview
24
24
years of professional experience
Work History
Leader/Associate Director, Business Technology
MVP Health Care
10.2022 - 01.2024
- Lead an interdisciplinary and inter-departmental team of business experts to create and manage an efficiency roadmap that aligned with enterprise goals encompassing both strategy and execution of efficiency initiatives
- Collaborated with the RPA (Robotic Processing Automation) Team to translate business requirements from across the enterprise to the software engineers during the development of process automation
- Taught about available technologies across the organization to promote innovation and foster an efficiency mindset
- Acted as the Subject Matter Expert in all operational areas seeking to automate FACETS processes, mostly claims and pricing applications.
- Led cross-functional teams to achieve company-wide goals, fostering a culture of collaboration and innovation.
- Spearheaded process improvements, leading to enhanced efficiency and cost savings across various departments.
- Analyzed data trends to inform decision-making processes, leading to more informed choices for future actions.
- Optimized operational workflows by identifying bottlenecks, implementing solutions that led to smoother processes across the organization.
Leader/Manager, Government Programs and Integrated Health
MVP Health Care
Schenectady
02.2021 - 10.2022
- Provided direct oversight for all Medicare, Medicaid and Integrated Health claims areas, consisting of exempt claims supervisors with twenty-five hourly staff all working with the FACETS and MACESS claims systems
- Provided direct oversight for the Claims Automation and System Enhancement team of professionals whose purpose was to refine business processes within Operations to create greater efficiency by reducing manual processes
- Analyzed data points to determine the best way to create efficiency within a process, i.e., Robotic Processing Automation, updates to base configuration, use of PCA’s, and workflow overrides within FACETS
- Drafted P&Ps for the Claims Automation program to establish controls and workflows surrounding robotic scripts
- Supported First Pass Workgroups for all lines of business as the SME in claims automation and system configuration, increasing first pass by 2% in 2021, and an additional 1% in 2022
- Gathered and analyzed claims data using reporting tools to track, trend, and identify opportunities to improve manual processes through updates to base configuration or robotic processing automation
- Work directly with the Robotic Processing Automation engineers translating business requirements to design, test, and implement scripts in an agile environment to incrementally roll out automated processes, which has resulted in over 60 FTE’s savings since 2020
- Work with the members of the claims teams to vet ideas and continuously develop their skill set to increase bench strength in Claims
- Responsible for all aspects of claims inventory for my teams/lines of business, including monitoring performance metrics to be compliant with corporate goals.
- Increased team productivity by streamlining communication and implementing effective project management strategies.
- Mentored junior staff members, helping them develop leadership skills and advance their careers within the organization.
- Championed change initiatives, successfully navigating teams through periods of transition while maintaining morale and engagement levels.
- Built high-performing teams by recruiting top talent and providing ongoing support through professional development programs.
- Overcame challenging deadlines and resource limitations by reallocating personnel and focusing on priority tasks.
- Reduced operational expenses by implementing cost-effective solutions and proactively monitoring budgetary allocation.
- Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.
- Maintained team flexibility and embraced change to adapt within dynamic markets.
Leader/Supervisor, Medicaid, QMP and Integrated Health Claims
MVP Health Care
Schenectady, NY
05.2019 - 02.2021
- Supervised twenty-three direct reports consisting of Medicaid claims examiners and a cross functional team of claims examiners and adjusters for Integrated Health who role was to adjudicate claims using FACETS
- Lead the initiative to bring Behavioral Health claims processing back in house from an external vendor, building the team and all surrounding functions/processes from the ground up ensuring a smooth transition
- Managed all aspects of claims inventory for my teams/lines of business, including monitoring of performance metrics to be compliant with corporate goals
- Monitored claims inventory to continuously review for first pass opportunities, exceeding the first pass expectations for Integrated Health year one
- Collaborated and maintained close relationships with Provider Configuration teams and Network/Contract Management to ensure a seamless transition for our behavioral health claims population
- Fully trained and experienced with reviewing and interpreting Predictive Index Profiles
- Implemented the “group” interview process for open claims examiner positions to engage leaders from all claims teams to determine the best fit for each team utilizing PI
- Responsible for root cause and reconciliation of denial rates above threshold for NYS Medicaid Carve In services
- Participated in CASE (Claims Automation and System Enhancement) work group providing support and developing the skill set to claims examiners in the group
- Worked with Robotic Processing Automation as the liaison to translate business requirements presented in CASE to the engineers.
