Priscilla Pacheco

- Collaborated with cross-functional leadership to develop operational strategies that improved case development and advanced STAR ratings

- Managed day-to-day operations using critical thinking to meet SLAs and KPIs for improved customer service.

- Led compliance audits and data trend analysis on over 1,500 cases to track performance metrics aligned with organizational strategy.

- Directed process optimization initiatives that reduced vendor grievances by 50% and enhanced service quality, conducting requirements-gathering sessions to translate business needs into actionable strategies for improved operational efficiency.

- Coordinated cross-departmental initiatives to enhance customer service experience, resolving complex issues within healthcare environments through strategic communication and analysis.

- Crafted and facilitated custom training programs with tailored learning materials for groups of up to 35 associates, fostering professional growth, enhancing team capabilities, and improving performance review outcomes through increased process understanding.

- Utilized qualitative data analysis to generate insights for program improvements, impacting customer experience and optimizing processes based on gap analyses across over 2,000 cases.

- Managed CMS contract modifications for second-level appeals by effectively coordinating across teams and serving as a liaison between CMS vendors and internal teams, gaining extensive experience in authoring and publishing regulatory documents in SharePoint to ensure compliance and clarity for all associates.

- Managed patient records ensuring HIPAA compliance crucial for maintaining high standards of privacy protection within healthcare environments.

- Facilitated communication among clinical staff focusing on budgetary oversight while coordinating daily meetings effectively.

- Documented medical care requests demonstrating expertise in handling confidential government and high-profile cases crucial for efficient site management, ensuring the utmost discretion and professionalism.