Summary
Overview
Work History
Education
Skills
Affiliations
Timeline
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Pamela Michele Getret-Ford

Pamela Michele Getret-Ford

Summary

Experienced professional with a proven track record of project management, leading and managing dynamic teams, growing business sectors, developing new business relationships, successfully reconciling cases, and adhering to quality standards in HEDIS data, Medicare Advantage Stars, Medicare/Medicaid, and 15 (+) years in the Health Care Industry. Account Manager at Lumen, Business Analyst at Carsom and Associates, and Network Contract Experience /Provider Relations at LA Workforce Commission and Optum. Skilled in multitasking in fast-paced environments, with experience in Matrix HR settings and delivering complex solutions in client-facing roles.

Overview

29
29
years of professional experience

Work History

Provder Relations

Optum
08.2024 - Current
  • Organized and detail-oriented with a strong work ethic.
  • Learns and adapts quickly to new technology and software applications.
  • Consistently Proves ability to learn quickly and adapt to new situations.
  • Assists with day-to-day operations, working efficiently and productively with all team members.
  • Demonstrates strong organizational and time management skills while managing multiple projects.
  • Strengthens communication skills through regular interactions with others.
  • Cultivate interpersonal skills by building positive relationships with others.
  • Use strong analytical and problem-solving skills to develop effective solutions for challenging situations.
  • Convey excellent communication skills, both verbal and written.
  • Completes tasks, recognize discrepancies and promptly address for resolution.
  • Use critical thinking to break down problems, evaluate solutions and make decisions.
  • Manage time efficiently in order to complete all tasks within deadlines.
  • Adaptable individual with exceptional interpersonal skills and talent for building relationships. Known for delivering outstanding service and enhancing client satisfaction. Focuses on fostering positive interactions and creating collaborative environment.
  • Demonstrates respect, friendliness and willingness to help wherever needed.
  • Works effectively in fast-paced environments.
  • Self-motivated, with a strong sense of personal responsibility.
  • Demonstrates a high level of initiative and creativity while tackling difficult tasks.
  • Pays attention to detail while completing assignments.
  • Resolves problems, improves operations and provides exceptional service.
  • Adaptable and proficient in learning new concepts quickly and efficiently.

Business Analyst

Carsom and Associates
11.2020 - 03.2025
  • Optimized data access and storage to improve performance of analytics systems.
  • Updated and developed scripts and queries to extract and analyze data from multiple sources.
  • Implemented business intelligence solutions to increase operational efficiency.
  • Utilized data visualization techniques to present and explain complex data sets.
  • Created data models to support decision-making processes.
  • Developed data mining algorithms to identify and classify patterns in data.
  • Designed and developed data pipelines to acquire, clean and process data.
  • Developed complex dashboard and reporting tools to track business performance metrics.
  • Generated standard and custom reports to provide insights into business performance.
  • Collaborated with stakeholders to identify business needs and data sources.
  • Developed customized reports, summarizing and presenting data in visually appealing format.
  • Developed and maintained data warehouses and data marts to support business operations.
  • Analyzed data to identify root causes of problems and recommend corrective actions.
  • Deployed predictive analytics models to forecast future trends.
  • Identified patterns and trends in large data sets and provided actionable insights.
  • Generated ad-hoc reports to evaluate specific business requirements.
  • Developed and implemented data governance policies and procedures.

Provider Relations Advocate

Optum
07.2023 - 08.2024
  • Helped meet changing demands by recommending improvements to business systems or procedures.
  • Conducted regular reviews of operations and identified areas for improvement.
  • Developed effective improvement plans in alignment with goals and specifications.
  • Collected, arranged, and input information into database system.
  • Supported creation of detailed, technical financial models to value potential acquisition targets.
  • Evaluated customer needs and feedback to drive product and service improvements.
  • Optimized customer experience by delivering superior services and effectively troubleshooting issues.
  • Provided reporting for forecast analysis and ad-hoc reporting in support of decision-making.
  • Devised and implemented processes and procedures to streamline operations.
  • Educated staff on organizational mission and goals to help employees achieve success.
  • Maintained database systems to track and analyze operational data.
  • Generated reports detailing findings and recommendations.
  • Gathered, organized and input information into digital database.
  • Provided professional services and support in a dynamic work environment.

