Jocelyn Backman-Perez
Bronx,NY
Summary
Results focused, collaborative, analytical Operations manager with 10+ years of experience working in the Health Care/Managed care industry. Proficient in data analytics, reporting, and performance metrics—help ensure adherence to department goals. Proven track record of developing processes, best practices, workflows, and training materials that optimize member care coordination and ensure compliance with state regulations and policies. Adept at working with all levels of an organization, performing audits, and vendor management. Known by colleagues as a relationship builder and problem solver who gets to the root cause of issues and resolves them.
Overview
21
21
years of professional experience
Work History
Managed Care TPA Oversight Manager/Project Manager
SOMOS
07.2022 - 03.2024
- Serve as liaison between SOMOS and the primary managed care TPA
- Ensure all performance goals and deliverables are attained on time and with quality
- Collaborate with stakeholders at all levels of the organization (VPs, Directors, product owners, technology leads, HR) to improve processes and promote problem-solving
- Handle vendor escalations independently and work with internal/client teams to resolve
- Conduct end-to-end investigation and root cause analysis of ongoing claim disputes to identify trends and help drive mitigation and resolution
- Communicate with a variety of internal/external sources (providers, MCOs, regulatory agencies, customers) on claim-related matters
- Maintain, track, and prioritize assigned claim, enrollment, authorization, or capitation issues and ensure timely mitigation with the outsourced vendor.
Project Manager, Care Management Operations/COVID Testing for NYS School
New York City Health and Hospital Cooperation
01.2016 - 01.2022
- Provided direct oversight to 9 staff from Care Management Operations and the UAS Coordination Team
- Supported the company’s growth from 2,000 to 45,000 members by creating reports, dashboards, and metrics that helped ensure adherence to internal policies and NYS regulations
- Collaborated with internal departments (Care Management, Member Services, Clinical, Infrastructure Team, Enrollment and Quality) to develop operational processes, workflows, training materials, and best practices that optimized member care coordination and ensured compliance with Integra Managed Care policies and NYS regulations
- Oversaw the creation of 20+ daily, weekly, and monthly management reports to ensure adherence to internal policies and NYS regulations
- Developed, maintained, and analyzed 4 performance dashboards to provide oversight of Care Management, Member Services, Enrollment, and UAS department operations
- Providing status reporting to the Deputy Director, NYS Public School Testing Providers and the Director for NYS Public School Testing regarding the progress, milestones, deliverables, risk, and issues communicating up to T2 leadership and escalating any issues in a timely manner
- Managed departmental projects from start to finish; completed all deliverables and resolved all issues in a timely/cost-effective manner.
Project Manager/Supervisor, Infrastructure/ Case Mgmt Ops
New York City Health & Hospital
02.2015 - 06.2019
- Managed a team of 5 UAS Coordinators, accountable for scheduling nurse assessments for over 13,000 members
- Provided operational oversight to ensure smooth day-to-day operations and optimize member care coordination
- Acted as liaison with external vendors to ensure UAS completion met DOH Guidelines: assessment completed timely and accurate; documentation submitted; assessment signed/finalized by the UAS nurse
- Worked with MLTC staff to assess program performance and develop improvement plans
- Prepared for OMIG audits/internal reviews: compiled data for member records, claims, and encounters
- Identified, tested, implemented, and configured nurse scheduling software to ensure management of UAS assessments and adherence to DOH Guidelines
- Trained and developed staff on best practices and software to meet regulatory/policy standards
- Acted as subject matter expert on QCSS Analyzer; introduced and implemented its use for UAS Reviewers and Finance
- Provided functional analysis of clinical operations via performance dashboards and Excel reports
- Developed/tested modifications to electronic health records (EHR).
Project Manager/Clinical Operations Specialist
New York City Health & Hospital
10.2008 - 02.2015
- Helped develop the UAS Team structure, workflows, training materials, and data analytic reports
- Supervised the Authorization Team to ensure member satisfaction and vendor fulfillment of services
- Implemented QAS analyzer to help meet MRT guidelines/regulations
- Co-led Transformation project to implement new Care Management workflows: performed case study testing in UAT and Sandbox environments; developed datasets, pathways, and scripts
- Analyzed key quality indicators/benchmarks and improved efforts to achieve organizational goals within the performance improvement plan
- Created/maintained dashboard scorecards to measure month over month performance of key deliverables
- Provided oversight and review of DME requests and CHHA referrals
- Developed, revised, and communicated policies and procedures
- Prepared workflows, spreadsheets, and pivot tables for Care Management activities
- Developed/analyzed departmental performance reports to provide optimal analysis of member services
- Evaluated staff performance and provided feedback to Care Managers
- Completed PIPs and annual evaluations.
Systems Analyst/ Operations Data Analyst
New York City Health & Hospital
03.2003 - 10.2008
- Provided direct support to senior leadership for Medicaid, Medicare, FIDA, and PACE lines of business at NYCHHC
- Collected, prepared, and presented data
- Maintained database that supported analytic needs including importing, aggregating, cleaning, and managing databases built from multiple data sources such as Tableau and Microsoft SharePoint
- Maintained Care Manager case load membership amounts and updated member demographics
- Served as department liaison to intake department in managing new membership start of cares
- Created reports related to member Care Plans and the Health Commerce System UAS-NY
- Assisted Senior Management with monthly reports, corporate projects, and medical budgeting
- Supported ad-hoc initiatives for service issue resolution and managed the receipt of member, provider and facility inquiries and grievances
- Developed training aids and scheduled monthly educational classes for staff
- Enforced Service Level Agreements (SLAs) to establish resolution expectations and timeframes
- Analyzed performance of Service Desk activities and documented resolutions, identified problem areas and devised delivery solutions to enhance quality of service
- Entered procurement requisition and transactions in Peoplesoft / ERP system
- Tracked and analyzed trends in BMC Remedy Help Desk requests and generated statistical reports
- Assessed need for system reconfigurations based on request trends and supplied recommendations
- Tracked and analyzed trends in BMC Remedy Help Desk requests and generated statistical reports
- Assessed need for system reconfigurations based on request trends and supplied recommendations
- Developed and enforced request handling and escalation policies and procedures
- Identified, recommended, developed, and implemented hands-on end user training programs throughout the corporation.
Education
M.D. - Cyber Secuirty And Digital Forensics
University of Maryland Global Campus
06.2025
Bachelor of Science - Computer Information Systems
Monroe College
Bronx, NY12.2007
Skills
- Microsoft Excel (advanced)
- MS SharePoint
- Payer
- Jira
- Care Compass (EHR system)
- QCSS Analyzer (assessments)
- Symplr DW system
Languages
Spanish
Native or Bilingual
Timeline
Managed Care TPA Oversight Manager/Project Manager
SOMOS
07.2022 - 03.2024
Project Manager, Care Management Operations/COVID Testing for NYS School
New York City Health and Hospital Cooperation
01.2016 - 01.2022
Project Manager/Supervisor, Infrastructure/ Case Mgmt Ops
New York City Health & Hospital
02.2015 - 06.2019
Project Manager/Clinical Operations Specialist
New York City Health & Hospital
10.2008 - 02.2015
Systems Analyst/ Operations Data Analyst
New York City Health & Hospital
03.2003 - 10.2008
M.D. - Cyber Secuirty And Digital Forensics
University of Maryland Global Campus
Bachelor of Science - Computer Information Systems
Monroe College
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