Senior Provider Pricing FACETS Configuration Analyst
MVP Health Care
Schenectady, NY
02.2018 - 05.2019
- Reviewed and assigned project requests received by the FACETS configuration team
- Ensured the team was meeting deadlines with the utmost accuracy
- Led larger-scale projects with a higher degree of difficulty and data analysis.
- Enhanced system performance through regular analysis and optimization of configurations.
- Ensured compliance with company standards by conducting thorough configuration audits.
- Trained junior team members on best practices in configuration management, improving overall team productivity and expertise.
- Conducted root cause analyses of configuration issues, identifying areas for improvement and implementing corrective actions accordingly.
- Evaluated and recommended appropriate tools for enhancing configuration management capabilities, contributing to continuous improvement initiatives.
- Collaborated with upper management to drive strategy and implement new processes.
Provider Pricing FACETS Configuration Analyst
MVP Health Care
Schenectady, NY
12.2015 - 02.2018
- Developed and implemented configuration into the FACETS system to accommodate systematic provider reimbursement and adjudication rules
- Responsible for the interpretation of requests, development of solutions, and file creation in support of efficient and accurate claim adjudication
- Responsible for the accurate and timely configuration and testing of provider contracts, processing control agents (PCA), procedure codes, explanation codes and system messages in the Facets, Networx, or Price N Ship applications as applicable
- Maintained detailed documentation related to work assignments to support audit processes
- Assisted in supporting the work necessary to complete Corporate and Departmental projects related to business systems configuration activities
- Performed regular queries of FACETS backend tables via Microsoft Access to test new and existing configuration and to aid in troubleshooting claims issues related to configuration.
- Developed comprehensive documentation for all configuration processes, facilitating knowledge sharing among team members.
- Established clear communication channels between stakeholders to ensure smooth execution of changes in system configurations.
- Safeguarded sensitive information by enforcing strict access controls on system configurations and related documents.
- Established a culture of continuous improvement within the configuration management team by regularly reviewing processes and implementing new best practices as needed.
- Analyzed existing systems and databases and recommended enhancements to solve business needs
Team Lead, QA Claims Auditor
MVP Health Care
Schenectady, NY
05.2013 - 12.2015
- Managed the FACETS claims audit team's workload distribution and individual Quality Assurance Claim Auditor production work management
- Audited and reported the quality of work performed by the Quality Assurance Claim Auditors
- Responsible for reviewing and responding to all QA error appeals received by the Quality Assurance department
- Generated and distributed all Quality Assurance monthly, quarterly and annual reports to senior leadership
- Initial point of contact for questions directed to the Quality Assurance department
- Subject matter expert for the Quality Assurance Claim Auditor
- Ran and reviewed monthly trending reports via queries within Microsoft access to determine root cause analysis for identified errors as well as develop and implement process improvements.
- Enhanced overall team performance by providing regular coaching, feedback, and skill development opportunities.
- Increased customer satisfaction by ensuring timely completion of projects and adherence to high-quality standards.
- Developed and maintained effective relationships with key stakeholders to better understand their needs and expectations.
- Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.
- Implemented process improvements that led to reduced turnaround times for critical tasks without compromising quality.
- Conducted regular progress reviews with individual team members to identify areas for improvement and provide guidance on career development opportunities.
- Established clear performance metrics for the team which helped in tracking progress towards set targets effectively.
- Influenced positive change within the organization through strategic thinking, innovation, problem-solving abilities, and consistent leadership style.
- Championed continuous improvement initiatives that resulted in optimized processes leading to cost savings for the organization.
- Explored new tools and technologies that enhanced the capabilities of the team members while enabling seamless collaboration across departments.
- Served as a role model for the team by demonstrating commitment to excellence, professionalism, and adherence to company values at all times.
- Coached team members in techniques necessary to complete job tasks.
- Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.
- Minimized resource and time losses by addressing employee or production issue directly and implementing timely solutions.
- Audited team performance and compliance with [Type] and [Type] standards.
- Monitored team performance and provided constructive feedback to increase productivity and maintain quality standards.
- Supervised team members to confirm compliance with set procedures and quality requirements.
- Assisted in recruitment of new team members, hiring highest qualified to build team of top performers.
