Summary
Overview
Work History
Education
Skills
Timeline
Generic

MICHELE JENDREJEWSKI

Sarver,PA

Summary

Highly experienced, with 25+ years dedicated to Medicare/DSNP, driving program excellence and improving outcomes for vulnerable populations.

Overview

25
25
years of professional experience

Work History

Product Consultant

Highmark Health
03.2022 - Current
  • Spearheaded the development of new and innovative products by identifying market needs, conducting comprehensive research and analysis, and evaluating implementation feasibility.
  • Improved product performance year-over-year through continuous monitoring, strategic design changes, and enhancements based on market trends and competitive analysis.
  • Managed the end-to-end implementation of new products, from preparing detailed design specifications to coordinating cross-functional teams, ensuring timely and successful launches.
  • Secured CMS approval for two new Highmark DSNP insurance products (DE & WV), a PA service area expansion, and three consecutive VBID applications.

Lead Provider Account Liaison

Highmark Wholecare
01.2018 - 03.2022
  • Improved Value-Based (VB) partner performance by analyzing data and implementing strategies to reduce MLR and enhance quality/financial outcomes.
  • Created comprehensive educational materials and training programs to support providers through changes in reimbursement, products, processing, and technology.
  • Resolved provider issues and provided guidance on new protocols, policies, and procedures, ensuring seamless service delivery.

Healthcare Market Consultant

United Health Group, Optum
09.2012 - 12.2017
  • Developed and delivered comprehensive training programs on Risk Adjustment programs and tools, resulting in increased provider adoption and improved documentation accuracy.
  • Drove improvements in Risk Adjustment Factor (RAF) performance and patient outcomes through data-driven analysis, consulting, and targeted intervention strategies focused on optimizing physician encounter submissions.

Senior Physician Advocate

United Healthcare
07.2000 - 09.2012
  • Managed a full range of contracting, provider relations and servicing interactions within UHG, including working on end-to-end provider claims and call quality, training on the physician portal, future service enhancements, and training & development of external provider education programs.
  • Identified and addressed critical gaps in our network composition and services, supporting strategic contracting and development initiatives to enhance network adequacy.

Education

Medical Assistant -

Career Training Academy
New Kensington, PA
01.1994

Skills

  • Technical Skills: Microsoft Office Suite (Excel, Power Point, and Word), Tableau and Salesforce
  • Analytical Skills: Data Analysis, Market Analysis, Critical Thinking, Strategic Thinking
  • Healthcare Skills: Physician Contracting & Servicing, Medical Billing & Coding, Risk Adjustment
  • Project Management: Project Management, Problem Solving

Timeline

Product Consultant

Highmark Health
03.2022 - Current

Lead Provider Account Liaison

Highmark Wholecare
01.2018 - 03.2022

Healthcare Market Consultant

United Health Group, Optum
09.2012 - 12.2017

Senior Physician Advocate

United Healthcare
07.2000 - 09.2012

Medical Assistant -

Career Training Academy

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