SANDRA HUDSON

Left the workforce to care for an ill family member.

• Facilitated smooth transitions between home care settings by coordinating services and communicating effectively with all parties involved.
• Supported daily hygiene needs of patients by assisting with bathing, dressing, dental care and personal grooming.
• Efficiently organized schedules for multiple clients simultaneously while maintaining high-quality care standards.
• Participated in ongoing professional development opportunities to stay current on best practices in caregiving techniques, enhancing the quality of care provided.
• Collaborated with healthcare team members to develop personalized care plans for patient, resulting in tailored support and improved wellbeing.
• Monitored clients' overall health and well-being and noted significant changes.
• Cooked meals and assisted patients with eating tasks to support healthy nutrition.
• Assisted patients with bathing, grooming, dressing, and oral hygiene care both in private residences and facilities.
• Provided compassionate and patient-focused care to cultivate well-being.
• Transported clients to and from medical appointments with safety and efficiency.
• Entrusted to handle confidential and sensitive situations in professional matter.
• Assisted with daily living activities, running errands, and household chores.
• Collaborated with healthcare team members to develop personalized care plans for patient, resulting in tailored support and improved wellbeing.
• Assisted in rehabilitation exercises as prescribed by medical professionals, guiding patient towards improved mobility and function.

• Handled provider and member appeals for Medicare Dual Special Needs Plans (DSNP) recipients.
• Examined and prepared cases for medical review and submission to the Clinical Nurses, Medical Director, and Independent Review Entity (IRE) (i.e., MAXIMUS Federal, Inc.) to deny or uphold appeal decisions.
• Managed daily inventory to ensure regulatory compliance with focus on accuracy, quality, and producing the best outcomes.
• Met the performance goals established for work productivity, efficiency, accuracy, and quality.
• Decreased case backlog by effectively prioritizing and managing high-volume caseloads.
• Provided excellent customer service by actively listening to customer concerns and empathetically addressing their needs throughout the appeals process.
• Researched and resolved written complaints submitted by consumers and physicians or providers.
• Conducted comprehensive reviews of claim denials, identifying errors or discrepancies that led to successful reversals on appeal.
• Obtained additional documentation required for case review.
• Rendered decision for non-clinical complaints using sound, fact-based decision making.
• Achieved higher success rates on appeal cases by closely analyzing denial reasons and crafting persuasive arguments for reconsideration.
• Managed sensitive member information with confidentiality and discretion, maintaining trust between customers and the company.
• Completed documentation of final appeals or grievance determination using appropriate templates.
• Processed and finalized appeals and grievances within agreed-upon turnaround time.
• Created ad hoc written communications to members and providers in response to claims and appeal inquiries.
• Assisted management in identifying areas of improvement, contributing to overall department efficiency gains.
• Created and shared process improvements to ensure team success and to support the company's quality turn-around-time initiatives.
• Supported fellow Appeals Representatives through peer coaching and knowledge sharing, fostering a collaborative work environment.

• Collaborated with stakeholders to gather feedback on current processes, using insights gained to drive targeted improvements.
• Enhanced operational efficiency by identifying and implementing process improvement strategies.
• Standardized organizational processes for consistency and ease of replication across departments.
• Performed URAC accreditation maintenance, audit support, and re-accreditation activities.
• Identified areas of improvement pertaining to in-house and 3rd party vendor processes to reduce business risks.
• Supported all delegated vendor desktop, on-site, annual and PIP/CAP audits/processes.
• Developed a Provider Network Change/Termination Notification Programs and a provider directory update process in accordance with the Ohio Department of Insurance (ODI) regulations..
• Developed a process to accurately capture, identify, and report managed care diagnosis to CMS and reduced the financial risk to the Managed Care Diagnosis Program.
• Conducted member and provider claim appeals, external review audits, complaints, and the Qualified Health Plan (QHP) and Essential Community Providers/Network Adequacy (ECP) annual processes.

• Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
• Obtained and documented patient medical history, vital signs and current complaints at intake.
• Input patient care information an electronic medical record (EMR) system.
• Collected laboratory specimens and prepared them for diagnostic testing.
• Assisted physicians and nurses with procedures as required.
• Performed routine (Clinical Laboratory Improvement Amendments (CLIA) waived clinical laboratory procedures..
• Administered parenteral injections.
• Maintained a clean and organized work area to facilitate efficient patient care delivery.
• Facilitated seamless transitions between appointments by efficiently preparing exam rooms for subsequent patients.
• Fostered a safe environment for patients by adhering to strict infection control protocols during clinical procedures.
• Sanitized, restocked, and organized exam rooms and medical equipment.
• Collaborated with medical and administrative personnel to maintain patient-focused, engaging, and compassionate environment.

• Managed a team of 10 Resource Management analysts to ensure the call center was adequately staffed at all time and to mitigate call-offs.
• Delivered quality service-oriented solutions to customers by working collaboratively with internal & external business partners.
• Implemented processes for improving operational efficiencies using change management methodologies.
• Provided key insights and reports on Call Center agent's performance to the business to optimize staffing and business process efficiencies.
• Developed processes for supporting functional strategies to resolve operational issues impacting service levels.
• Accomplished multiple tasks within established timeframes.
• Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
• Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
• Cross-trained existing employees to maximize team agility and performance.
• Communicated clearly with employees, suppliers, and stakeholders to maintain established business goals.
• Monitored and analyzed business performance to identify areas of improvement and make necessary adjustments.

• Managed a team of 4 Business Analysts responsible for supporting SAP/CRM, and Case Management Systems.
• Managed the daily operations related to order management, inventory systems processing, and problem resolution.
• Provided support as Subject Matter Expert (SME) for migration of the medical order processing system to CRM.
• Identified and validated business system processes to bridge gaps needed for improving order management processes.
• Developed project plans, identified & filled project resource needs, managed projects on time and on budget.
• Collaborated with stakeholders across business units to improve the quality of products/services delivered by IT team.
• Gathered and managed high-level business requirements.
• Scoped, planned, and prioritized multiple project deliverables, based on data warehousing dependencies and changing business needs.
• Performed integration acceptance testing and provided post implementation support to end users.
• Created and managed a knowledge information repository and the data governance processes.
• Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
• Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
• Cross-trained existing employees to maximize team agility and performance.
• Developed a strong company culture focused on employee engagement, collaboration, and continuous learning opportunities.
• Achieved departmental goals by developing and executing strategic plans and performance metrics.
• Built high-performing teams through effective recruitment, onboarding, and talent development initiatives.
• Streamlined workflows by identifying bottlenecks in existing systems and implementing appropriate solutions.
• Optimized resource allocation by conducting regular performance evaluations and providing personalized coaching for staff development.
• Led change management initiatives to drive organizational transformation without compromising employee morale or productivity levels.
• Drove operational efficiency through data-driven decision-making processes, leveraging analytics tools for informed strategy development.
• Established risk mitigation strategies to safeguard against potential operational challenges or disruptions.
• Established team priorities, maintained schedules, and monitored performance.
• Defined clear targets, objectives and communicated to team members.
• Evaluated employee performance and conveyed constructive feedback to develop skills.
• Established performance goals for employees and provided feedback on methods for reaching milestones.

• Managed the Medical and Pharmaceutical 2nd tier Supplier Diversity Spend Reporting process.
• Provided analytical support to facilitate a $4 billion federal subcontracting initiative across business segments.
• Functioned as tactical liaison for customers and field reps to identify and increase small businesses spending.
• Identified and integrated “best-in-class” diverse suppliers into the supply chain.
• Managed the Vendor Diversity Classification process.
• Substantially grew the supplier base by identifying, properly classifying, and capturing valid unreported spend.
• Created and disseminated spend reports to the customer base, sales team, and United States Department of Defense.
• Monitored 12 financial systems interfaces across business segments to capture and ensure data accuracy.
• Partnered with corporate, distribution, and manufacturing teams on local and regional sourcing projects.
• Participated in networking events to expand professional connections and attract new clientele.
• Developed strong relationships with clients through regular communication and excellent customer service