Dress for Success New Orleans, Immediate Past Board President
NADINE HAMPTON BROWN
Provider Operations Leader
LA
Summary
Seasoned Provider Data Operations Manager and talented leader with over 20 years of experience applying exceptional planning and problem-solving abilities toward enhancing business plans and day-to-day activities. Results-driven and resilient in developing teams while improving processes and increasing productivity. Bringing solid understanding of industry trends, excellent communication skills, talent for spotting areas in need of improvement and implementing changes with strategic approach.
Overview
25
25
years of professional experience
2
2
years of post-secondary education
Work History
Manager, Provider Data
Peoples Health
Metairie, LA
01.2013 - Current
- Maintains network provider records and develops maintenance strategies that are compliant with regulatory and organizational requirements
- Ensures all provider records are compliant with CMS, state guidelines, and accreditation requirements
- Work directly with Provider Relations to ensure provider disputes are handled in a fast, fair, and cost-effective manner
- Implemented process automation initiatives that reduced cost and increased team productivity
- Works with managers and staff at all levels of the organization to explore solutions, resolve problems, redistribute resources, and adjust priorities to meet the changing program needs of the department and to ensure progress in meeting departmental goals and benchmarks
- Set team direction and provide guidance to all staff members
- Review contact reimbursement language to determine provider financial set-up in the claims processing system.
- Worked closely with organizational leadership to guide operational strategy.
- Oversaw operations and provided corrective feedback to achieve daily and long-term goals.
- Monitored office workflow and administrative processes to keep operations running smoothly.
- Established departmental performance goals and provided feedback for underperforming areas.
Provider Affiliation Supervisor
Peoples Health
Metairie, LA
01.2006 - 01.2007
- Maintained daily production standards to ensure timely processing of claims
- Monitored workflow to improve employee time management and increase productivity.
- Evaluated employee performance and coached and trained to improve weak areas.
- Mentored newly hired employees and developed training manual to use for reference.
- Created and managed project plans, timelines and budgets.
- Investigated and resolved complex provider data management issues
- Monitored team performance to ensure established and provider data quality benchmarks are met.
Claims Trainer
Peoples Health
Metairie, LA
01.2005 - 01.2006
- Designed, implemented, and conducted claims training, including development of training materials and identify training needs
- Communicated training progress to management during and after training in a qualitative and efficient matter
- Train and/or re-train Claims staff to support department operations including claims processing, adjustments, overpayment recoupment, auditing
- Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
- Identified department needs, developed training materials and implemented strategies to prepare employees thoroughly for job demands.
- Conducted needs assessments to identify gaps in performance and develop targeted learning solutions.
Benefits Configuration Analyst
PEOPLES HEALTH
Metairie, LA
01.2000 - 01.2004
- Configured software applications to ensure the correct provision of benefits to members, and payments to providers according to current year plan bids and provider contracts
- Solved configuration issues and implemented solutions with appropriate documentation and Manager approval
- Assisted Network Development with auditing of contract/amendment configuration
- Identified and implemented all additions/changes to benefits/pricing requirements initiated by CMS.
Marketing Representative
HOMESIGHT OF SOUTHEAST LA
Lutcher, LA
01.1999 - 01.2000
- Established relationships with referral sources such as physicians, hospitals, long-term care facilities and assisting living facilities.
- Ensured referral source lists were governed by the organization and approved.
- Communicated frequently with all referral sources to ensure the expectations of referral sources and patients’ needs were satisfied
- Evaluated marketing strategies and make necessary recommended changes to Management.
- Determined customers' needs and provided brand awareness and recommendations to fulfill requirements.
- Strengthened outreach by coordinating events to maximize marketing initiatives.
Education
Medical Assistant -
Ascension College
Gonzales, LA 08.1995 - 12.1996
Management & Leadership Certification -
Louisiana State University
Baton Rouge, LA 04.2014 - 04.2015
Skills
Excel, Word, PowerPoint, SQL, Amisys Advance (claims systems), Macess EXPundefined
Interests
Emerging Philanthropist of New Orleans Alumnae
Young Audiences of Louisiana Charter Schools Board Member
Peoples Health Culture Inclusion and Diversity Committee Chair
Links, Inc Member
Timeline
Management & Leadership Certification -
Louisiana State University
04.2014 - 04.2015
Manager, Provider Data
Peoples Health
01.2013 - Current
Provider Affiliation Supervisor
Peoples Health
01.2006 - 01.2007
Claims Trainer
Peoples Health
01.2005 - 01.2006
Benefits Configuration Analyst
PEOPLES HEALTH
01.2000 - 01.2004
Marketing Representative
HOMESIGHT OF SOUTHEAST LA
01.1999 - 01.2000
Medical Assistant -
Ascension College
08.1995 - 12.1996
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