Summary
Overview
Work History
Education
Skills
References
Timeline
Generic

Stacy Canter

Knoxville,TN

Summary

I am a Healthcare Operations expert with over 26 years of experience. I possess exceptional expertise in claims, provider maintenance, claims processing, configuration and design, coding, business analysis, and end-to-end testing. My 15+ years of experience in Agile/Scrum have honed my skills in assisting with user stories, design, and test planning. I am highly skilled in designing process flows and swim lanes in MS Visio, with an in-depth understanding of the Healthcare industry, including project management, business analysis, and operational development. My exceptional diagnostic and analytical skills have enabled me to consistently deliver complex projects, manage business continuity, and participate in incident management, problem management, and change management processes. I work closely with business partners, providing top-tier leadership and expertise in structuring, planning, and post-implementation support. Additionally, I develop project plans and manage the plan when necessary. I possess complete knowledge of the SDLC, including post-production support and user acceptance testing. My proficiency in writing business requirements documents, functional requirements documents, technical writing, and business process flow in both their As-Is and To-Be forms is unparalleled. My extensive knowledge, skills, and experience make me an invaluable asset to any organization requiring a Healthcare Operations expert. I am confident in my ability to leverage my expertise to drive success and growth, and I am excited to bring my skills to any organization in need of my services.

Overview

15
15
years of professional experience

Work History

Mgr. Healthplan Application Operations

Bright Healthcare/Remote
2022.07 - Current
  • Manage a team of 3+ members
  • Provides leadership and expertise in structuring, planning, and post-implementation support efforts
  • Help establish metrics, key performance indicators, and service level agreements for driving the performance of the team
  • Participate in incident management, problem management, and change management processes
  • Ensures the operation is in accordance with established procedures and practices
  • Works with the team to manage overall day-to-day operations to improve costs, performance, and end-user satisfaction
  • Develop project plans and manage to the plan (when necessary)
  • Identify process/application/business improvement opportunities.
  • Designed best practice documentation for development.
  • Defined project-wide performance metrics such as developmental milestones, timeline goals and required completion dates.
  • Guided team in layout modifications to improve functionality.
  • Oversaw development and implementation of improvements to support and network operations.

Principal Business System Analysis

United Healthcare Group/Optum Healthcare
2020.06 - 2022.06
  • Responsible for the management of business processes and project oversight for the Facets Product Team
  • Collaborated with multiple teams identifying and implementing solutions for claims processing, process improvement, and automation opportunities
  • Work closely with business partners to influence their business and technical decisions and prioritize initiatives throughout key business cycles
  • Accountable for delivery of complex and transformational multi-year upgrade programs/projects
  • Help manage business continuity, including needs analysis, design, plan implementation, and documentation
  • Provides leadership and expertise in structuring, planning, and post-implementation support efforts
  • Coordinates and partners with the I.T
  • And Business leaders (both in the U.S and India) to optimize service design, delivery, and support
  • Participate in incident management, problem management, and change management processes.
  • Created new procedures to streamline operations by minimizing average completion times and reducing failure rates.
  • Evaluated current processes to develop improvement plans.
  • Produced detailed and relevant reports for use in making business decisions.
  • Conducted thorough reviews of operations to devise and deploy improvement strategies.
  • Compiled research data and gave professional presentations highlighting finds and recommended optimizations.

Associate Director, Architecture and Key Initiatives

United Healthcare Group/Optum Healthcare
2019.11 - 2020.05
  • Management of business and technical resources for business process improvement and project oversight for the Benefits Configuration Team
  • The team was responsible for identifying and implementing solutions for claims processing, process improvement, and automation opportunities
  • Manage a team of 9+ members
  • Responsible for departmental decisions and management
  • Work closely with business partners to influence their business and technical decisions and prioritize initiatives throughout key business cycles
  • Accountable for delivery of complex and transformational multi-year upgrade programs/projects
  • Help manage business continuity, including needs analysis, design, plan implementation, and documentation
  • Provides leadership and expertise in structuring, planning, and post-implementation support efforts
  • Supports and develops a pipeline of expertise that will meet long-term business goals
  • Coordinates and partners with the I.T and Business leaders (both in the U.S and India) to optimize service design, delivery, and support
  • Participate in incident management, problem management, and change management processes
  • Shares responsibility for the strategic direction of the group, ensuring that it aligns and meets the business objectives and goals
  • Ensures the operation is in accordance with established procedures and practices
  • Works with the team to manage overall day-to-day operations to improve costs, performance, and end-user satisfaction
  • Determine resource needs for projects and staffing appropriately
  • Develop employees and teams
  • Identify process/application/business improvement opportunities.

