ROSE ARELLANO
Summary
Encouraging manager and analytical problem-solver with talents for team building, leading and motivating, as well as excellent customer relations aptitude and relationship-building skills. Proficient in using independent decision-making skills and sound judgment to positively impact company success. Dedicated to applying training, monitoring and morale-building abilities to enhance employee engagement and boost performance.
Overview
20
20
years of professional experience
Work History
Manager
Accenture
09.2020 - Current
- Maintain oversight of multiple billing, claims and Onboarding teams for Life Insurance client- to anticipate, identifyand assess complex issues/problems – Oversaw daily office operations for a team of 3 Supervisors and 60members
- Developed and implemented a corresponding plan of action to bring situations to resolution
- Communicatedchanges to management & stakeholders and guides team leads with resolutions, as needed
- Accountable for day-to-day business objectives and prepares/executes operational practices/work programs
- Ensures proper execution of processes by teams & ensures the volume of work produced meets Service Level
- Agreements (SLA) and exceeds quality standards
- Subject matter expert with industry expertise to support client & team lead questions, escalations, problem solvingand work instruction updates
- Conducted root cause analysis for escalations or SLA misses and to recommended and implemented solutions toimprove overall customer satisfaction
- Understood and managed to client SLAs and department's/product's key performance requirements
- Demonstrated understanding of the customer's business and market needs and maintained high customersatisfaction ratings
- Conducted & presented to key client stakeholders in an executive manner to provide Operational updates, highlightrisks and issues along with Process opportunities
- Responsible to prepare, coordinate and conduct performance appraisals and counsel employees on career andperformance/disciplinary issues
- Documented SOPs and business processes and analyzed procedures to meet changing business needs
- Point of Contact / Liaison between client and staff – client facing weekly calls
- Identify cost savings with profitability, utilization, resource planning tools and develop business continuity plans
- Responsible for preparing, coordinating and conducting annual performance appraisals and counsel employees oncareer and performance/disciplinary issues
- Collaborate with cross-functional team members to identify “desired state” and develop/implement processimprovement recommendations and/or tools to support the team and supporting business units.
Medicare Secondary Subject Matter Expert Consultant
05.2020 - 12.2021
- Medicare Secondary Subject Matter Expert Consultant for Liability, Workers Comp and No-Fault Insurance andlawyer firms on Medicare conditional payments
- Assisted TPLs with Medicare Secondary Payer appeals, rules, creation of processes and forms
- Consulted TPLs on specific cases they were not financially responsible for
Director of Outreach
Corp - Commercial Repayment Center
02.2019 - 05.2020
- Established and managed Outreach relationships and activities with the Medicare Secondary Payer stakeholdercommunity
- Interpreted and communicated new or revised CMS or CRC policies to internal members and stakeholders
- Onsite visits to stakeholder offices to provide education of the CRC program and payers responsibility to makepayment
- Hosted several collaboration meetings with stakeholders at our Sunrise office to improve MSP processes
- Attended NGHP conferences as a headliner speaker
- Participated on Workers Compensation panels to supply feedback on the MSP processes and regulations
- Managed a team of outreach executives on a day-to-day basis supporting the CRC collaborative relationships withthe stakeholder community
- Oversaw complex high-level appeal review
Director of Healthcare Billing and Recovery
Performant Corp, Commercial Repayment Center
01.2018 - 02.2019
- Supported the transition of the CRC contract from incumbent CGI to new contractor to Performant
- Established processes to recover mistaken Medicare primary payments with data from Section 111 data and
- Common Working File
- Created, prepared and conducted MSP training for staff
- Interpreted the Code of Federal Regulations (CFR) and CMS instructions and established SOPs and businessprocesses
- Determined liability for workers' compensation, automobile no-fault and group health plans by researching andanalyzing available data against Medicare secondary payer regulations
- Worked directly with COB&R contractors, Performant IT, Quality Assurance, Training and Call Center to establishimproved production and higher revenue results
- CMMI Certified
- Reported any issues and weekly progress to upper management
- Accountable for meeting service level agreements (SLA) and key performance indicators (KPIs) and creating
- Performance Plans if needed when not met
CRC BPO Operations Manager
CGI Federal, Commercial Repayment Center
07.2012 - 01.2018
- Oversaw daily office operations for a team of 5 Supervisors and up to 150 members
