Michelle Phillipy
Phoenix,AZ
Summary
Leader leveraging extensive experience and problem-solving skills to communicate work priorities, deadlines, and parameters to meet organizational goals with accuracy while maintaining customer service excellence. A track record of ensuring client satisfaction through effectively training team members, understanding client needs, and analytical reasoning. Listens to ideas and feedback from team members and adjusts the strategy if necessary.
Overview
13
13
years of professional experience
Work History
Care Coordinator
Optum, UnitedHealth Group
10.2024 - Current
- Entered customer demographic data into company databases.
- Logged call information and solutions provided into the internal database.
- Joined forces with clinical staff to assist Military beneficiaries and their dependents in coordinating 24-hour a day, 7-day-a-week acute care services.
Network Engagement Manager
UnitedHealthcare
02.2023 - 08.2023
- The NEM role is a provider facing critical role tied to UHN affordability thru Point of Care Assist activation, utilizing along with provider performance through the HPP program, reflecting the company’s strategic investment in improving the provider’s network performance.
- Outreached to approximately 20 UHN contracted providers to discuss ways to improve provider relationships by decreasing costs and abrasions by leveraging technology tools (EPP, POCA, DocASAP, API Marketplace, etc.).
- Independently, led engagement management initiatives including working with external providers on the appropriate use of network resources and tools, adoption of point of care enablement technology, self-service adoption, all interoperability efforts and affordability targets, and overall education, resulting measure target improvement over 10%.
- Partnered with EMR vendor partners to drive Point of Care Assist adoption, activation, and utilization, resulting in a 25% increase in engagement.
- Analyzed and reported on KPIs to validate and demonstrate success of marketing campaigns.
- Developed creative presentations, trend reports, kitted assets, and product data sheets. Mentored Practice Administrators on best practices and protocols to maximize productivity.
Population Health Manager
Bayless Integrated Healthcare
08.2020 - 08.2021
- Work directly with the Clinical Outcomes Director to improve health outcomes. Responsible for collecting, tracking, analyzing, and reporting the status of outcomes/KPIs for the department’s scorecard and dashboard to include approximately 175 providers..
- Improved the health outcomes of a group of patients by monitoring and identifying individual patients within that group, based on their behavioral health, psychiatric, and/or medical conditions.
- Advocated for patient healthcare needs by coordinating care to minimize the fragmentation of the healthcare delivery systems, to include a 78% increase in Annual Wellness visits, assisting in the continuity of care.
- Created customized chart prep care plans, working with hospital staff and families to assess and meet individual needs.
HEDIS Coordinator
Blue Cross Blue Shield of Arizona FEP
06.2017 - 02.2020
- Responsible for making Arizonans healthier by discovering, reviewing, implementing, and reporting outcomes for approximately 30 initiatives annually focused on preventive care and chronic disease. Assisted with planning, budgeting, legal requirements, and structuring health fairs throughout Arizona.
- Developed, organized, and conducted quarterly educational webinars for the provider network, including application and delivery of CEs.
- Created and published a quarterly provider newsletter focusing on selected topics regarding quality improvement.
- Developed focused resources and published on the company website concerning HEDIS measures, detailing measure definition, coding requirements for compliance, and improvement strategies. The conception of ideas, creation of programs, implementation, and reporting are ongoing requirements.
- Entered data, generated reports, and produced tracking documents.
- Gathered and organized materials to support operations.
- Organized meetings for executives and coordinated the availability of conference rooms for participants.
- Coordinated individual duties after careful evaluation of each employee's skill level and knowledge.
- Improved customer satisfaction scores through application of superior conflict resolution and problem-solving skills.
- Resolved issues through active listening and open-ended questioning, escalating major problems to the manager.
Program Manager
HonorHealth
11.2012 - 09.2016
- Responsible for creating and implementing operational policies and procedures, and fostering a creative and innovative environment to assist in meeting Population Health strategic initiatives. Championed and contributed to CMS/MSSP EHR Incentive Programs attestation and quarterly attribution management.