Care Navigator

Optum
03.2022 - 07.2023
  • Educated member on gaps in care and assisted with scheduling provider appointments.
  • Maintained confidential health information according to state and federal regulations.
  • Assisted members with social determinants of health and linked to appropriate community resources.
  • Identified gaps in care and assisted in closure of gaps.
  • Identified barriers when treatment goals not met, treatment plan not followed or important appointments missed and collaborated in redeveloping patient treatment goals.
  • Educated patients on insurance and healthcare plans.
  • Developed care plan based on provider treatment plan, evidence-based chronic care guidelines and patient and family goals for patient.
  • Participated in regular team meetings, huddles, staff meetings and quality improvement projects to improve patient care.
  • Assisted patients in scheduling doctor and healthcare appointments.
  • Coached patients on self-advocacy.
  • Facilitated nursing care and individual patient and family education to support high risk and chronic disease management.
  • Organized patient schedules and assisted in planning transportation and payments.
  • Assisted with and facilitated transition of care from hospitals, rehabilitation facilities, and skilled nursing facilities to home.
  • Consulted with medical staff and ancillary department to eliminate barriers to delivery of care and identified service delivery problems and potential for patient management intervention.
  • Applied administrative knowledge and courtesy to explain procedures and services to patients.
  • Helped address client complaints through timely corrective actions and appropriate referrals.
  • Resolved customer complaints using established follow-up procedures.
  • Provided excellent customer service to patients and medical staff.
  • Compiled and maintained patient medical records to keep information complete and up-to-date.
  • Followed document protocols to safeguard confidentiality of patient records.
  • Offered simple, clear explanations to help clients and families understand hospital policies and procedures.
  • Worked with patients to ascertain issues and make referrals to appropriate specialists.
  • Recommended service improvements to minimize recurring patient issues and complaints.

Account Manager

Lumen Technologies
04.2021 - 10.2021
  • Consulted with businesses to supply accurate product and service information.
  • Attended monthly sales meetings and quarterly sales trainings.
  • Maintained current knowledge of evolving changes in marketplace.
  • Collaborated with managers to provide customer feedback and recommend operational changes to meet emerging trends.
  • Greeted customers and offered assistance with selecting merchandise, finding accessories and completing purchases.
  • Developed, maintained and utilized diverse client base.
  • Achieved or exceeded company-defined sales quotas.
  • Worked with sales team to collaboratively reach targets, consistently meeting or exceeding personal quotas.
  • Set and achieved company defined sales goals.
  • Informed customers of promotions to increase sales productivity and volume.
  • Contributed to team objectives in fast-paced environment.
  • Negotiated prices, terms of sales and service agreements.
  • Fielded customer complaints and facilitated negotiations, resolving issues and reaching mutual conclusions.
  • Built relationships with customers and community to promote long term business growth.

Network Contract Manager

Louisiana Workforce Commission
01.2008 - 04.2021
  • Mitigated business risks by analyzing contracts' potential impacts and avoiding unfavorable terms.
  • Tracked contracts for management and issued regular tracking reports covering current status and upcoming milestones.
  • Onboarded and trained new staff to keep team efficient and prepare team members to effectively handle demands of simultaneous and large-scale contracts.
  • Monitored contracts' performance to detect non-compliance with terms and deficient returns and organize proactive resolutions.
  • Maintained AWARE database for with contract, vendor and customer information.
  • Analyzed new laws and regulations to identify required changes and proactively adjust systems.
  • Interpreted contact terms and coordinated solutions to resolve disputes between clients and service providers.
  • Managed, supervised and controlled execution of contracts ranging from $5,000 to $150,000
  • Compiled required documentation to keep contracts compliant with Medicare/Medicaid requirements.
  • Negotiated and executed contracts on behalf of department.
  • Improved office operations by automating client correspondence, record tracking and data communications.
  • Coordinated office events, seminars and meetings for staff and clients.
  • Built and managed processes for tracking and monitoring department performance.
  • Improved customer satisfaction scores through application of superior conflict resolution and problem-solving skills.
  • Identified opportunities to streamline processes and improve office operations and efficiency.
  • Implemented project management techniques to overcome obstacles and increase team productivity.
  • Cultivated strong relationships with vendors and partners supporting administrative operations.
  • Organized and updated databases, records and other information resources.
  • Built highly-efficient administrative team through ongoing coaching and professional development opportunities.
  • Created reports, presentations and other materials for executive staff.
  • Created organized filing system to manage department documents.
  • Hired, managed, developed and trained staff, established and monitored goals, conducted performance reviews and administered salaries for staff.
  • Analyzed and solved multi-faceted problems that effected executive leaders and business initiatives.

Case Manager

Department of Children and Family Services
11.2006 - 01.2008
  • Developed and implemented comprehensive case management plans to address client needs and goals.
  • Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
  • Assisted clients in navigating housing, legal services and public benefits to gain access to valuable resources.
  • Provided leadership, guidance and support to staff members.
  • Developed and implemented training programs for staff.
  • Established and maintained relationships with key stakeholders.
  • Researched best practices and developed strategies to improve program outcomes.
  • Advocated for social and community service programs to increase awareness and funding.
  • Analyzed trends and data to inform decision-making and program development.
  • Referred clients to appropriate team members, community agencies and organizations to meet treatment needs.