QA Claims Auditor
MVP Health Care
Schenectady, NY
10.2009 - 05.2013
- Audited all aspects of FACETS claims for all lines of processing accuracy for accuracy
- Provided detailed error notifications with supporting documentation to claims examiners daily
- Provided monthly results to Supervisors and Managers, as well as provide feedback to training
- Identified error trends and areas for process improvements
- Worked on specialized client audits.
- Enhanced claim accuracy by meticulously reviewing and auditing claim submissions.
- Collaborated with claims adjusters, ensuring proper investigation and resolution of complex cases.
- Conducted training sessions for new Claims Auditors, sharing best practices and fostering professional development.
- Contributed to departmental goals by consistently meeting or exceeding personal audit targets and deadlines.
- Collaborated with other departments as needed to ensure seamless communication during the claims process, promoting effective teamwork across the organization.
- Provided valuable insights from audit findings to senior management for strategic decision-making purposes regarding operational improvements or risk mitigation efforts.
- Managed a diverse caseload of claims while maintaining attention to detail and accuracy under time-sensitive conditions.
- Mitigated potential risks associated with high-dollar claims by carefully analyzing relevant data points before arriving at a final determination.
- Served as a subject matter expert within the Claims Auditor team, offering guidance when needed to support overall team effectiveness.
- Participated in ongoing professional development opportunities to stay current on industry trends, enhancing personal skill set and benefitting the organization.
- Improved interdepartmental workflows by proactively addressing communication gaps or process inefficiencies, fostering a more productive work environment.
- Prioritized daily tasks to satisfy workload demands and department's turnaround goals.
- Researched issues related to claims processing to identify origins and implement corrective solutions.
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Followed up on potentially fraudulent claims initiated by claims representatives.
FACETS Claims Adjuster
MVP Health Care
Schenectady, NY
10.2007 - 10.2009
- Responded to provider appeals by performing FACETS claim adjustments and provided written responses when appropriate
- Provided support to the Provider Services telephone unit by handling complex claim issues and education for all lines of business.
- Provided exceptional customer service during emotionally difficult situations for policyholders following accidents or natural disasters.
- Evaluated coverage accurately by interpreting complex insurance policies and applying them to specific claim scenarios.
- Researched and analyzed policy contracts to verify proper payment of claims.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
Medical Claims Investigator
Progressive Insurance
Albany, NY
06.2006 - 12.2006
- Managed an inventory of No-fault claims requiring a more in-depth review of the facts of loss and corresponding medical treatment for related injuries
- Referred suspicious claims to SIU, reviewed and interpreted affidavits, reviewed and interpreted medical reports, prepared lines of questioning to be addressed during an examination under oath
- Conducted in-depth provider investigations to include verification of proper licensing.
- Improved case resolution rates by conducting thorough investigations and utilizing effective interviewing techniques.
- Ensured compliance with legal regulations during investigations, minimizing risk for litigation or procedural errors.
Medical Claims Representative
Progressive Insurance
Albany, NY
06.2005 - 06.2006
- Managed an inventory of No-fault claims, specifically, assessing injuries being claimed and the medical treatment being rendered, as lost wage claims
- Developed and executed action plans around coverage investigations, fraud, loss control and recovery in accordance with insurance policy contracts, medical bill coding rules and state regulations.
- Enhanced accuracy of processed claims with meticulous attention to detail and knowledge of coding systems.
- Collaborated with healthcare providers for timely resolution of discrepancies, ensuring accurate reimbursement.
- Managed high-volume claim submissions, consistently meeting deadlines and maintaining a high level of accuracy.
- Supported departmental goals by working closely with team members to maintain consistent quality standards across all submitted claims.
- Contributed to overall department success through regular participation in meetings, sharing ideas for improvement initiatives.
- Optimized workflow processes within the team by analyzing current procedures and suggesting effective solutions.
- Demonstrated adaptability by handling various types of medical claims across multiple specialties while maintaining accuracy.
- Supported organizational growth through active engagement in professional development opportunities, consistently seeking ways to enhance skills and industry knowledge.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Researched and resolved complex medical claims issues to support timely processing.
- Paid or denied medical claims based upon established claims processing criteria.