- Coordinated all CMS education and communication amongst 10 direct reports and 70 primary care offices to include up to 6 providers per practice, appropriate administration to ensure compliance. Coordinated all efforts for PQRS/GPRO annual MSSP reporting.
- Served as a program administrator that interfaced and was a resource to provider practices and medical staff.
- Developed and prepared program metrics, outcomes, and reports.
- Supervised Patient Navigators and Data Analysts in program development and maintenance efforts.
- Achieved operational objectives by contributing information and recommendations to strategic plans and reviews; preparing and completing action plans; implementing production, productivity, quality, and customer-service standards; resolving problems; completing audits; identifying trends; determining system improvements; and implementing change.
- Worked closely with BCBS and Optum PCMH programs to improve STARS metrics, hence providing a superior patient experience and creating the foundation to improve the health of Arizonans, as well as achieving high incentive dollars for the network.
- Met with project stakeholders regularly to assess progress and make adjustments.
- Addressed and resolved technical, financial, and operational concerns by working with team members and directors.
- Coached team members on productivity strategies to accomplish challenging goals.
- Interacted with customers and clients to identify business needs and requirements.
- Devised creative solutions to critical customer and user needs.
- Identified program obstacles and communicated possible impacts to the team.
- Demonstrated strong writing and presentation skills to develop briefs, memorandums, and analytical reports for Network Providers, ACO Providers, and all Practice administrators.
- Worked with subject matter experts to develop and implement mentoring programs to promote better learner experiences.
- Collaborated with business leadership to set priorities based on business needs, resource capacity and risk exposure.
- Facilitated workshops and conducted one-on-one training to educate team members.
- Participated in pilot tests and revised programs based on feedback and results.
- Engaged and worked alongside cross-functional stakeholders to manage strategic initiatives.
- Leveraged project management processes and tools to define and execute projects.
- Set aggressive targets for employees to drive company success and strengthen motivation.
- Defined clear targets and objectives and communicated to other team members.
- Established team priorities, maintained schedules and monitored performance.
- Established performance goals for employees and provided feedback on methods for reaching those milestones.
- Streamlined and monitored quality programs to alleviate overdue compliance activities.
- Evaluated employee performance and conveyed constructive feedback to improve skills.
- Leveraged data and analytics to make informed decisions and drive business improvements.
- Planned, created, tested, and deployed system life cycle methodology to produce high-quality systems to meet and exceed customer expectations.
Data Analyst
HonorHealth
04.2012 - 04.2015
- Worked with clients and business owners to understand their business needs to help define project requirements supporting HCC Improvement, cost efficiency, reduction in hospital utilization, and risk plan management.
- Provided regularly scheduled reports about physician and practice referral trends, claims data, the overall increase in annual PPMP, procedural services, imaging rates, and hospital utilization to key stakeholders.
- Created ad-hoc reports for medical experts and managers, with Business Intelligence apps, Qlikview, Excel.
- Consulted medical experts on the design and implementation of diagnostic reporting projects that successfully increased the accuracy of HCC scoring and changed the standard of scheduling and chart maintenance.
- Developed and implemented program schedules to meet deadlines for a Blue Cross Blue Shield- PCMH risk contract and a UHC-Optum risk plan, all while ensuring each program-maintained profitability.
- Identified and tracked key milestones while managing plans and recommended adjustments to cross-functional team plans as needed resulting in successful reporting and an increase in a year-to-year incentive from multiple insurance companies..
- Monitored and communicated the progress of each risk program delivery and ensured timely and effective communication of the status in schedule and assessment of risks/issues.
- Negotiated and influenced cross-functional teams to ensure appropriate resourcing levels are engaged and maintained throughout the execution of the plan allowing successful improvement in HCC scoring and improvement in chart maintenance and scheduling.
- Lead three data analysts from fruition of the Population Health, and the ACO department of HonorHealth, then John C. Lincoln, Network and ACO.
