Nicole Elmore
Mc Calla,Alabama
Summary
Talented Policy Analyst with strong interpersonal, communication, and collaboration skills, seeking a position as a Unit Manager. 10+ years’ experience in medical policy, complex case management, predetermination, and utilization management. Efficient in streamlining internal operations and coaching various individuals, with the overall goal of increasing performance and productivity. Strong background in leadership, vendor negotiations, research, and data analysis. Organized, driven and adaptable with excellent planning and problem-solving abilities.
Overview
10
10
years of professional experience
Work History
Medical Policy Analyst I
Blue Cross Blue Shield Of Alabama
06.2018 - Current
- Conducted extensive research for proper billing practices to evaluate utilization and medical cost management decreasing costs by 10%.
- Researched and analyzed data related to medical policies and healthcare industry trends.
- Increased productivity by creating Transplant Work Group which has decreased amount of emails and questions regarding transplant related requests.
- Skilled in Employee Training and Education.
- Demonstrated project management skills by developing agendas, adherence to timelines, and interacting with and presenting information to different departments.
- Drafted and presented reports outlining policy actions.
- Modified, updated and processed existing policies.
- Maintained positive provider relations by addressing problems head-on and implementing successful corrective actions.
- Prepared and drafted new policies to benefit company in meeting objectives.
Transplant Care Coordinator- Registered Nurse
Blue Cross Blue Shield Of Alabama
06.2013 - 06.2018
- Stream-lined Transplant approval process to create better workflow for transplant team.
- Skilled in Transplant Predeterminations and Utilization management.
- Skilled in Employee Training and Education.
- Collaborated closely with Marketing, Claims, and Network Integrity regarding Transplant issues.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Analyzed clinical trial data and collaborated with physicians for determinations.
Education
American Academy of Professional Coders
Associate of Science - Nursing
Jefferson State Community College
Birmingham, AL05.2009
Bachelor of Science - Biology
Guilford College
Greensboro, NC12.1999
Skills
- Effective verbal and written communication skills
- Employee Training
- Leadership Skills
- Excellent conflict management and interpersonal skills
- Research and Critical Thinking
- Organizational Efficiency
- Skilled in Interpreting and Analyzing Data
- Excellent Presentation Skills
- Knowledge of Claims and Processing
- Experienced in NCQA standards
- Skilled in Complex Case Management
- Skilled in Utilization Management and Predetermination
Timeline
Medical Policy Analyst I
Blue Cross Blue Shield Of Alabama
06.2018 - Current
Transplant Care Coordinator- Registered Nurse
Blue Cross Blue Shield Of Alabama
06.2013 - 06.2018
American Academy of Professional Coders
Associate of Science - Nursing
Jefferson State Community College
Bachelor of Science - Biology
Guilford College
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