LEAH BROWN
Atlanta,GA
Summary
Healthcare professional experienced in full-cycle projects. Adept at data comparison, extraction, and reporting to identify trends and potential risks. Flexible, able to implement creative and quick solutions to identified impediments. Knowledge of CMS, NCQA, JCAHO, Workers Compensation, Third-Party Payors accreditation, Medicare and Medicaid lines of business.
Overview
24
24
years of professional experience
Work History
Sales Associate/ Member Navigator
Clover Health
01.2021 - 03.2023
- Assisted members navigate their health plan benefits.
- Coordinated with care team and customer service to work together on the member's behalf.
- Provided level support to members as I served a key acquisition channel by selling benefits based on the campaign.
- Communicated as needed with members medical providers and community resources.
- Maintained calm demeanor and professionally managed issues in busy, high-stress situations.
- Engaged with customers to build rapport and loyalty.
Community Lead Generation Manager
Clover Health
11.2020 - 01.2021
- Built and maintained relationships with potential enrollees while manning the stands at selected locations.
- Increased awareness and support of Clover Health health plans while gaining "leads" for our Clover Health team.
- Function as a consultant and concierge to members.
- Interacted well with customers to build connections and nurture relationships.
- Tracked trends and suggested enhancements to both challenge and refine Clover Health plan offerings.
Career Break
Pursued Various Activities
09.2018 - 02.2020
- Took intentional pause to focus on full-time caregiving, Uber Eats Driver-Part Time and traveling.
- A part-time remote small business consultant for various businesses, recommends changes to policies and establishes procedures that affect an immediate organization. Assists in preparing project presentations, organize and implement training workshops, in cooperation with partners, driving issue identification and resolution, summarize project status, effective management reports, and facilitate reports.
- Unemployed 3/2020-10/2020- due to Covid Pandemic.
Sr. Project Manager
SPH Analytics
02.2017 - 09.2018
- Managed multiple concurrent large-scale, high complexity projects in a matrix environment.
- Led pipeline implementations for 250+ data ingestions projects and provided ongoing client support.
- Extracted data from SQL and Oracle databases and physical records to identify data trends and mitigate risk.
- Interacted with internal IT, engineering, and maintenance resources as well as upper management.
- Coordinated and created project timelines.
- Reviewed contracts and documents to manage the $1.2 million project scope.
- Reported regularly to managers on project budget, progress and technical problems.
- Verified quality of deliverables and conformance to specifications before submitting to clients.
- Tracked project and team member performance closely to quickly intervene in mistakes or delays.
- Maintained open communication by presenting regular updates on project status to clients.
- Monitored project progress, identified risks and implemented corrective measures to acquire success.
- Coordinated cross-functional teams to determine timely delivery and compliance of project requirements.
- Maintained schedules to meet key milestones at every project phase.
- Updated customers and senior leaders on progress and roadblocks.
- Analyzed project performance data to identify areas of improvement.
- Scheduled and facilitated meetings between project stakeholders to discuss deliverables, schedules and conflicts.
Physician Liaison/ Project Data Management
Northside Hospital Atlanta
10.2015 - 01.2017
- Managed providers credentialing data in Cactus.
- Weekly team meetings with the Revenue Cycle Department, provided credentialing updates and improvements based on identified data trends.
- Utilized multiple communication channels (email, phone call, in-person) to communicate providers education needs and process improvements.
- Managed Cactus software for the Data Management team , special projects, and resolved technical issues with IT.
- Utilized Cactus physician database system, performed database queries and report development.
Project Manager
Georgia Department Of Public Health- Contract
03.2015 - 07.2015
- Managed the Autism project budgets, and timelines.
- Planned the Autism project, events and monitored the progress.
- Created brochures and agenda for events.
- Regularly communicating with stakeholders to arrange meetings, confirm program schedules, and discuss any program problems.
- Ensured that internal and external teams are regularly informed of the status of the program.
- Regularly communicated with management regarding the programs status and any problems or potential problems.