- Assisted in John C. Lincoln renewal to include collaboration with all Network providers as well as sustaining up to 42 speacialty providers to assist in providing continuity of care resulting in quality measurement results.
- Created various Excel documents to assist with pulling metrics data and presenting information to stakeholders for concise explanations of best placement for needed resources.
- Produced monthly reports using advanced Excel spreadsheet functions.
- Utilized data visualization tools to effectively communicate business insights.
- Used statistical methods to analyze data and generate useful business reports.
- Created dashboards to monitor and track key performance indicators.
- Generated standard and custom reports to provide insights into business performance.
- Generated ad-hoc reports to evaluate specific business requirements.
- Utilized data visualization techniques to present and explain complex data sets.
- Developed and maintained data warehouses and data marts to support business operations.
- Developed data mining algorithms to identify and classify patterns in data.
- Identified patterns and trends in large data sets and provided actionable insights.
- Created data models to support decision-making processes.
- Deployed predictive analytics models to forecast future trends.
Education
Bachelor of Science - Health Education Health Promotion
Arizona State University
Phoenix, AZAssociate of Arts - Healthcare Administration
University of Phoenix
PhoenixSkills
- Proficient in Microsoft Office Word, Excel, PowerPoint, Publisher and Access
- Department go-to person for all computers, reporting issues
- QlikView
- Application Support
- Proficient in all BCBSAZ FEP, Computational Software- BI and Epic applications
- Business Objects Report Developer
- Multidisciplinary team collaboration
- Data entry
- Medical terminology
- Interdepartmental collaboration
- Healthcare operations
- Stakeholder management
- Data interpretation
- Implementation management
- Decision-making
- Self-Directed
Accomplishments
- Supervised team of 25 staff members.
- Collaborated with team of 15 in the development of quality improvement measurement projects.
- Achieved Medicare Shared Savings, MSSP by completing analysis and data capturing with accuracy and efficiency.
- Achieved 1.6 million dollars in incentives through effectively helping with OPTUM STARS.
- Achieved $650,000. in incentives through effectively developing programs with BCBS PPO, incentive program.
- Achieved improved quality measures results, such as preventative care, chronic disease management, and patient experience with identified populations through effectively creating education resources as well as close collaboration with primary care office managers..
Core competencies
- Proactive Healthcare
- Network Engagement Management
- Health Information Technology
- Community Outreach
- Continuous Process Improvement
- Data Analysis
- Patient Advocacy
Timeline
Care Coordinator
Optum, UnitedHealth Group
10.2024 - Current
Network Engagement Manager
UnitedHealthcare
02.2023 - 08.2023
Population Health Manager
Bayless Integrated Healthcare
08.2020 - 08.2021
HEDIS Coordinator
Blue Cross Blue Shield of Arizona FEP
06.2017 - 02.2020
Program Manager
HonorHealth
11.2012 - 09.2016
Data Analyst
HonorHealth
04.2012 - 04.2015
Bachelor of Science - Health Education Health Promotion
Arizona State University
Associate of Arts - Healthcare Administration
University of Phoenix
Similar Profiles
Lisa PorterfieldLisa Porterfield
Executive Assistant at Optum, UnitedHealth GroupExecutive Assistant at Optum, UnitedHealth Group
Briana MakuzaBriana Makuza
Senior Customer Service Representative at Optum, UnitedHealth GroupSenior Customer Service Representative at Optum, UnitedHealth Group
ANGEL J. RIVERAANGEL J. RIVERA
Customer Care Representative at Optum, UnitedHealth GroupCustomer Care Representative at Optum, UnitedHealth Group
Daniel TurczynowskyDaniel Turczynowsky
Operations Service Supervisor at First Citizens BankOperations Service Supervisor at First Citizens Bank
Alexis R. SmithAlexis R. Smith
Director of Operations – Grants Management & Donor Engagement at Jewish Family & Children’s ServiceDirector of Operations – Grants Management & Donor Engagement at Jewish Family & Children’s Service