SHELLY GREEN
Framingham,MA
Summary
Dynamic leader with extensive experience in healthcare enrollment and provider relations, notably at Tufts Health Plan. Excelled in streamlining processes, achieving 100% data accuracy in provider enrollments, and leading high-performing teams. Proficient in HealthRules Payor and adept at fostering collaborative relationships. Demonstrated ability to deliver results and drive improvements.
Overview
20
20
years of professional experience
Work History
Supervisor – Public Plans Member Enrollment
Tufts Health Plan / Point32Health
01.2019 - Current
- Oversee and manage team of 10 Specialists and assignments of daily work from various channels
- Responsible for the day to day enrollment functions for Public Plan Members both in MA and RI across all lines of business
- Participated in go-live exercise with conversion to new core system HealthRules Payor (HRP), supporting the enrollment team while also learning the new system simultaneously
- Participate in annual Open Enrollment process for Direct, managing high volume 834 enrollment transaction volume and ensuring daily fallout was resolved within standard department timelines
- Manage and delegate all daily work as well as time sensitive and ad hoc projects
- Was the main go to for contract vendor (NTT), ensured work was received, assigned, and completed in a timely fashion
- Collaborate, interact and maintain relationships with internal departments such as Claims, Member Services, Pharmacy and PP Reporting
- Collaborate with Manager of PP Enrollment and Revenue Reconciliation to balance the distribution of work during high volume and ensure timely completion of files and/or projects
- Point of contact for escalations from partnering agencies such as HSA and the Connector
- Identify system functionality trends and membership data trends, working to implement short-term and long-term solutions and prevent any downstream membership impacts
- Work in unison with Business Analysts and Management to make sure Quality Control reports and workflows are accurate and kept current
- Schedule regular 1 on 1 meetings with staff to provide department and company updates, coaching, hold staff accountable, and discuss paths for development
- Hold team meetings for staff for training refreshers (for both MA and RI) and to allow the team to discuss and share tips and ideas with peers
- Interview and train new hires
- Performs duties of the Manager in their absence
Supervisor – Provider Enrollment
Steward Health Care Network (SHCN)
01.2018 - 01.2019
- Responsible for the day to day management of the SHCN Provider Enrollment team, managing both daily enrollment operations and enrolling physicians into SHCN-contracted managed care health plans
- Supervised and coordinated the full cycle of Provider Enrollment functions for SHCN across the entire physician network
- Worked collaboratively with provider offices and local chapters to streamline the accurate submission of enrollments to health plans
- Partnered with Data Analytic team to facilitate data accuracy to ensure downstream data integrity in Sales Force
- Managed email inbox ensuring incoming work was appropriately delegated and completed to meet SLA’s
- Decreased six-month backlog of provider enrollment inventory within 2 months, enabling 24-48 hour turn around for all enrollments and approval notices
- Tracked and logged all PPA contract approval requests and assigned out to team to process
- Updated weekly tracking PPA tracking grid cap numbers for weekly management review
- Actively implemented, managed and oversaw MassHealth rollout of enrollments and all requests of the ACO
- Implemented QC process to enable better accuracy of data input, striving for and leading up to 100% data accuracy in analytic reports for Care Radius
- Managed annual MSSP and BPCIA contract paperwork of coordination and mailings for CMS compliance, ensuring all deadlines were met and accuracy of 100%
Supervisor - Provider Relations Management (Contract- Meduvi LLC)
Tufts Health Plan
01.2016 - 01.2017
- Assisted with day to day aspects of the provider information management team including provider interaction ensure that all provider data request metrics are achieved
- Maintained the flow and processing of information within Provider Information Management team to ensure turnaround times were achieved
- Assisted providing support to staff as appropriate and necessary
- Input provider data into Monument Xpress, checked credentials to ensure proper billing in system
- Established, built and maintained a positive working relationship with the Provider Information Management team as well as internal and external audits to ensure that all data is processed according to policy
- Reviewed, assigned, and worked daily reports which aided in QC of the data to ensure data quality and integrity
- Supervised provider data quality initiatives in conjunction with the Manager of Provider Information Management
- Participated in business requirements and workflow discussions for system conversion to HealthRules Payor (HRP)
Financial Assistant
RightTurnBiz.org
01.2013 - 01.2016
- Prepared daily bank deposits, maintained all Account Receivable, Account Payable and patient files and contributed in month-end close proceedings
- Using QuickBooks, processed daily cash reporting for checks, patient credit cards and cash, posted all G/L entries
- Ensured accuracy of all bi-weekly employee timesheets
- Verified all Purchase Orders with correct receipts
- Completed monthly recognition of Patient Reimbursement Accounts
- Reviewed Insurance EOB’s against claims to ensure billing/payment accuracy to resolve any billing issues or questions
- Created and presented PowerPoint modules for employee training as needed
Lead Transaction Accounts Analyst
Athena Health
01.2005 - 01.2013
- Provided support to team of 15 posting representatives
- Reviewed all claims billing and ensured accuracy, and reconciled daily payment batches
- Interpret various EOBS to ensure accurate posting of medical claims
- Ran daily reports using Excel to help manage ticket volume, reduce posting errors, and address client concerns and issues
- Contributed to and maintained training documents for posting team regarding client specific workflows
- Trained high profile clients on company’s software and posting workflows and policies
- Trained and mentored new hires as needed
Education
Associates - Liberal Studies and Sciences
Middlesex Community College
Bedford01.2002
Skills
- Microsoft Office
- HealthRules Payor
- Monument Xpress
- Clarity
- SQL
Timeline
Supervisor – Public Plans Member Enrollment
Tufts Health Plan / Point32Health
01.2019 - Current
Supervisor – Provider Enrollment
Steward Health Care Network (SHCN)
01.2018 - 01.2019
Supervisor - Provider Relations Management (Contract- Meduvi LLC)
Tufts Health Plan
01.2016 - 01.2017
Financial Assistant
RightTurnBiz.org
01.2013 - 01.2016
Lead Transaction Accounts Analyst
Athena Health
01.2005 - 01.2013
Associates - Liberal Studies and Sciences
Middlesex Community College
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