Summary
Overview
Work History
Education
Skills
Timeline
Generic
MARY E. MATEO

MARY E. MATEO

Healthcare Call Center Manager
Bluffton,SC

Summary

OPERATIONS DIRECTOR Driven, innovative, and knowledgeable leader with a passion for utilization management, contact center, and business operations management with extensive knowledge of auditing, training, and coaching to inspire contact center staff with a focus on healthcare organizations. Political tact and business acumen with a proven history of gaining the confidence of top-level administrators and the ability to engage, influence, and collaborate with all stakeholders strategically. Talented professional considered knowledgeable leader and dedicated problem solver. Brings [Number] years of valuable expertise to forward company objectives. Attentive to detail with experience in coordinating projects, programs and improvements.

Overview

18
18
years of professional experience

Work History

Program Manager

Abbvie Inc
08.2022 - Current
  • Responsible for the performance management and daily operational oversight of vendor partners executing customer experiences supporting the U.S
  • Patient Services Patient Support Services Tele-Experience programs, including key performance and quality metrics
  • Ensured a high level of patient service by driving the team's production to exceed goals
  • Primary liaison to manage relationships with key vendor partners
  • Providing day-to-day oversight of vendor partners
  • Understands business challenges, responding with relevant solutions and delivering a consistent industry-leading patient experience for Patient Support programs
  • Partnered with both Abbvie and vendor training resources to ensure customer-facing team members are knowledgeable on brand programs and services available to patients
  • Responsible for tracking vendor Quality and Compliance performance results and trends to the direct supervisor and other members of management
  • Primary oversight of patient escalation management and responsible for providing corrective action or support for escalation closure
  • Identified opportunities to improve patient experience through quality monitoring of interactions and CSAT survey analysis
  • Created and managed the approvals of supporting materials leveraged by vendor team members through AbbVie's regulatory submission process as needed.

Central Scheduling Supervisor

St. Joseph's/Candler Healthcare
03.2022 - 08.2022
  • Provide coaching and mentoring to 15+ surgical and imaging scheduling staff members in a fast-paced environment scheduling surgical and imaging requests from both physicians and patients for a large hospital system
  • Ensuring that staff is following policy, contractual obligations, and industry standards
  • Developed and maintained process flow diagrams for training scheduling center staff
  • Managed all administrative duties related to timecards, PTO approvals, and work schedules
  • Train contact center staff to comply with call center standards following federal and state laws, company policy, HIPAA, URAC, NCQA, and contractually defined regulations and protocols
  • Gathered feedback to report to technical support for testing and troubleshooting software, network, and equipment issues impacting the contact center
  • Supervise and provide feedback for each team member in the contact center area to improve employee development
  • Provided the lead in motivating team members in the contact center area to perform at the highest level possible and provide quality customer service for improved customer loyalty
  • Developed partnership with human resources to address attendance, evaluate performance, corrective action, and behavioral issues in a timely and professional manner
  • Responsible for monitoring, auditing, and educating agents on live and recorded call quality and accuracy.

Senior Manager

eviCore Healthcare
01.2017 - 05.2021
  • Coach and guide three clinical leaders who directed a team of 65 remote physical, occupational, and speech therapists for the Specialized Therapies Product
  • Lead and manage all day-to-day administrative functions and operational support within the department to ensure value and quality service to our members, providers, and stakeholders
  • Responsible for developing and building a culture of accountability with a shared vision of departmental excellence
  • Evaluated gap data analysis, statistics, and process mapping, identifying opportunities for quality and continuous process improvements and design strategies and recommendations to executive leadership to implement
  • Provides feedback to Workforce Management on capacity planning to ensure that staffing resources are utilized to effectively support workflows to positively impact customer experience, improve patient care, meet tight deadlines, regulatory compliance, and contractual service level agreements adherence
  • Through mentorship, evaluate and provided career planning and management development for direct reports
  • Effectively coordinated and communicated an organizational structure change and strategic direction for performance measures and best practices for productivity and developed performance improvement reporting on key performance indicators
  • Improved employee engagement and department culture through quarterly team meetings that provided organizational communications on the changing environment and clinical education presentations
  • Utilizing Tableau and Excel spreadsheets, implemented data-driven collection methods for special projects to develop an improved and more efficient workflow
  • Developed a partnership with the Appeals and Grievances team to collaborate on responses to patient, provider, and CMS concerns
  • Tracking expenses and providing budgeting and financial reports on overtime and training costs to leadership.

Director

eviCore Healthcare
01.2016 - 01.2017
  • Monitored and directed forecasting activities to maintain correct physician staffing ratios
  • Provided data and forecasts for physician scheduling and resource requirements
  • Collaborated with the Talent Acquisition Team (Human Resource Team) to assist in the recruiting, interviewing, hiring, new hire orientation, and onboarding of over 50 physicians for the medical management team
  • Managed a Team of 6 Physician Licensing Associates and the administration of licensing documentation for all clinicians within the organization to meet health plan licensing requirements.

