Qiana Bradley

• Deliver personalized support to improve daily health and well-being
• Coordinate with healthcare professionals regarding appointments, medications, and wellness needs
• Serve as a liaison between clients, families, and healthcare providers to ensure care quality
• Provided compassionate support and guidance to clients during challenging life transitions or medical events.

• Conducted in-depth claims analysis to identify opportunities for improving CMS Stars rating
• Collaborated with cross-functional teams to optimize operational compliance and reduce financial risk
• Analyzed reporting systems that tracked compliance metrics and provided insights for leadership
• Conducted compliance audits, ensuring adherence to regulatory standards and internal policies.

• Implemented a sustainable process to monitor the member and provider experience, while increasing self-service in the online tool for all Medicaid Markets
• Increased productivity in Insights submissions within call center operations and all Medicaid markets
• Implemented Microsoft List for managing project implementation
• Led Medicaid OE for all states ensuring alignment between call advocates and each Medicaid Market

• Designed and managed the Expanded Benefits program that delivered value-added services to members
• Mentored analysts in business analysis, process modeling, and operational best practices.
• Identified performance metrics and provided improvement recommendations to leadership.
• Built a multi-state documentation system ensuring process accuracy across FL, KY, SC, and OH.
• Reduced intake processing time by 29% with a no-code data centralization platform.
• Developed a self-service web form on the company website, speeding up member reimbursements.

• Identified process improvement opportunities, enhanced organizational systems, and monitored initiatives to ensure continued operational performance. Also served as team lead for behavioral health Medicaid and Dual (Medicare/Medicaid) programs and compiled data to generate reports used for strategizing on process improvements.
• Aligned Humana enterprise-wide systems with Affordable Care Act Section 1557 by conducting thorough data analysis and creating processes that prohibited healthcare discrimination.
• Received company STAR award for collaborating with IT, SMEs, and stakeholders in successfully implementing state waiver process.
• Passed audits for Medicaid performance measure validation (PMV) by sharing expertise regarding claims processes and other requested process-related information.

• Managed ASO/self-funded accounts and served as point of contact to clients during insurance application process.

• Excelled at aligning procurement initiatives across organization. Displayed sound judgement in managing and controlling expenses on clinical items, technology, staffing augmentation, and outside services.
• Analyzed insurance claims to ensure correct payments and rectify any complications regarding systems and compliance issues.
• Designed 2-digit codes for mobile unit providers that increased number of accurate claims processed.

• Supported analysts, compiled performance reports, and resolved CMS/DOI complaints. Aligned hospital systems/physician offices and attended audits to ensure proper claim adjudication for contracts. Managed 2 teams comprising 5 analysts and specialists.