Renee Jones
New York ,New York
Summary
Insightful Manager with subject matter expert in Medicare Secondary Payer policy and regulations. Proficient in primary and supplemental plan coordinationof benefits. Talented leader with analytical approach to business planning and day-to-day problem-solving.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Process Improvement Manager
General Dynamics Information Technology Inc
07.2021 - Current
- Appointed as the BCRC Point of Contact for the National Council for Prescription Drug Programs (NCPDP) various task groups to collaborate educate and troubleshoot problem areas and concerns
- Subject Matter Expert (SME) for multiple large-scale research efforts to remove or reduce invalid Medicare Secondary Payer (MSP) records
- Collaborated with CMS Medicare Secondary Payer Integration Contractor (MSPIC) and Medicare Secondary Payer System Contractor (MSPSC)
- Identified and supported numerous policy changes and system innovations
- Conducted focus groups, surveys and feedback sessions to gather input from stakeholders
- Developed and audited practices, programs and reporting system metrics for optimal efficiency
- Improved efficiency and effectiveness of performance and management of processes across department by 20%.
CWF Manager, Coordination and Recovery Contractor
GDIT
05.2018 - 07.2021
- Managed daily activities of Common Working File (CWF) Coordination Unit to ensure compliance with BCRC contract requirements
- Coordinated with Medicare intermediates, carriers, HMOs, Manage Care Plans, CMS and subcontractors’ information and tasks related to carrying out BCRC contract requirements
- Troubleshot BCRC systems and CWF discrepancies; initiated and monitored resolution process
- Improved operational planning and business frameworks to enhance resource utilization and reduce waste by 30%.
CWF Manager
Emblem Health
08.2017 - 05.2018
- Managed daily activities of Common Working File (CWF) Coordination Unit to ensure compliance with BCRC contract requirements
- Improved operational planning and business frameworks to enhance resource utilization and reduce waste by 20%.
Project Manager, CWF Supervisor
Emblem Health
10.2012 - 02.2014
- Orchestrated projects within strict timeframes and budget constraints by solving complex problems and working closely with senior leaders
- Developed training, task and process guidelines and communicated clear and concise directions to employees.
Education
Some College (No Degree) - Business Administration and Management
Skills
- CMS MSP Regulations Expert
- Coordination of Benefits Expert
- Claim Adjudication and Recoupment
- G-Suite
- MS Office
- Training and Development
- Technical Writing
- Analytical and Critical Thinking
- Problem Anticipation and Resolution
- Managing Operations and Efficiency
- Excellent Communication
- Dependable and Responsible
- Teamwork and Collaboration
- Adaptable to Changing Conditions
Certification
Lean Specialist, 2022
Timeline
Process Improvement Manager - General Dynamics Information Technology Inc
07.2021 - Current
CWF Manager, Coordination and Recovery Contractor - GDIT
05.2018 - 07.2021
CWF Manager - Emblem Health
08.2017 - 05.2018
Project Manager, CWF Supervisor - Emblem Health
10.2012 - 02.2014
Southern New Hampshire University - Some College (No Degree), Business Administration and Management
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