Kimberly Vargo
Millersburg,PA
Summary
Quality professional with in-depth expertise in quality analysis, known for driving impactful improvements. Proven ability to implement effective quality control processes and enhance operational efficiency. Highly collaborative and adaptable, committed to achieving results and ensuring team success.
Overview
25
25
years of professional experience
Work History
Quality Analyst III
Anthem/ Elevance Health
03.2021 - 02.2025
- Company Overview: (Remote)
- I was acknowledged as Highest production performer in 2022
- Completed collaborated interviews for the manager and associate positions to ensure a strong team
- Developed and maintained quality assurance procedure documentation
- Created and revised procedures, checklists and job aids to reduce errors
- Analyzed quality and performance data to support operational decision-making
- Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies
- Collaborated with cross-functional teams to develop and implement targeted solutions for identified quality issues, ensuring continuous improvement
- Identified process inefficiencies through meticulous data analysis, leading to streamlined operations and increased productivity
- Led root cause analysis initiatives that resulted in significant reduction in recurring defects
- Evaluated vendor performance by conducting regular audits, ensuring adherence to established quality standards and requirements
- Facilitated cross-departmental training sessions, increasing awareness and understanding of quality standards
- Reduced time to market, carefully coordinating with development teams to prioritize critical fixes
- Ensured product compliance with industry standards, meticulously reviewing specifications and conducting relevant tests
- Identified and addressed process bottlenecks, streamlining workflows for faster turnaround times
Lead-APDO- GBD & Commercial Contracts/ Application
Anthem/ Elevance Health
06.2015 - 03.2021
- Company Overview: (Remote)
- Act as a Lead and oversee the activities of the 40 Contract/ Application staff
- Serve as liaison between all functional areas to resolve provider enrollment issues and ensure uniform data and data flow
- Ensure desk levels and resources documentation was accurate
- Worked effectively in fast-paced environments
- Worked well in a team setting, providing support and guidance
- Assisted with day-to-day operations, working efficiently and productively with all team members
- Managed time efficiently in order to complete all tasks within deadlines
- Used critical thinking to break down problems, evaluate solutions and make decisions
- Strengthened communication skills through regular interactions with others
- Adaptable and proficient in learning new concepts quickly and efficiently
- Demonstrated strong organizational and time management skills while managing multiple projects
- Learned and adapted quickly to new technology and software applications
- Self-motivated, with a strong sense of personal responsibility
- (Remote)
Network Data Specialist II
Anthem/ Elevance Health
12.2014 - 06.2015
- Company Overview: (Kelly Services)
- Responsible for accurate, timely maintenance of provider information on claims, and provider databases
- Assist in synchronization of data among multiple claims systems and application of business rules as they apply to each database
- Validates the data to be housed on provider databases and ensuring adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing
- Consistently met deadlines and delivered high-quality work, demonstrating a strong commitment to excellence in data management
- Reviewed and updated client correspondence files and database information to maintain accurate records
- Managed sensitive information responsibly, adhering to strict security protocols and maintaining confidentiality at all times
- Assisted in meeting regulatory requirements by ensuring proper documentation and adherence to data governance policies
- (Kelly Services)
Medicine Assistant
Christian Psychotherapy
01.2013 - 11.2014
- Manage and oversees 7 providers' schedules, pull charts, submit prior- authorizations
- Manage charts and script pads
- Call in all refills and or new prescriptions
- The first point of contact with drug representatives
- Submit referrals for new patients
- Performed scheduling, and reception duties
- Educated patients on proper medication usage and potential side effects, empowering them to take an active role in managing their health conditions
- Regularly updated healthcare providers on patients' progress, facilitating timely adjustments to care plans as needed
- Consistently maintained accurate medication records, reducing the risk of medication errors
Client Service Scheduling Coordinator
Home Instead
10.2012 - 11.2012
- Scheduling CNA's and Companions to help elderly and disabled individuals in their homes or within facilities with daily needs
- Proactively identified scheduling issues and developed quick solutions to promote efficiency and profitability
- Managed daily scheduling conflicts to reduce operational backlogs and support full shift-coverage
Client Service Coordinator
Personal Homecare Inc.
