Summary
Overview
Work History
Skills
Awards
COMPUTER SKILLS
Timeline
Generic

Shirley L Cook

Greensboro

Summary

I would like to obtain a position with United Healthcare Group that best utilizes my experience from customer service to provider demographics and contracts. I have experience in developing and training others to aid in their overall performance. I have a passion to enhance the providers and customers experience with United Healthcare.

Results-driven management professional with proven ability to lead teams to success. Strong focus on team collaboration, operational efficiency, and achieving measurable outcomes. Adept at strategic planning, process improvement, and fostering culture of accountability and excellence. Known for adaptability and consistently meeting changing organizational needs.

Overview

13
13
years of professional experience

Work History

Provider Data Consultant

United HealthCare Group
01.2018 - Current
  • The ACO Core Team is the core externally facing matrix team in support of an ACO relationship, made up of the ACO Account Manager, CPC, MMD and Regional HCE individuals collaboratively working together to create success for the ACO.
  • Responsible for supporting ACO success: financial, quality, member/patient, and provider satisfaction.
  • Collaborate to create and manage:
  • Support for ACO Action Plan (Business Plan and Clinical Action Plan)
  • Working relationship/engagement with ACO
  • Data/Analysis and information, and problem solver.
  • ACO Account Manager owns relationship, in certain situations (FQHC) the C&S CMO will be the relationship owner.
  • The ACO Account Manager is accountable for the performance and coordination of the ACO core team.
  • Responsible for establishing the Clinical Action Plan and a strong working relationship with the ACO including all tactical steps which include installing new workflows, processes and/or technologies to achieve ACO success.
  • Provide consultative services to ACO, CPC and MMD on areas to investigate for the ACO Action Plan.
  • Provide consultative services to ACO on how to utilize the data and financial reporting package to drive the best results.
  • Prioritizes, escalates issues timely and regularly communicates ACO status to the relationship owner.
  • I handled the state of FL in the SE ACO for 2 years, and now I am serving the SE/NE ACO with new accounts.
  • Promoted to L27 position in July 2021 Provider Data Consultant and taking on more responsibility.
  • I have been training team members, filling in the gaps and learning curves missed along the way.

Provider Install Specialist/SME/Buddy Advocate

UnitedHealth Group
01.2015 - 01.2018
  • Mentored employees not meeting quality standards on best practices, system navigation, and coaching the employees to the point of graduating the program by attaining consistent quality scores through auditing work prior to submission.
  • Facilitates cross-functional training classes teaching the fundamentals of NDB for contractual and demographic maintenance. Demonstrates the workflow process and best practices in presentations in person and virtually.
  • Facilitates on-the-job-training (OJT) to train newly hired/trained loaders on what the job entails and how to receive 100% quality while performing their tasks.
  • Creates handouts with Microsoft Office to provide to best practices and references to training classes.
  • Cross-trained in RCL accommodate business needs due to a high demand for additional coaches.
  • Experience with contracts and state regulations.
  • Value Check Audits for CAT team involving research, corrections, and coaching.

Subject Matter Expert / RARE Rapid Analyst Resolution Expert

01.2012 - 01.2015
  • Analyzed metrics to identify behaviors and coaching Health Advisors (HA) on best practices to raise performance while documenting the coaching sessions for their supervisors.
  • Supervisors used the SME for extra training when applicable.
  • Participated in cross-functional meetings to identify HA in need of coaching or assistance from a tenured team member.
  • Provider issues were analyzed with reviews of claims with provider information loaded in UHC system for processing.
  • Identified and resolved issues preventing improper processing.

Skills

  • Professional Demeanor
  • Conflict Resolution Specialist
  • Coaching/Development
  • Multi-Tasking
  • Goal & Team Oriented
  • Public Speaking
  • Claims Processing
  • Relationships
  • Training
  • Provider Contracts
  • Loading Data
  • Analyst /Audits

Awards

Service Hero Award in 2013 for the “Count on Us” Campaign

COMPUTER SKILLS

Microsoft Word, Microsoft Outlook, Microsoft Excel, Microsoft PowerPoint, NDB (including, C&S, BSARS, COSMOS, Commercial Contracts, Medicare and Medicaid and Directories), Phycon, Nexus, WebEx, Emptoris, Orbit, DocuSign, HOST ORS, COSMOS, CSP FACETS, ISET, WAND, IDARS, UNET

Timeline

Provider Data Consultant

United HealthCare Group
01.2018 - Current

Provider Install Specialist/SME/Buddy Advocate

UnitedHealth Group
01.2015 - 01.2018

Subject Matter Expert / RARE Rapid Analyst Resolution Expert

01.2012 - 01.2015

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Shirley L Cook