- Directed staff and upper management through two Federal healthcare contracts from startup through wind down(CRC GHP and NGHP)
- 316 million recovered for the Medicare Fund for fiscal years 2014-2016
- Documented SOPs and business processes and analyzed procedures to meet changing business needs
- Point of Contact / Liaison between CRC and the Blues Association
- Spearheaded cross-functional initiative to provide growth opportunities for members; promoted 50 members
- Implemented innovative programs to increase member loyalty and reduce turnover; retention rate increased by 25%
- Interpreted and communicated new and revised CMS or CGI policies to members
- Developed and achieved financial and growth goals
- Strategically planned methods to achieve operational goals and targets
- Continually maintained and improved the company's reputation and positive image
- Established operational goals and work plans and delegated assignments to subordinate Supervisors
- Managed 2 startup projects (CRC GHP and NGHP) during the last 5 years
- Worked directly with IT, Quality Assurance, Training and Call Center to meet client's needs
- Initiated rollout of enhancements and implementation to ProperPay for members
- Reported any issues and weekly progress to upper management
Accounts Receivable Supervisor
Fresenius Medical Care
08.2003 - 06.2012
- Accountable for meeting service level agreements (SLA) and key performance indicators (KPIs) and creating
- Performance Plans if needed when not met, Supervised 11 Medical Healthcare collection associates
- Collected 15 million Medicare AR monthly for End Stage Renal Disease (ESRD) claims for 125 clinics
- Worked RTP claims with Medicare
- Rebilled claims, submitted appeals to Medicare, VA, Medicaid, HMO's and commercial claims
- Monitored payments due from Commercial and Government insurance companies and promptly contactedinsurance companies on untimely payments
- Proven track record of reducing A/R collection days from 6 months to 45 days
- Calculated Coordination of Benefits for ESRD to ensure payment from the proper insurance carrier
- Investigated and refunded claims paid in error
- Applied payments and reconciled receipts to account receivables
- Educated staff on state and federal statutes, rules and regulations governing home care services
- Investigated and refunded claims paid in error
- Participated in 2 SOX audits
- Accountable for meeting service level agreements (SLA) and key performance indicators (KPIs) and creating
- Performance Plans if needed when not met
Education
Bachelor of Business Administration - Healthcare, Healthcare and Project Management
Strayer University
Member of National Honor Society CMMI Certified Lean Six Sigma Yellow Belt Certified Situational Leadership Certificate Leadership Series Certificate Effective Leader Series - undefined
Skills
- 12 years of Management experience in the healthcare industry in a leadership role
- 12 years' experience with insurance contracting, finance, consulting, or relevant healthcare
- 12 years' experience with fee-for-service
- Demonstrated expertise in healthcare (payor or provider space)
- Ability to engage directly with senior level executives
- Subject Matter Expert (SME) Medicare Secondary Payer (MSP) for Non-Health Group Health Plans (NGHP) and Group Health
- Plans (GHP)
- 21 years of Healthcare Revenue Cycle Management (Medicare, Medicaid, Commercial, VA, Tricare, TPAs and Providers)
- 8 years with 2 Medicare Commercial Repayment Center (CRC) contractors, start-up and implementation
- 21 years working with Healthcare payor contracting issues
- 8 years engaging directly with decision makers at government and commercial plans
- Issue and Conflict Resolution
- Project Management
- Staff Management
- Team Leadership
- Coaching and Mentoring
- Verbal and Written Communication
- Process Payments
- Business Management Principles
- Productivity Performance
- Managing Terminations
- Key Performance Indicators (KPI)
- Quality Standards
- Cross-Functional Team Management
- Financial Forecasting
- Government Policy
- Time Management
- Job Assignments
- Finance and Accounting Operations
- Procedural Streamlining
- Greet Guests
- Information Confidentiality
- Order Supplies
- Business Planning
- Complex Problem-Solving
- Business Intelligence
- Strategic Planning
- Organizational Policies
- Managing Career Progression
- Business Process
- Risk Management
- Performance Tracking and Evaluations
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Know the true value of time; snatch, seize, and enjoy every moment of it. No idleness, no laziness, no procrastination: never put off till to-morrow what you can do to-day.
Philip Dormer Stanhope, Lord Chesterfield
Timeline
Manager
Accenture
09.2020 - Current
Medicare Secondary Subject Matter Expert Consultant
05.2020 - 12.2021
Director of Outreach
Corp - Commercial Repayment Center
02.2019 - 05.2020
Director of Healthcare Billing and Recovery
Performant Corp, Commercial Repayment Center
01.2018 - 02.2019
CRC BPO Operations Manager
CGI Federal, Commercial Repayment Center
07.2012 - 01.2018
Accounts Receivable Supervisor
Fresenius Medical Care
08.2003 - 06.2012
Bachelor of Business Administration - Healthcare, Healthcare and Project Management
Strayer University