Lezlie Apple

• Leading a pivotal role as the Solution Manager in generating 7-10 million dollar savings for the enterprise upon implementation of the Standard and Alternative Project
• Define & document business solutions & quality controls to support evolving business needs
• Support the HCPm Ops & Delivery teams with business definition & usage of provider network capability needs
• Coordinate with the delivery teams to ensure the appropriate implementation & adoption of business solutions necessary to support new & evolving business needs
• Partner with Provider Data users to ensure accurate application & usage & consistent business outcomes
• React & respond to escalated issues to ensure integrity of data attributes and relation ships to ensure consistency in usage across users of provider data & associated business outcomes
• Works within established architecture to support Intake process, resolve escalated governance issues & lead initiatives as assigned
• Analyzing intake requests to determine impact to the current data management environment & balancing new requests with the implementation and delivery priorities and future business needs
• Establish & develops relationships with key stakeholders and representatives to establish & monitor progress against project goals & objectives
• Identify & work to remove barriers that slow or prevent the successful attainment of process/productivity improvement & administrative efficiency that will lead to cost reduction and competitive analysis.
• Holistically manage solution implementation & adoption through the delivery and implementation.
• Resolve issues & determine contingency plans & triggers for risks. As needed, escalate issues to appropriate audiences including key business leaders & team members
• Partners with matrix organizations to ensure that appropriate action is taken to identify & implement initiatives

Streamlined internal processes through the implementation of innovative tools and technologies, fostering a more efficient work environment.
• Participated in industry conferences and seminars for staying up-to-date with emerging trends and best practices relevant to Solutions Advising profession.
• Managed multiple projects simultaneously while adhering to strict deadlines, showcasing strong time management skills.
• Collaborated with cross-functional teams to design comprehensive solutions addressing client needs and expectations.

• Worked independently and collaboratively with off shore Cigna business partners to verify and document quality defects with opportunities and coaching to improve.
• Assessed the accuracy, completeness, and currency of Networks, Contracts, Demographic and Reimbursement data within Cigna systems.
• ImSpearheaded audit projects for top providers
  Resulted in nearly half a million dollars saving for the company and stakeholders
• Conducted independent data analysis to improve quality in Provider data for customer, client, and provider experience of quality outcomes
  

• Facilitated deployment of provider communications under Operations and Contracting
• Managed multiple communication distribution projects for external provider business communications (e.g., network implementations, policy and administrative changes, new programs), publications (e.g., Network News) and e-mail campaigns
• Designed, operated, controlled, and monitored procedures and documentation for new and established processes - Including development of Sharepoint sites and leading projects that include user friendly databases
• Orchestrated complex end-to-end process for provider mail, email and fax distribution lists, including data extraction, review, management, manipulation, and maintenance for multiple Communication Leads and matrix partners
• Tracked associated metrics for all external provider business communications

• Engaged in database design and implementation of new and established projects/processes for Contracting Network Development and Competitive Insights
• Managed (National – All Lines of Business) NCQA Project, Netminder Project (South East Hub) and Network Adequacy CMS Market Exchange for Individual Family Plan Networks
• Ran developer databases (CPF & HCPM-PRDS) during monthly refresh process, among other database projects
• Created and produced ad hoc reporting for Regional Network Access Hubs
• Managed continuous process evaluation and identification of database and project changes that impacted data requirements in order to meet project requirements and facilitate process improvement

• Analyzed facility and ancillary contracts/fee schedules to ensure medical coding and service terms were in compliance with loading guidelines and implemented contracts according to strategic plan
• Audited accounts, ensuring pricing accuracy and compliance with organizational and governmental specific mandates
• Researched, coordinated and responded to questions from matrix partners providing quick resolutions that met needs in order to prevent elevated issues/complaints
• Communicated with Contract Negotiators/Providers ensuring demographic accuracy in Cigna systems
• Actively participated in multiple work-group projects that resulted in efficiencies in business processes
• Reviewed operations systems and procedures, recommended improvements to job aids that increased efficiency and ensured smooth operation and administration of provider agreements