Michelle Joseph
Phoenix,AZ
Summary
Results-driven healthcare operations professional with a proven track record in quality assurance and business process improvement. Skilled business analyst known for analytical prowess and adept problem-solving abilities. Successfully boosted Provider Web-Portal authorizations submission usage from 19% to 53%. Experienced in training telephonic Intake Clinicians and Medical Directors on Clinical Guideline software for Utilization Management, utilizing DMAIC format to identify process improvement strategies for small projects.
Overview
20
20
years of professional experience
Work History
Senior Business Process Analyst
TriWest Health Care Alliance
11.2022 - Current
- Responsible for gathering business rules, developing process design, and implementation of process solutions. Collaborate with departments to identify inefficiencies and areas for improvement in workflows and procedures. Perform data analyst, conduct process mapping, work with stakeholders to streamline operations and enhance productivity. Facilitate meetings and prioritize process requirements. Collaborate with Vendors to implement process solutions. Work with Project Managers to assist with requirements, tracking progress and addressing any issues or changes that occur throughout the project lifecycle.
Business Analyst/UM Business Change Specialist
Bright Healthcare/EXL Services (Bright Healthcare Contractor)
12.2020 - 11.2022
- Responsible for organizing and executing assigned business projects on behalf of clients (internal and external) according to client's requirements. Creating and analyzing report data to solve problems and improve processes. Create and manage timeline driven workplans and create process flow documentation to support Utilization Management (UM) Teams. Assist with Corporate Inter-Rater Reliability (IRR) Testing for Utilization Management (UM) staff to assess and measure the level of consistency among utilization management staff and adherence to organizational medical management criteria or standard.
Workforce Management Specialist
Blue Cross Blue Shield of Arizona
05.2019 - 12.2020
- Responsible for managing the performance of 150 telephonic intake and clinical vendor resources in India and the Philippines. Performed workforce management forecasting for off-shore employees along with Avaya phone system set-up. Accomplishments include creating reporting accuracy tools to manage nursing and customer services staff’s case load. Actively involved with creating desk level procedures for end-to-end users. Performed as the main point of contact for system issues associated to phone and data reporting for on-shore and off-shore staff. Responsible for executing daily workforce management reports for Leadership for appropriate off-shore staff. Responsible for supplying reports directly associated to turn around accuracy for Medicare Advantage Utilization Management. Participated in assisting itemization reports for Vendor Management of off-shore invoice accuracy.
Health Quality Assurance Partner Management Specialist
Blue Cross Blue Shield of Arizona
11.2016 - 05.2019
- Responsible for report management of assigned Wellness, Maternity and Disease Management contracts. Identified system enhancements for managing issue resolution tracking associated to Care Management and Disease Management. Implemented interdepartmental communication by creating a SharePoint for the department. Led efforts to implement business process improvement initiatives for onboarding new vendors, streamlining URAC oversite and annual complaint auditing. Created and managed on boarding processes for new hires for the department.
Quality Assurance Analyst
TriWest Health Care Alliance
12.2005 - 11.2016
- Responsible for the development and maintenance of Training and Quality Assurance Program materials for claims, customer service and healthcare services. Supported the implementation of system and program redesign. Worked closely with assigned Project Managers to determine the scope of training needs resulting in plans, schedules, and implementation of small to medium scale projects.
Education
High School Diploma -
Archbishop Brady
St. Paul, MNSkills
- Process optimization
- Quality improvement strategies
- System deployment
- Vendor performance oversight
- Skilled in Six Sigma process improvement techniques
- Data analysis and reporting in Microsoft CRM
References
Toni, Biddle, Toni.Biddle@azblue.com, 602-318-6600, Blue Cross Blue Shield of Arizona, Business Colleague
Timeline
Senior Business Process Analyst
TriWest Health Care Alliance
11.2022 - Current
Business Analyst/UM Business Change Specialist
Bright Healthcare/EXL Services (Bright Healthcare Contractor)
12.2020 - 11.2022
Workforce Management Specialist
Blue Cross Blue Shield of Arizona
05.2019 - 12.2020
Health Quality Assurance Partner Management Specialist
Blue Cross Blue Shield of Arizona
11.2016 - 05.2019
Quality Assurance Analyst
TriWest Health Care Alliance
12.2005 - 11.2016
High School Diploma -
Archbishop Brady
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