Maritza C. Ellison
Chantilly,VA
Summary
Results-oriented professional with over 9 years of experience in the healthcare industry, seeking a leadership position in a corporate environment. Committed to continuous learning and development, aiming to contribute to an organization that values experiential growth and understands the importance of fostering career advancement. Focused on maximizing expertise, driven to make a meaningful impact while achieving personal and professional growth.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Senior, Project | Process Improvement Manager
Elevance Healthcare
01.2023 - Current
- Coordinated with stakeholders to define project requirements, ensuring alignment with business goals and objectives.
- Implemented project management methodologies and best practices. Currently efforts have increased team efficiency by 25%.
- Identified and mitigated risks. Current results have produced results leading to a 30% reduction in project delays and cost overruns.
- Facilitated change management processes, improvement adaptability and minimizing impacts on project timelines
- Knowledge and experience with multiple project management software applications to include MS Project, Smartsheet, and Jira to assist with process tracking, risk management and project statuses.
- Collaborated with IT department on integration of new software and tools, optimizing processes for enhanced efficiency and effectiveness.
- Ensured compliance with company policies, and regulatory requirements throughout the project lifecycle.
- Reduced operational costs with the implementation of Lean Six Sigma methodologies.
Senior Network Program Manager- Business Enablement
UnitedHealth Group
01.2017 - 01.2023
- Directed multiple, concurrent projects within a complex program, ensuring alignment with strategic business objects and milestones
- Established and maintained strong relationships with key stakeholders, ensuring support for program initiatives.
- Developed strategic plans, setting clear objectives and achievable milestones for the team.
- Performed root cause analysis across processes and technology
- SharePoint building and coding within PowerApps
- Developed and managed program budget exceeding $10 million, consistently delivering under budget while meeting quality standards
- Conducted comprehensive program evaluations, identifying areas for improvement and recommending actionable solutions.
Senior Network Program Manager- National Team
UnitedHealth Group
01.2017 - 01.2023
- Led program performance reviews, identifying best practices and implementing corrective actions as needed
- Assisted with ACO group for Northeast Contracting
- Monitored and audited business goals and direction of the data
- Implemented new issue reduction processes for National team including all 4 regions
- Assisted in the CLM build reviews, amendment front to end review and contract creations
- Managed/ Owned UHN Settlement and Contract Exception process, audits, and enhancements
Provider Relations Manager- Interim Advocacy Director
UnitedHealth Group
01.2017 - 01.2023
- Managed relationships with a network of over 350 tier one health systems, ensuring high levels of satisfaction and engagement
- Developed and implemented strategies to improve provider network performance, resulting in a 42% increase in the quality care metrics
- Managed a team of provider relations specialists, providing guidance, support and performance feedback
- Provided client consultation and facilitate client meetings over the phone and face-to-face and lead with collaboration and influence
- Compile various grids with commensurable and incommensurable data then communicated the data to Leadership
- Conducted market analysis to identify opportunities for network expansion and improvement
- Public speaking at various events such as Town Halls and EXPOs
Account Relations Manager
WellCare Health Inc.
01.2014 - 01.2017
- Managed four vendor sites: Ft
- Lauderdale, FL; Augusta, GA; Manila, Philippines and Honolulu, HI (copious amounts of travel required)
- Enhanced vendor management processes, resulting in improved vendor performance and cost savings
- Provided training on pre and post payment claims
- Trained new claim processors on Federal, CMS and State regulations as well as their requirements and state specific processes
- Rebuilt the strategic flow of 1.0 vendors and Provider Communication Institutional vendors on how to handle complaints from provider(s)
- Partnered with various Directors and VPs to set new operational priorities, goals and maintained budgets
- Identified opportunities to improve our department results pertaining to Provider Surveys, Medicare Star Metrics and Customer Service then implemented a plan to obtain higher ratings
- Reviewed and analyzed different reports pertaining to Finance, Inventory and Staffing of employees
- Trained internal escalation teams on root causing and the resolution of claims
- Ability to master Microsoft products- Excel, Visio, PowerPoint
- Ability to create basic SQL queries and operate in Tableau
Claims Specialist II - Sr. Claims Data Analyst
WellCare Health Inc.
01.2014 - 01.2017
- Perform New Hire and Vendor Audits
- Perform side by side coaching (in house)
- Planned and structured resources necessary to accomplish and exceed Company Goals and Objectives
- Handled High Dollar claims that are escalated up to Directors and VPs
- Completed compliance audits including mock audits
- Review audits and dispute if necessary (Handle 2nd level audits mediations)
- Reviewed and studied ICD-9 and ICD-10
Education
Saint Leo University
11.2024
Diploma -
Terry Parker High School
Skills
- Organizational Leadership
- Vendor Relations
- Compliance
- Six Sigma
- Agile
- Performance Enhancement
- Coaching and Facilitation
- Data Analytics
- Computer Technology
- Stakeholder Engagement
- Organizational Change Management
- UB04 / HCFA
- Claims Analysis
- User Acceptance Testing
Certification
- Six Sigma- Green Belt Trained
- Agile Trained
- Advanced Problem Solving Certified
- PMI Project Management Professional (PMP) Certified - 12/31/24
Businesstechnicalskills
- Organizational Leadership
- Provider | Vendor Relations
- Compliance
- Six Sigma
- Agile
- Performance Enhancement
- Coaching and Facilitation
- Data Analytics
- Computer Technology
- Stakeholder Engagement
- Organizational Change Management
- UB04 / HCFA
- Claims Analysis
- User Acceptance Testing
Timeline
Senior, Project | Process Improvement Manager
Elevance Healthcare
01.2023 - Current
Senior Network Program Manager- Business Enablement
UnitedHealth Group
01.2017 - 01.2023
Senior Network Program Manager- National Team
UnitedHealth Group
01.2017 - 01.2023
Provider Relations Manager- Interim Advocacy Director
UnitedHealth Group
01.2017 - 01.2023
Account Relations Manager
WellCare Health Inc.
01.2014 - 01.2017
Claims Specialist II - Sr. Claims Data Analyst
WellCare Health Inc.
01.2014 - 01.2017
Diploma -
Terry Parker High School
- Six Sigma- Green Belt Trained
- Agile Trained
- Advanced Problem Solving Certified
- PMI Project Management Professional (PMP) Certified - 12/31/24
Saint Leo University
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