MS SQL SSAS, SSIS, SSRS
Teri Pung
Health Care Executive
Nashville,TN
Success isn't just about what you accomplish in your life; it's about what you inspire others to do.
Unknown
Summary
Senior leader experienced with strategic planning, operational management, and team development. Utilizes comprehensive business and technical acumen to drive organizational success and foster growth. Track record of implementing effective strategies that enhance productivity and profitability. Expertly managed large-scale projects, driving significant improvements in operational efficiency. Valued for reliability, adaptability, and results-oriented approach.
Overview
25
25
years of professional experience
Work Preference
Work Location
RemoteHybridWork History
Sr Vice President Operations & Payment Integrity
XO Health
10.2023 - 12.2024
- Start-up
- Reduced pre-revenue claim software expenses by $10 million by selecting an AI enabled, market leading
- Brought best in industry vendor solutions and personnel and led the cross-functional, companywide implementations
- Build, facilitation, and delivery of XO Health operational departments to include utilization management, claims, eligibility, network and payment integrity
- Partnered with Chief Medical Officer on clinical code analysis to identify high-risk/high-cost services to ensure alignment with payment model, benefit design, and prior auth requirements, to reduce cost of care
- Authored provider network operations manual to support network contracting and align with contractual agreement
- Presented solutions progress and financials to senior executives and board members
Vice President Claims Processing Services
AmeriHealth Caritas
12.2022 - 10.2023
- Responsible for strategic direction and organization of all transactional processing activities totally more than $20 billion annually
- Resolved a 4-year backlog of claim appeals/disputes inventory resulting in over $12 million in unnecessary LPI payments
- Lead multi team effort to collaborate, brainstorm and implement auto-adjudication and robotic processing automation resulting in $8 million savings
- Guide reporting and analytics reorg to remove unnecessary reports and align remaining reports with KPIs, KRAs, and state SLAs
- Oversaw new vendor evaluation and implementations, SOWs and contract review
Vice President Business/Product Innovation (Contractor)
OneHome Health
06.2021 - 09.2022
- Established product solution dept of 4 from concept to high functioning contributor of OneHome
- Implementation of clinical and administrative program road map resulting in a $50M admin savings across departments
- Created Product/IT council charter to bring executives and stakeholders together on W.I.N.N "what's important now and next"
Vice President Product Solutions
myNEXUS
07.2017 - 06.2021
- Start-up
- Visionary and executor of multiple administrative, clinical and financial processing systems
- Design and implementation of proprietary claims/payment integrity systems and departments reducing outsourcing costs, FTE expense, and FWA leakage by over 35%
- Restored strategic partnerships with key business associates resulting in 20% increased productivity and business scalability
Sr. Director Claims Operations (Contractor)
New Century Health
03.2016 - 03.2017
- Operations and technical lead for all claim related development projects
- Introduction of paper to electronic (P2E) solution achieving 98% EDI from 70%
- Established claim processing Service Level Agreements (SLA's) metrics reducing claim processing TAT from 8 days to 1-2 days
- Implemented EFT/835 solution to improve provider payment efficiency and reduce calls by 20%
Sr. Manager Claims Ops & Claims AR
Med Solutions/EviCore Healthcare
05.2014 - 03.2016
- Operational and technical lead for all claims related development projects
- Reduced claims accounts receivable cost per touch by 1.4 million
- Achieved 100% client SLA metrics from 70% when assigned department
- Built and managed data reporting and analytics team for the purpose of discovering and supporting operational efficiencies
- Mentored junior staff members for skill development and career progression within the organization
Lead Business Analyst Senior Specialist (Contractor)
Cigna HealthSpring
06.2013 - 05.2014
- Data analysis and reporting lead
- Lead for new web applications to reduce cost and improve customer experience, i.e., online provider directory
- Act as a subject matter expert (SME) on product development team
- Assist business users, project managers and product development in optimizing project scope - managing expectation of users and management
Vice President Data Mining & Query Operations (Contractor)
SCIO Health Analytics
11.2011 - 06.2013
- Start-up
- Led data analysis and query development
- Developed company wide implementation strategy allowing centralized master data solution improving data validity and department silos
- Provided recommendation to resolve company AR issues resulting in increase of collection rate by 60%
- Initiated successful rollout of enterprise-wide claims application
Accounts Receivable Manager / Query Operations
The Little Clinic
02.2008 - 11.2011
- Implemented outsourced accounts receivable department reducing aged AR by 50%
- Reconfigured AR EMR system eClinicalWorks to newer version for automation of 837 claim submission and 835 payment posting
- Develop new automated accounts receivable reporting solutions to track production and payments
Director of Query Operations
AIM Healthcare
10.2000 - 02.2008
- Start up
- Successfully implemented a highly productive reporting environment supporting internal business divisions, health plans and providers across 50 states, resulting in a 50% ROI savings
- Chartered a predictive modeling project to reduce data size, improve report execution times and increase revenue, resulting in a 10-million-dollar ROI savings year one
Accomplishments
● Introduced and streamlined processes for accounts receivable billing staff, resulting in a year one 4.6 million cost per touch ROI
● Initiated and implemented a report automation process resulting in a 63% lift in operational productivity
● Streamlined and automated manual system processes resulting in a 4-million-dollar annual FTE savings
Development, Data Analysis, and Analytics
● Successfully implemented a highly productive reporting environment supporting internal business divisions, health plans and providers across 50 states, resulting in a 50% ROI savings
● Contributed to deep dive data, system and process analysis to reduce FTE cost-per-touch, resulting in a 20% savings in FTE expense
● Chartered a predictive modeling project to reduce data result size, improve report execution times and increase revenue opportunity, resulting in a 10-million-dollar ROI savings
Skills
- Strategic planning and leadership
- Articulate communication
- Data analysis
- Cross-functional collaboration
- Operational excellence
- Information technology
- Policies and procedures
- Partnership development
- KPI tracking
- Process improvement
- Healthcare systems and regulation
- Decision making
- Results orientation
- Performance improvement
- Team building
- Analytical and critical thinker
- Regulatory compliance
- Innovation management
Education
Business Accounting /Technology -
03-1992
Timeline
Sr Vice President Operations & Payment Integrity - XO Health
10.2023 - 12.2024
Vice President Claims Processing Services - AmeriHealth Caritas
12.2022 - 10.2023
Vice President Business/Product Innovation (Contractor) - OneHome Health
06.2021 - 09.2022
Vice President Product Solutions - myNEXUS
07.2017 - 06.2021
Sr. Director Claims Operations (Contractor) - New Century Health
03.2016 - 03.2017
Sr. Manager Claims Ops & Claims AR - Med Solutions/EviCore Healthcare
05.2014 - 03.2016
Lead Business Analyst Senior Specialist (Contractor) - Cigna HealthSpring
06.2013 - 05.2014
Vice President Data Mining & Query Operations (Contractor) - SCIO Health Analytics
11.2011 - 06.2013
Accounts Receivable Manager / Query Operations - The Little Clinic
02.2008 - 11.2011
Director of Query Operations - AIM Healthcare
10.2000 - 02.2008
Laramie College - Business Accounting /Technology,
Affiliations
- Recreational Aviation Foundation (RAF)
- Mental Health Strong
Activities
- Healthcare Executives
- John Maxwell Leadership
- Greater Nashville Technology Council
- OZ Principles
Software
Azure DevOps, Jira
Aha!, Mondaycom, Smartsheet
MS Excel, Word, Access, SharePoint, PowerPoint
Visio, Lucidchart, Drawio, Snagit
Azure Cloud, PowerBI, Fabric
Teams, Slack, Zoom
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