Leandra Hernandez

Strategic Planning:

• Developed long-term strategic plans to guide operational activities and drive business growth
• Worked with senior management to establish organizational objectives and create actionable plans to achieve them

Process Optimization:

• Evaluate existing processes and workflows to identify inefficiencies and areas for improvement
• Enhanced Operations Efficiency
• Monitor and analyze financial performance, identifying opportunities for cost savings and revenue growth
• Promote networking and collaboration to remove barriers for facilities to operate effectively and efficiently

Data Analysis:

• Increase our Encounter Claim process by 90% by identifying and addressing key drivers of system configuration and 837 submission improvement by Provider
• Create reports and dashboards to present findings and provide actionable recommendations to stakeholders

Operational Exellence

• Skilled in Claims Operations and System Configuration, collaborating with corporate business owners to ensure that the health plan processes for claims and encounters align with regulatory requirements for each applicable line of business
• Process expert specializing in Claims Operations, System Configuration , Provider Data Management, Credentialing, Enrollment, Encounters, Provider Dispute Resolution, G&A, and Member Retention
• Work in conjunction with the Provider Issue Research and Resolution function and the provider claim reconsideration process Coordinate activities and execute strategies to address opportunities for improving provider satisfaction and reducing operational risk in collaboration with Provider Services
• Works with VP staff and senior management to develop and implement provider and member service strategies to improve access and Provider satisfaction with the Plan