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Kellie Malone
Katy,USA
Summary
Accomplished Healthcare Strategy and Operations Executive with 20 years of experience in enterprise transformation and operational innovation. Specializes in diagnosing operational challenges and creating scalable models that align with executive leadership objectives. Proven ability to convert fragmented processes into sustainable frameworks, emphasizing data-driven decision-making and disciplined execution. Knowledgeable in health plan operations across Government Programs and Commercial segments, focusing on enterprise testing and process automation.
Overview
24
24
years of professional experience
Work History
Director of Enrollment Operations
Sentara Health Plan VA
2022.01 - Current
- Lead and manage all inbound 834 transactions, ensuring accurate and timely enrollment processing for Commercial Groups, Medicare, Medicaid, and Individual Products within the QNXT Core system. Created, trained, and directed a specialized team to support and monitor the quality of inbound and outbound enrollment data.
- Oversaw all outbound 834 transmissions and eligibility extracts, establishing rigorous quality controls and best practices for data integrity and regulatory compliance.
- Established a team dedicated to ensuring quality standards and compliance regulations across all operations.
- Oversaw outbound 834 transmissions and eligibility extracts, implementing quality controls and best practices to ensure data integrity and regulatory compliance.
- Reduced vendor error rate by 22% through implementation of quality controls.
Director of Business Operations
Texas Children’s Health Plan Houston, TX
2020.01 - 2022.01
- Managed system configuration, provider configuration, enrollment and eligibility, and provider data integrity and quality teams. Led process improvement initiatives to realign configuration processes, eliminating waste and errors. Established foundational documentation, including policies and procedures, standard operating procedures, and process flows.
- Implemented Epic Tapestry system to improve healthcare management processes from September 2021 to August 2022.
- Completed Tapestry certification for accounts payable claims and contracts to ensure compliance and accuracy.
- Created cross-functional work groups to ensure comprehensive process development
Director of Operations
WellCare Health Plans Houston, TX
2017.01 - 2020.01
- Managed business processes, activity reports, and performance data to measure productivity and goal achievement, identifying areas for cost reduction and program improvement.
- Influenced Executive Leadership to apply pre-go-live testing approach to improve Claim accuracy in Production
- Integrated multiple teams in 3 separate locations to one shared goal
- Led team to execute strategic plan effectively
- Implemented best practices and added value to organization
- Implemented best practices that enhanced operational effectiveness within organization.
- Facilitated consistency and strong leadership to ensure compliance during difficult times
Director of Operations
Universal American (now WellCare) Houston, TX
2011.01 - 2017.01
- Spearheaded cross-functional team and provided leadership across organization for system upgrades, streamlining processing. Analyzed business impact, created and executed a test plan for system upgrades and implementation.
- Implemented strategies to save $5.5M in rework costs.
- Developed methods to eliminate waste in budget management.
- Researched and documented processes, presenting findings to Executive Leadership to eliminate re-work
- Created training program for team and expanded responsibilities to reduce re-work
- Created and implemented comprehensive tracker and work management application for appeals and grievances, ensuring compliance
- Created and implemented all-inclusive tracker and work management application for appeals and grievances to ensure compliance
- Partnered with A&G Leadership, processing staff, and QA teams to resolve workload and increase oversight
Senior Business Analyst
Universal American (now WellCare) Pensacola, FL
2003.01 - 2011.01
- Led Medicare Part D Operations Department, managing data integrity and analysis across the organization, creating and documenting process flows and quality checks to ensure sustainability and repeatability of processes.
- Managed development of web portal for members to enhance user experience.
- Oversaw creation of member-facing web portal
- Researched competitors’ sites and gathered internal inputs to identify call center needs, informing strategic improvements.
- Created a QA tool, performed initial quality checks to review accuracy of manual processing
- Documented SIPOC for manually processed transactions, developed code to automate transactions and outputs
- Researched competitors’ sites and solicited internal inputs to understand call center needs
Education
Bachelor - Business Management
York College
York, EnglandSkills
- Operational Strategy
- Operational Excellence
- Process optimization
- Regulatory Compliance
- Change Management
- Data-driven decisions
- Cross-Functional Leadership
- Performance metrics
- Executive Leadership
- Organizational Design
- Strategy & Operations
- Enterprise Transformation
- Operating Model Development
- Operation Diagnostics
- Operational Automation
- User Acceptance Testing
- Team Development
- Team Development
Timeline
Director of Enrollment Operations
Sentara Health Plan VA
2022.01 - Current
Director of Business Operations
Texas Children’s Health Plan Houston, TX
2020.01 - 2022.01
Director of Operations
WellCare Health Plans Houston, TX
2017.01 - 2020.01
Director of Operations
Universal American (now WellCare) Houston, TX
2011.01 - 2017.01
Senior Business Analyst
Universal American (now WellCare) Pensacola, FL
2003.01 - 2011.01
Bachelor - Business Management
York College