Monica Standfill
Stockton,CA
Summary
With over 23 years of experience in managed healthcare and third-party administration, I have excelled in roles such as billing manager, call center supervisor, and production operation units. As an outgoing and self-motivated leader, I constantly seek opportunities to expand my knowledge in the ever-evolving healthcare industry. Bringing strategic leadership and operational excellence, I drive organizational success as a senior management professional. My skills in project management, team collaboration, and process optimization allow me to achieve results with a keen focus. I navigate complex challenges, foster a culture of accountability, and adapt to evolving business needs. Known for strong decision-making abilities, effective communication, and building high-performing teams, I am dedicated to driving success in any organization.
Overview
23
23
years of professional experience
Work History
Senior Manager of Provider Relations
Blue Shield of California
12.2022 - Current
- Experienced in project management and adept at utilizing data-driven insights to inform strategic decisions
- Effectively managing team with a book of business that includes 8 IPA’s and over 34 large hospital systems
- Managed large-scale projects and introduced new systems, tools, and processes to achieve challenging objectives.
- Implemented and developed operational standards, policies and procedures.
- Conducted performance evaluations, compensations and hiring to maintain appropriate staffing requirements.
- Utilized data-driven insights to make informed decisions that resulted in higher returns on investments.
Senior Provider Relations Coordinator
Blue Shield of California
11.2018 - 12.2022
- Lead and organize meetings with stakeholders, present metrics, explain policies, and provide expertise to 3 IPA's, large northern California territories of hospitals, surgery centers and specialty providers
- Achieve a 100% Excellent rating on external surveys and participate in transformation work while demonstrating Blue Shield's values
- Monitored contractual agreements with providers, ensuring adherence to established terms and conditions while fostering positive working relationships.
- Evaluated provider feedback regarding organizational processes or policies, sharing insights with relevant stakeholders for continuous improvement efforts.
- Conducted regular provider audits to ensure compliance with company policies and industry regulations.
Group Billing Manager
Blue Shield of California
01.2017 - 11.2018
- Manager overseeing 1 operational specialist and 20 direct reports, ensuring $900 million in receivables are collected monthly
- Maintain performance dashboards and provide financial summaries for senior management's data-driven decisions
- Conduct daily, weekly, and monthly financial reporting, variance analysis, and presentations
- Set performance and learning goals for staff
- Coordinate month-end close activities, reviewing system entries
- Develop and track retroactive adjustment revenue
- Perform supervisory duties including one-on-ones, engagement, timekeeping, scorecards, and coaching
Relationship Management Supervisor
Blue Shield of California
09.2016 - 01.2017
- Responsible for addressing issues on a broader scale for all Installation and Billing Operations Teams
- Collaborate with EDI, Operational Governance, and Incident Support Teams to identify, resolve, and respond to internal and external partners
- Streamline customer interactions to enhance the overall customer experience
- Managed a diverse team of professionals, fostering an inclusive and collaborative work environment to drive success. Responsible for 600M in billing revenue inquiries
Interim Manager for Small/Large Group-Group Teams
Blue Shield of California
04.2016 - 09.2016
- Manage two teams of over 20 intermediate and senior processors, including contingent staff
- Ensure 98%+ SLA compliance for access to care for new and renewing large groups
- Track and maintain SLAs for all large group maintenance work
- Handle timecards, performance management, engagement building, interviews, and project management for large groups like CalPERS
- Implement cross-training plans, manage changes, and collaborate daily with Underwriting, Sales, Product, Member, and Conversion Teams
- Continuously recognized for consistent meeting of the Access to Care goals that was previously outside of goal
- Recruiting for Supervisors and Processors writing all interview questions, scheduling, and onboarding
Large Group Installation and Renewal Supervisor
Blue Shield of California
04.2015 - 04.2016
- Manage a team made up of intermediate and senior large group processors, analysts, and contingent staff
- Responsible for meeting business SLA of 98% or better for access to care for all large (LG) new and renewing groups
- Track and maintain SLA’s for all LG maintenance work
- Process timecards, performance management, build engagement, conduct interviews, project manage LG such as CalPERS
- Work through change management, build and implement cross-training plans and partner with Underwriting, Sales, Product, Member and Conversion Teams daily
- Awarded in May 2015 for mentoring Supervisor