- Forecasts potential schedule delays and developed alternate plan.
Payor Relation Specialist/Provider Data Management
Alliance Spine And Pain Center
09.2014 - 02.2015
- Managed projects in a timely manner to meet set deadlines.
- Understanding of managed care contracting; processes and language used in formulating the rate structures of a managed care contract and ability to interpret contract reimbursement.
- Communicated with direct staff and internal/external customers through reports and presentations.
- Identified trends, revenue opportunities, and revenue leakage to work towards a resolution with providers and payors.
- Credentialed providers and facilities.
Project Manager/ Provider Data Management
Peach State Health Plan / Contract
09.2013 - 07.2014
- Monitored the daily activities of the Provider Maintenance Administrators; coordinated workflow and assignments to ensure timeliness and accuracy.
- Assisted with monthly reporting, data trend analysis, and special projects as required.
- Coordinated materials needed for Request for Applications (RFA’s) and new business.
- Facilitated monthly updates for provider verifications regarding provider enrollment specifications, tracking provider data.
- Managed Medicare and Medicaid provider directory process including achieving and maintaining compliance with the state with regards to the Medicare and Medicaid directory; maintains website provider directory.
Project Manager
Loving Kindness Healthcare System/ Contract
06.2012 - 08.2013
- Managed project schedules and budgets, contract administration, credentialing, and network provider development.
- Interfaced with management teams and promoted renewable business with clients.
- Standardized processes to align with organizational structure, established process improvements.
- Set deadlines, supervised responsibilities, and provided status updates to leadership.
- Supported Provider Operations interactions with the Medicare, Medicaid, and Third-Party vendors.
Provider Relations/Credentialing Specialist
Cypress Care
05.2009 - 04.2012
- Implemented and executed strategic plan for assigned Specialty Network vendors.
- Managed relationship with vendors and maintained vendor database. Prepared vendor management reports.
- Queried provider data using logic formulas to develop metrics, communicating through Pivot tables, charts, and spreadsheets.
- Identified issues for assigned providers and develop solutions for both parties.
- Maintained regular communications and meetings with key provider contacts.
- Worked with supporting teams to ensure timely delivery of products and services.
- Interacted with facility administrators and clients to obtain credentialing information and process any needed provider or facility enrollment application.
Education
M.S. Degree - Project Management
Strayer University
Atlanta, GA03.2017
M.B.A Degree -
Strayer University
Atlanta, GA03.2015
B.S. Degree - Organizational Studies Leadership & Business
Robert Morris University
12.2006
Skills
- Critical-Thinking
- Leadership
- Problem-Solving
- Time Management
- Customer Service
- Analytical
- Software tools: Excel/Access/Word, SQL
- Systems: Cactus, Amisys ,Epic, Salesforce, MMIS, PECOS, Data Warehouse
- Project Methodologies: Agile, Scrum
Timeline
Sales Associate/ Member Navigator
Clover Health
01.2021 - 03.2023
Community Lead Generation Manager
Clover Health
11.2020 - 01.2021
Career Break
Pursued Various Activities
09.2018 - 02.2020
Sr. Project Manager
SPH Analytics
02.2017 - 09.2018
Physician Liaison/ Project Data Management
Northside Hospital Atlanta
10.2015 - 01.2017
Project Manager
Georgia Department Of Public Health- Contract
03.2015 - 07.2015
Payor Relation Specialist/Provider Data Management
Alliance Spine And Pain Center
09.2014 - 02.2015
Project Manager/ Provider Data Management
Peach State Health Plan / Contract
09.2013 - 07.2014
Project Manager
Loving Kindness Healthcare System/ Contract
06.2012 - 08.2013
Provider Relations/Credentialing Specialist
Cypress Care
05.2009 - 04.2012
M.S. Degree - Project Management
Strayer University
M.B.A Degree -
Strayer University
B.S. Degree - Organizational Studies Leadership & Business
Robert Morris University
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