05.2012 - 08.2012
- General office and secretarial functions
- Manage clients care services, supervise and training of new home care aides
- Assign cases to aides, scheduling
- Distribute paychecks
- Maintained detailed records of client interactions, enabling better tracking of account history and facilitating continuity among team members handling the same accounts
- Enhanced client satisfaction by promptly addressing inquiries and resolving issues efficiently
Office manager/ Receptionist
Shaw Laser Eye
03.2012 - 05.2012
- Interface with members over the phone, in person or via external emailing, obtain needed information
- Oversaw office inventory activities by ordering and requisitions and stocking and shipment receiving
- Process payments from insurance and patients
- Open & close the office and doctors' workstations and equipment
- Handled sensitive information with discretion, maintaining confidentiality of company documents and personnel records
- Provided exceptional customer service when addressing client inquiries or concerns via phone calls or email correspondence
A/R Collection Representative
Coventry Health/ Health America
12.2007 - 03.2010
- Company Overview: Southern Health
- Working monthly aging reports for groups that have not paid monthly premiums 30 days out
- Making and receiving phone calls, to collect premiums
- Issued letters of reminder, terminations, and missed premiums
- Reported accounts to outside collection agencies
- Process financial payments to group accounts
- Prepare monthly status reporting as needed
- Southern Health
Enrollment & Billing Customer Service
United Concordia
06.2004 - 11.2007
- Company Overview: Tricare Dental Program
- Answering in bound phone calls regarding their enrollment and eligibility, and billing
- Performing manual audits
- Maintained accounts as needed
- Respond to email correspondence
- Delinquent accounts and collections call out bound
- Tricare Dental Program
Account Administrations, Customer/ Provider Services, & Claims Processor
Capital Blue Cross
07.2000 - 04.2004
- Enter enrollments, student certifications
- Inbound calls from both providers and customers regarding benefits and claims
- Claim entry and processing and adjustments
- Verified enrollment, eligibility and provided benefit information
Education
Bachelor's Degree - Healthcare Management
University of Phoenix
Phoenix, AZDiploma - Business
Susquenita High School
Duncannon, PAAssociate of Science - Health Administration
University of Phoenix
Tempe, AZSkills
- Office Management Skills
- Proficiency in MS Office
- Database Management
- Critical Thinking
- Analytical Problem-Solving
- Accurate Data Entry
- Medicare Compliance Understanding
- Medicaid Knowledge
- Experienced with Healthcare Vocabulary
- Health Insurance Expertise
- Claims Management
- Credentialing Management
- CMS knowledge
- Compliance with State Regulations
- Effective Communication
- Team Leadership
- Regulatory Affairs Knowledge
- Performance Assessment
- Experience in Healthcare Operations
- Trend Analysis
- Data Quality Assessment
- Provider Contracting Expertise
- Training Team Members
- Process Optimization
- Continuous Quality Enhancement
Timeline
Quality Analyst III
Anthem/ Elevance Health
03.2021 - 02.2025
Lead-APDO- GBD & Commercial Contracts/ Application
Anthem/ Elevance Health
06.2015 - 03.2021
Network Data Specialist II
Anthem/ Elevance Health
12.2014 - 06.2015
Medicine Assistant
Christian Psychotherapy
01.2013 - 11.2014
Client Service Scheduling Coordinator
Home Instead
10.2012 - 11.2012
Client Service Coordinator
Personal Homecare Inc.
05.2012 - 08.2012
Office manager/ Receptionist
Shaw Laser Eye
03.2012 - 05.2012
A/R Collection Representative
Coventry Health/ Health America
12.2007 - 03.2010
Enrollment & Billing Customer Service
United Concordia
06.2004 - 11.2007
Account Administrations, Customer/ Provider Services, & Claims Processor
Capital Blue Cross
07.2000 - 04.2004
Diploma - Business
Susquenita High School
Associate of Science - Health Administration
University of Phoenix
Bachelor's Degree - Healthcare Management
University of Phoenix
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