Quality Analyst
CDPHP
Albany, NY
08.2003 - 10.2004
- Monitored performance for Provider Service Telephone Representatives and Correspondence Representatives to include silent monitoring of incoming telephone calls and review of completed correspondence
- Maintained all quality data in Microsoft Access database for the purpose of retrieving reports to present performance results on a weekly basis to each representative and their supervisor
- Identified areas for improvement and developed and conducted training and re-training to new and existing employees on issues identified through the quality process and any new initiatives implemented in Provider Services
- Conducted the 'Excellence in Customer Service' training on a yearly basis
- Acted as an expert to the provider service staff to assist with complex claim, benefit and eligibility issues as well as interpreting provider contracts
- Worked closely with the Provider Relations Staff to identify areas for provider education based on common issues that arise during quality review.
- Identified process inefficiencies through meticulous data analysis, leading to streamlined operations and increased productivity.
- Collaborated with cross-functional teams to develop and implement targeted solutions for identified quality issues, ensuring continuous improvement.
- Conducted thorough root cause analyses on recurring defects, resulting in the implementation of effective corrective actions.
- Provided detailed reports on quality metrics to senior management, enabling informed decision-making regarding process improvements.
- Led root cause analysis initiatives that resulted in significant reduction in recurring defects.
- Compiled and distributed weekly feedback to team leaders and managers to improve service time and quality while increasing productivity.
- Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies.
- Developed and maintained quality assurance procedure documentation.
Correspondence Representative
CDPHP
Schenectady, NY
09.2002 - 08.2003
- Provide organized, timely and consistent review of provider correspondence and claim appeals within regulatory timeframes
- Researched all correspondence and claim appeals using in-depth knowledge of claims processing with CPT-4 and ICD-9 codes along with corporate policies and procedures specific to all lines of business.
- Increased customer satisfaction by addressing and resolving complaints in a timely manner.
- Exceeded performance targets through diligent work ethic and focus on results-driven tasks.
- Optimized workflow processes, allowing for more efficient use of resources and reduced turnaround times on projects.
Subject Matter Expert, Claims
UnitedHealthcare
Albany, NY
06.2000 - 09.2002
- Provided internal technical support regarding complex eligibility, claim, benefit, and provider contract issues to the customer/provider service representatives
- Performed claims adjustments on a priority basis
- Worked closely with the management team to identify areas for improvement in the training curriculum
- Mentored new hires as well as existing associates in need of additional one-on-one training.
- Developed effective training materials for diverse audiences, resulting in improved skillsets and increased job satisfaction.
- Enhanced team performance by providing expert guidance on critical projects and strategic initiatives.
- Mentored junior team members, contributing to their professional growth and development.
- Served as a liaison between technical experts and business stakeholders to ensure alignment on project objectives and deliverables.
Education
Active Licensed Cosmetologist -
Orlo School of Hair Design and Cosmetology
Albany, NYAccounting -
Sage JCA
Albany, NY01.1993
Skills
- Continuous Improvements
- Line Management
- Incidents Management
- Quality Assurance Controls
- Process Improvement
- Analytical Thinking
- Problem Solving
- Technical Expertise
- Cross-functional Collaboration
- Organizational Skills
- Strategic Planning
- Creative Thinking
Timeline
Leader/Associate Director, Business Technology
MVP Health Care
10.2022 - 01.2024
Leader/Manager, Government Programs and Integrated Health
MVP Health Care
02.2021 - 10.2022
Leader/Supervisor, Medicaid, QMP and Integrated Health Claims
MVP Health Care
05.2019 - 02.2021
Senior Provider Pricing FACETS Configuration Analyst
MVP Health Care
02.2018 - 05.2019
Provider Pricing FACETS Configuration Analyst
MVP Health Care
12.2015 - 02.2018
Team Lead, QA Claims Auditor
MVP Health Care
05.2013 - 12.2015
QA Claims Auditor
MVP Health Care
10.2009 - 05.2013
FACETS Claims Adjuster
MVP Health Care
10.2007 - 10.2009
Medical Claims Investigator
Progressive Insurance
06.2006 - 12.2006
Medical Claims Representative
Progressive Insurance
06.2005 - 06.2006
Quality Analyst
CDPHP
08.2003 - 10.2004
Correspondence Representative
CDPHP
09.2002 - 08.2003
Subject Matter Expert, Claims
UnitedHealthcare
06.2000 - 09.2002
Active Licensed Cosmetologist -
Orlo School of Hair Design and Cosmetology
Accounting -
Sage JCA