Rhonda Tilson
Sand Springs,OK
Summary
Dynamic senior executive with a track record of propelling sustainable growth by leveraging strategic relationships and operational excellence. Exceptional at steering financial and personnel functions to maximize profitability. Renowned for pioneering innovative operational techniques and marketing strategies, significantly boosting market share. Skilled communicator adept at forging enduring relationships with clients, vendors, and stakeholders at all levels.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Director of Claims
Health Payer Consortium
08.2022 - 02.2024
- Improved claim resolution efficiency by implementing new processing systems and protocols.
- Reviewed complex claims cases, providing expert guidance to adjusters on proper handling techniques.
- Collaborated with other departments to identify trends in claims activity and develop strategies for loss prevention.
VP of Payment Integrity Solutions
Alaffia Health
08.2021 - 08.2022
- Established a successful partnership with key industry players, resulting in increased market share for the organization.
- Developed and executed targeted business development initiatives, leading to an expansion of the company''s client base.
- Revised corporate policies and procedures to ensure compliance with evolving industry regulations, mitigating potential risks.
VP of Strategic Relations
Valenz
02.2019 - 08.2021
- Revolutionized operational workflow with multiple platforms integrating cross team departments for centralized access
- Led Payment Integrity, provider relations, and cost containment efforts, enhancing strategic leadership across teams.
- Negotiated favorable contracts with vendors, securing advantageous terms for the company while maintaining strong professional relationships.
Director Client Retention
TML Multistate IEBP
02.2017 - 02.2019
- Managed the marketing team for 972 Texas Cities, focusing on plan design and member engagement for optimized plan performance
- 9Achieved a 15% net growth target through strategic marketing efforts. Maintained a 95% retention rate.
- Recruited, hired, and trained initial personnel, working to establish key internal functions and outline scope of positions for new organization.
Chief Marketing/Operations Officer
ResourceOne Administrators
04.2005 - 02.2017
- Updated and published standard operating procedures (SOPs) using stakeholder, customer and employee input and feedback resulting in clearer and more useful instruction for users.
- Collaborated with executives and management to review projected revenue and adjust resources accordingly.
- Interfaced with department heads to establish tracking mechanisms and processes that created clear and effective information flow internally and with customers.
Education
Bachelor of Arts - Special Education
Western Governors University
01.2014
Bachelor of Science - Business Administration
CSU-Fresno
01.1992
Skills
- Strategic Leadership & Vision
- Operational Efficiency & Process Improvement
- Innovative Marketing & Market Expansion
- Client Relationship & Account Management
- Project Management & Execution
- Team Development & Coaching
- Data-Driven Decision Making & Analysis
- Provider Negotiations & Contract Management
Certification
- Certified Professional Coder (CPC), AAPC 02/2024
- Certified Medical Auditor (CPMA), AAPC 02/2024
Timeline
Director of Claims
Health Payer Consortium
08.2022 - 02.2024
VP of Payment Integrity Solutions
Alaffia Health
08.2021 - 08.2022
VP of Strategic Relations
Valenz
02.2019 - 08.2021
Director Client Retention
TML Multistate IEBP
02.2017 - 02.2019
Chief Marketing/Operations Officer
ResourceOne Administrators
04.2005 - 02.2017
Bachelor of Arts - Special Education
Western Governors University
Bachelor of Science - Business Administration
CSU-Fresno
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