Patient Services Coordinator

CORA Physical Therapy
01.2024 - Current
  • Warmly greet and build rapport with patients through in-person and phone interactions
  • Answer incoming calls promptly and politely; screen calls and take/relay messages as necessary
  • Verify patient insurance for outpatient therapy benefits (applicable locations only)
  • Manage incoming physician referrals and prescriptions
  • Provide communication on first visit expectations to all new patientsManaged sensitive patient data with strict adherence to HIPAA regulations, ensuring privacy and confidentiality at all times.
  • Provided patient with after-visit summary and scheduled next appointment to maintain continuous care and facilitate treatment plan.
  • Responded effectively to challenging situations involving distressed or dissatisfied patients while maintaining a calm demeanor and positive attitude.
  • Advise patients of their financial responsibility (i.e., deductible, co-pay, or co-insurance responsibility per visit)

Director

CareCore National, LLC
01.2015 - 12.2016
  • Managed the Contact Center Quality Management Audit (QA) and Contact Center Training Teams
  • Led and directed a team of 3 managers, five trainers, and 12 quality auditing leads
  • Managed and maintained staff training documents, knowledge base, and resource database on Sharepoint
  • Partnered with external and internal stakeholders such as marketing and sales team, vendor management teams, and Operations Leadership to monitor and assess auditing effectiveness, reducing the number of internal audits performed on each agent while delivering high-quality standards and customer satisfaction, reducing provider and member complaints
  • Reviewing Performance analysis, collaborated with the team on training development and quality improvement initiatives for training staff
  • Implementation of monthly calibration meetings with quality auditing team and contact center supervisors to facilitate collaboration between departments
  • Developed the project implementation of the Ulysses Customer Service solutions to the auditing process to drive improved and accurate contact center interactions with customers, increasing friendly, courteous first call resolution and improving the coaching skills of the contact center supervisors
  • Worked with Contact Center Leadership to identify creative and flexible training strategies during urgent hiring needs.

Director

CareCore National, LLC
01.2008 - 01.2015
  • Oversight of daily operations, staffing, training and development, performance evaluation to effectively develop and improve the complex environment of a large-scale customer support call center operation at two sites
  • Supervisory responsibilities include; managing and directing contact center cross-functional teams; the recruitment, hiring, and training of employees
  • Planning, assigning, and directing work; appraising performance; developing employees with calm compassion; addressing client service relations and resolving quality assurance issues
  • Subject matter expert on the prior authorization review process and health plan insurance
  • Through business process analysis, developed and implemented strategic plans to address customer requirements for service excellence and state and federal regulation of Medicare and Medicaid business
  • Provide guidance and directed forecasting and workforce activities and set performance goals accordingly for a fast-paced, high-volume contact center
  • Developed successful and productive business partnerships with external and internal customers such as Provider Relations, Claims, Training, Client Management, and Operations to effectively communicate trends and investigate issues
  • Accountable to the multiple leadership levels, tracking operational issues and providing updates to include necessary corrective action and follow-up to ensure resolution and operational compliance.

Education

Associates of Science - Healthcare Administration – in

SOUTHERN NEW HAMPSHIRE UNIVERSITY

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PIKES PEAK COMMUNITY COLLEGE
COLORADO SPRINGS, CO

Skills

  • Operational Excellence Drives Improvement Extensive Managed Care Experience Consistent and Collaborative, Team Oriented Leadership Skills and Management Experience Continuous Improvement Performance Management Skills Strong Analytical and Problem-Solving Skills Call Center Supervisory Experience Conflict Resolution Skills Outstanding Written and Verbal Communication Skills Courageous Change Management Emotional Intelligence Vendor Management Service Delivery NCQA and URAC Standards Extensive Knowledge of Medicare, Medicaid, and Other Managed Care Plans CPT Code and ICD10 Coding Knowledge Medical Terminology
  • TECHNICAL and COMPUTER SKILLS
  • Proficient with
  • Microsoft Office applications; Outlook, Word, Excel, Visio, and PowerPoint and with Google Docs Experienced with Webex, Zoom, MS Teams, and Google Meet Working knowledge of IEX WFM software, Avaya CMS, Virtual Observer, Five9, PowerBi, Authenticx Ali, and Cisco Telephone systems
  • Adaptable and Flexible
  • Employee Coaching and Mentoring
  • Triage Meetings
  • Performance Tracking and Evaluations
  • MS Office Applications
  • Team Leadership
  • Policy and Procedure Improvement
  • Interpersonal Skills

Work Type

Full TimeContract Work

Work Location

Remote

Important To Me

Company CultureWork from home optionPaid time off401k match

Timeline

Patient Services Coordinator

CORA Physical Therapy
01.2024 - Current

Program Manager

Abbvie Inc
08.2022 - Current

Central Scheduling Supervisor

St. Joseph's/Candler Healthcare
03.2022 - 08.2022

Senior Manager

eviCore Healthcare
01.2017 - 05.2021

Director

eviCore Healthcare
01.2016 - 01.2017

Director

CareCore National, LLC
01.2015 - 12.2016

Director

CareCore National, LLC
01.2008 - 01.2015

Associates of Science - Healthcare Administration – in

SOUTHERN NEW HAMPSHIRE UNIVERSITY

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PIKES PEAK COMMUNITY COLLEGE

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