Unemployment Claims Team Leader

Louisiana Workforce
03.2006 - 11.2006
  • Reviewed applications for different aid programs and determined which qualification criteria for individuals.
  • Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
  • Communicated with people from various cultures and backgrounds on application process.
  • Sorted out jobs relevant to interests of candidates to forward information to candidates.
  • Scheduled appointments with applicants to gather information and explain benefits processes.
  • Used strong analytical and problem-solving skills to develop effective solutions for challenging situations.
  • Worked effectively in fast-paced environments.
  • Demonstrated a high level of initiative and creativity while tackling difficult tasks.

Insurance Claims Analyst

State Farm
10.2001 - 03.2005
  • Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
  • Evaluated original investigation reports and documents to resolve secondary concerns.
  • Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
  • Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
  • Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
  • Analyzed information gathered by investigation and reported findings and recommendations.
  • Followed up on potentially fraudulent claims initiated by claims representatives.
  • Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred.
  • Maintained claims data in varies systems.
  • Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.

Assistant Store Manager

Books-A-Million
04.1996 - 10.2001
  • Supervised and evaluated staff to help improve skills, achieve daily objectives, and attain advancement.
  • Rotated merchandise and displays to feature new products and promotions.
  • Walked through store areas to identify and proactively resolve issues negatively impacting operations.
  • Reconciled daily sales transactions to balance and log day-to-day revenue.
  • Provided weekly work schedules to employees to accommodate business demands and vacation requests.
  • Managed opening and closing procedures and recommended changes to enhance efficiency of daily activities.
  • Processed payments for credit and debit cards and returned proper change for cash transactions.
  • Interviewed, hired, and trained staff associates and equipped to comply with company policies and procedures.
  • Developed and maintained strong relationships with vendors to facilitate timely product delivery.
  • Analyzed customer feedback and implemented strategies to improve customer experience.
  • Created and maintained safe and secure work environments for employees.
  • Supervised creation of exciting merchandise displays to catch attention of store customers.
  • Launched staff engagement, gender diversity and cultural programs in addition to robust reporting tool that increased operational quality.
  • Managed purchasing, sales, marketing and customer account operations efficiently.
  • Implemented business strategies, increasing revenue, and effectively targeting new markets.
  • Reduced financial inconsistencies while assessing and verifying billing invoices and expense reports.
  • Handled problematic customers and clients to assist lower-level employees and maintain excellent customer service.
  • Scheduled employees for shifts, taking into account customer traffic and employee strengths.
  • Trained and guided team members to maintain high productivity and performance metrics.
  • Reported issues to higher management with great detail.
  • Tracked employee attendance and punctuality, addressing repeat problems quickly to prevent long-term habits.
  • Verified inventory counts remained within monthly tolerance levels and compiled financial data in compliance with budget.
  • Coached sales associates in product specifications, sales incentives, and selling techniques, significantly increasing customer satisfaction ratings.

Education

BS - CRIMINAL JUSTICE, Psychology

GRAMBLING STATE UNIVERSITY

Master of Health Administration -

Capella University
10.2025

Skills

  • Salesforce proficiency
  • Avaya system expertise
  • Genesys platform expertise
  • CRM software proficiency
  • Proficient in Zoom
  • TEAMS
  • NICE
  • Pulse
  • Proficient in IEX
  • Adobe Sign
  • PowerPoint
  • Advanced Excel proficiency
  • Proficient in Microsoft Office
  • Outlook
  • Visual presentation design
  • Access
  • Tableau analytics proficiency
  • Proficient in BI tools
  • SharePoint
  • CMS
  • CTI
  • Proficient in COSMOS
  • Snowflake
  • SQL data analysis
  • Facets
  • OnBase
  • ACET
  • LeaveSource
  • EAdmin
  • CPT coding
  • ICD-9 coding
  • Data Analysis
  • MedNet system expertise
  • Six Sigma

Affiliations

  • Executive Board-Living Well Foundation- January 2021-Present

Timeline

Provder Relations

Optum
08.2024 - Current

Provider Relations Advocate

Optum
07.2023 - 08.2024

Care Navigator

Optum
03.2022 - 07.2023

Account Manager

Lumen Technologies
04.2021 - 10.2021

Business Analyst

Carsom and Associates
11.2020 - 03.2025

Network Contract Manager

Louisiana Workforce Commission
01.2008 - 04.2021

Case Manager

Department of Children and Family Services
11.2006 - 01.2008

Unemployment Claims Team Leader

Louisiana Workforce
03.2006 - 11.2006

Insurance Claims Analyst

State Farm
10.2001 - 03.2005

Assistant Store Manager

Books-A-Million
04.1996 - 10.2001

BS - CRIMINAL JUSTICE, Psychology

GRAMBLING STATE UNIVERSITY

Master of Health Administration -

Capella University

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Pamela Michele Getret-Ford