Associate Director, Health Plan Operations

United Healthcare Group/Optum Healthcare
2012.05 - 2019.10
  • Responsible for tactical management of business processes and health plan operations for national and regional health plan
  • Leading a team identifying and implementing solutions for provider, enrollment, and claims processing
  • Lead a team of technical and business resources in developing solutions to accommodate business needs
  • Manage a team of 18+ members
  • Responsible for departmental decisions and management
  • Provide strategic direction, coaching, and development of leaders & staff within the teams
  • Work closely with business partners to influence their business and technical decisions and prioritize initiatives throughout key business cycles
  • Accountable for delivery of complex and transformational multi-year upgrade programs/projects
  • Help manage business continuity, including needs analysis, design, plan implementation, and documentation
  • Provides leadership and expertise in structuring, planning, and post-implementation support efforts
  • Help establish metrics, key performance indicators, and service level agreements for driving the performance of the various teams
  • Supports and develops a pipeline of expertise that will meet long-term business goals
  • Coordinates and partners with the I.T
  • And Business leaders (both in the U.S
  • And India) to optimize service design, delivery, and support
  • Oversight of business process analyst/development team
  • Oversight of the QA Testing Team as it relates to HPO
  • Participate in incident management, problem management, and change management processes
  • Shares responsibility for the strategic direction of the group, ensuring that it aligns and meets the business objectives and goals
  • Responsible for the overall effectiveness and efficiency of the various Health Plan Operations and Business Process teams
  • Ensures the operation is in accordance with established procedures and practices
  • Works with the team to manage overall day-to-day operations to improve costs, performance, and end-user satisfaction
  • Work with customers on prioritizing projects
  • Develop project plans and manage the plan (when necessary)
  • Determine resource needs for projects and staffing appropriately
  • Develop employees and teams
  • Identify process/application/business improvement opportunities.
  • Assisted senior leadership in managing all aspects of operations.
  • Prioritized tasks and allocated resources appropriately to keep teams focused and productive.
  • Communicated all capacity, sourcing and technology gaps with upper management.
  • Engaged analytical subject matter experts outside project teams to drive troubleshooting of critical process-related deviations and enhance process improvements.
  • Supported continuous process and performance improvement for manufacturing issues, robustness and compliance.
  • Trained and mentored new employees on industry practices and business operations.
  • Worked closely with management to provide effective assistance for specific aspects of business operations.
  • Tracked key business metrics and made recommendations for proactive adjustments to policies and procedures.
  • Evaluated employee performance and conveyed constructive feedback to improve skills.
  • Established team priorities, maintained schedules and monitored performance.
  • Leveraged data and analytics to make informed decisions and drive business improvements.
  • Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
  • Developed detailed plans based on broad guidance and direction.
  • Planned, created, tested and deployed system life cycle methodology to produce high quality systems to meet and exceed customer expectations.

Senior Service Delivery Lead

The TriZetto Corporation
2009.01 - 2012.01
  • Managed high-profile BPO and Hosted clients in a complex, regulatory environment with a variety of structures, priorities, and products
  • Day-to-day management included client meetings, troubleshooting, creating requirements documents and DLP’s, implementation documentation, and issue lists
  • Senior-level experience in Facets, QNXT, and TriZetto Medicare/Medicaid products
  • Facilitated complex presentations to customers at an Executive level weekly and quarterly
  • Managed user-level system and product issues with follow-through to resolution
  • Managed and directed internal relationships throughout the company, from peers to Executive Leadership
  • Delivered consistent and exceptional results in various projects and initiatives including: Assumed ownership of multi-plan configuration design and development, including tracking and completion, for a Medicare benefit plan to meet the regulatory requirements for growth
  • Worked alongside our performance team to alleviate application system latency and slowness and bring root cause to light, steering and refocusing, as necessary.

Education

High School Diploma -

Silsbee High School
Silsbee, TX
05.1990

Skills

  • Agile & Scrum
  • FACETS, SunGard MACESS, TriZetto Medicare Suite, ICES, HSS Suite, McKesson Mainframe Claims Processing, MS SQL Server
  • MS Excel, MS Word, MS Visio, SharePoint, MS PowerPoint, Onyx Ticket Management, HP Tool Suite, Citrix, Rapid SQL, Tidal Scheduler
  • Staff Development
  • Strategic Planning
  • Performance Management
  • Operations Management
  • Policy Implementation
  • Complex Problem-Solving
  • Project Management
  • Verbal and Written Communication
  • Business Planning

References

Available upon Request

Timeline

Mgr. Healthplan Application Operations

Bright Healthcare/Remote
2022.07 - Current

Principal Business System Analysis

United Healthcare Group/Optum Healthcare
2020.06 - 2022.06

Associate Director, Architecture and Key Initiatives

United Healthcare Group/Optum Healthcare
2019.11 - 2020.05

Associate Director, Health Plan Operations

United Healthcare Group/Optum Healthcare
2012.05 - 2019.10

Senior Service Delivery Lead

The TriZetto Corporation
2009.01 - 2012.01

High School Diploma -

Silsbee High School
Stacy Canter