Rachael Tooley
Chesapeake,VA
Summary
Personable and analytical professional with expertise in understanding and addressing client needs. Possessing a solid foundation in market analysis and data interpretation, I bring strong problem-solving and interpersonal skills to the table. Committed to delivering impactful strategies that drive client success.
Overview
15
15
years of professional experience
Work History
Sr Project Manager I
United Health Group
11.2023 - Current
- · Managed Designated Diagnostic Provider (DDP) program with team lead, which included creating resource tools for internal partners to access DDP information and provider lists.
- · Collaborated with the Ireland data team to access CMS relativity's for provider expansion in the DDP program.
- · Provided training to our internal partners, e.g. Network Management and Sales Teams.
- · Assisted with Product initiatives such as claim reviews for Urgent Care and Ambulatory Surgery Center's, which led to configuration updates for our claim processes.
- · Updated letters/communications, FAQ's and websites.
- · Provided support to Network Management and Sales teams on Provider status in the DDP program and steps needed for inclusion.
- · Coordinates completion of projects or end-to-end business process activities across various functional areas
- · Investigates non-standard requests and issues, complete projects on time and within scope
- · Interface with operations/partners on business system needs
- · Provides subject matter expertise in areas including project scope definition, risk identification, project methodology, resource allocation, facilitation, and other areas of expertise based on established project management techniques
- Led cross-functional teams for successful project delivery within scope and schedule constraints.
- Directed changes to project scope and cost and implemented appropriate change management processes to keep project on track.
Network Programs Consultant
United Health Group
01.2021 - 11.2023
- Coordinated with leadership on State Regulatory requirements and filings for several Northeast states, including Connecticut, Maryland, Massachusetts, New Hampshire, Pennsylvania, Rhode Island, Virginia, Washington DC, and West Virginia
- Developed training and process documents for state filings
- Established a process for the CAA (Consolidated Affordability Act) for the Northeast and Mid-Atlantic markets, including reports for leadership on volume and type of demographic requests received
- Collaborated with the Program Managers in the Northeast and Mid-Atlantic markets to complete demographic updates and ensure correct outfacing directory information
Network Programs Consultant/ Project Firefly
United Health Group
01.2020 - 12.2021
- Established integral interdepartmental relationships to support and serve the needs for Project Firefly, including amendment builds, execution of amendments and loading products in various systems, MSPS fee schedule development specific to WC Property & Casualty, issue resolutions for project roadblocks, CLM system issue resolutions.
- · Created Property and Casualty mass mailing initiatives that included managing mailing lists, preparation of all collateral/materials and collaboration with Mass Mail Team ensuring deadlines were met.
- · Developed processes for utilization by Fulfillment team to support Property and Casualty mailing initiatives.
- · Utilized various systems e.g., CORE, Phycon, Titan RAD, and HIVE in order to complete provider/facility/ancillary loads. Ensured that loads were completed correctly and updated websites to reflect completions. Assisted with all operational processes.
- · Researched contracts for contract language pertaining to workers compensation and confirmed contracts that were viable for our amendments.
- Discovered several contracts viable for Property and Casualty products, which generated $10 million in revenue.
- Closed out project successfully with one team member, including training for future teams in implementing Property and Casualty within their markets
Contract Management Expert
United Health Group
11.2018 - 01.2020
- Executed various tasks concerning FQHC/RHC contracts in several markets, including new agreements, rate changes, service items, and amendments
- Communicated with network management concerning contracts and practitioners
- Skilled at working independently and collaboratively in a team environment.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Excellent communication skills, both verbal and written.
Provider Market Data Management
United Health Group
05.2011 - 11.2018
- Maintained standards for database integrity and quality assurance, coordinate corrective activities to clean database and retain users, and manage communication processes with other departments regarding database improvements.
- Conducted audits and provided feedback to reduce errors and improve processes and performance, maintaining current provider data to ensure the quality of the network.
- Worked with care providers and medical groups to maintain current rosters, demographics, and network status.
- Mentored new hire team members and Subject Matter Expert for team of16.
Provider Phone Representative/On Job Training Coach
United Health Group
07.2009 - 05.2011
- Assisted providers with claim questions and benefits for our members.
- Assigned to PPR New Hire Classes to coach new hires throughout training and assisted trainer with administrative tasks.
- Conducted 1-on-1 sessions with trainees providing Strengths and Opportunities on weekly basis,
- Investigated and resolved customer inquiries and complaints quickly.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
Education
Master of Social Work - Social Work
The University of Texas At Arlington
Arlington, TX01.2020
Bachelor of Social Work - Social Work
The University of Texas At Austin
Austin, TX01.2015
Skills
- Highly developed written and oral communication skills
- Analysis & evaluation
- Subject matter expert
- Risen to challenging responsibilities and follows through with direct
- Demonstrated ability in all major software applications: Microsoft Word, PowerPoint, SharePoint, Excel, and Access
- Issue resolution
- Team leadership & development
- Attention to detail
- Client relationships
Timeline
Sr Project Manager I
United Health Group
11.2023 - Current
Network Programs Consultant
United Health Group
01.2021 - 11.2023
Network Programs Consultant/ Project Firefly
United Health Group
01.2020 - 12.2021
Contract Management Expert
United Health Group
11.2018 - 01.2020
Provider Market Data Management
United Health Group
05.2011 - 11.2018
Provider Phone Representative/On Job Training Coach
United Health Group
07.2009 - 05.2011
Master of Social Work - Social Work
The University of Texas At Arlington
Bachelor of Social Work - Social Work
The University of Texas At Austin
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