- Continuously recognized for consistently meeting Access to Care goals previously outside of goal
- Awarded for sharing best hiring practices and organizing successful job fairs
- Recognized as an engagement leader
Customer Care Business Readiness Supervisor
Blue Shield of California
07.2013 - 04.2015
- Supervised a team of 33 comprising processors and analysts—both exempt, non-exempt, and contingent staff
- Responsibilities included reviewing daily inventory and cycle times, meeting and exceeding system implementation timeframes, drafting and testing documented learning processes (DLP), focusing on inventory management, team engagement, and performance management
- Additionally, wrote interview questions, conducted interviews, ensured execution of pre- and post-group membership migrations across all business lines, completed payroll, maintained attendance records, collaborated closely with the manager and director of Installation and Billing, reported, analyzed, and planned system fixes and workflows, and was cross trained in all systems and business lines
- 22 employees successfully hired and onboarded in Q1 of 2014
- Recognized for mentoring new Supervisors
- Recognized as an engagement leader
Customer Operations Supervisor
Blue Shield of California
02.2012 - 07.2013
- Managed a team of 19 Customer Service Representatives, reviewed daily statistics, and met or exceeded expectations for first call resolution, average handle time, and customer satisfaction ratings
- Completed payroll with a high focus on team engagement and attendance, partnered closely with peers and stakeholders, and reported to senior management
- Awarded bonuses for supervising a top-performing team and exceeding goals, establishing the best attendance records in one year
- Appointed to hire 45 new customer service representatives in collaboration with recruiting
- Rapidly mastered systems for reporting purposes
- Awarded a bonus trip to Las Vegas on 11/15/2012 for achieving the most World Class Calls within the first quarter
Appeal/Grievance Coordinator
Health Plan of San Joaquin
04.2008 - 03.2010
- Handled all Appeals and Grievances from Members and Providers and escalated calls and questions from customer service staff
- Reported quarterly on appeals and grievances to major health bureaus (DMHC, MRMIB, DHS)
- Responded timely within Medicare and private insurance guidelines with acknowledgment and resolution letters
- Organized a grievance committee to review priority cases and rulings, tracked and followed through to completion on state fair hearing cases, MRMIB inquiries, and claims resolutions
- Collaborated closely with quality assurance and Utilization Management for timely case resolution
- Maintained HIPPA compliance with yearly regulation and law renewals, developed workflows for tracking appeals, and ensured accurate processing of facility and professional claims across multiple lines of business
- Trained providers on EDI, started an auditing unit for claims, reviewed and processed reinsurance cases, conducted trainings on new contracts and business lines, organized incoming processing materials, and served as a lead and SME in the Claims unit
- Received recognition from Chief Operational Officer for successful reporting two years in a row
- Implemented unity and workflows between Utilization Management, Quality Review, Claims Department, and Member Services to meet timelines effectively for Member/Provider Grievance and Appeals
- Received peer-voted Member Services award for effective Team Leadership
- Implemented and led Claims Auditing Unit
- Served as a Supervisor mentor
- Acknowledged by Human Resources for handling Performance Management professionally and respectfully
- Recognized as a top performer in Productivity and Accuracy in claims processing
- Delivered successful trainings on EDI processes to external Providers
- Promoted four times in six years in the Claims Department at HPSJ
Claims Analyst IIII, Claims Auditor, Reinsurance Coordinator
Health Plan of San Joaquin
11.2001 - 04.2008
Education
Some College (No Degree) - Registered Health Information Administration
Modesto Jr. College
Modesto, CASkills
Strategic planning
Cross-functional collaboration
Operations management
Staff management
Customer relationship management
Managing operations and efficiency
Timeline
Senior Manager of Provider Relations
Blue Shield of California
12.2022 - Current
Senior Provider Relations Coordinator
Blue Shield of California
11.2018 - 12.2022
Group Billing Manager
Blue Shield of California
01.2017 - 11.2018
Relationship Management Supervisor
Blue Shield of California
09.2016 - 01.2017
Interim Manager for Small/Large Group-Group Teams
Blue Shield of California
04.2016 - 09.2016
Large Group Installation and Renewal Supervisor
Blue Shield of California
04.2015 - 04.2016
Customer Care Business Readiness Supervisor
Blue Shield of California
07.2013 - 04.2015
Customer Operations Supervisor
Blue Shield of California
02.2012 - 07.2013
Appeal/Grievance Coordinator
Health Plan of San Joaquin
04.2008 - 03.2010
Claims Analyst IIII, Claims Auditor, Reinsurance Coordinator
Health Plan of San Joaquin
11.2001 - 04.2008
Some College (No Degree) - Registered Health Information Administration
Modesto Jr. College
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