Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Terri Hutto

McCalla,AL

Summary

Dynamic Senior Project Manager at CVS Healthcare with expertise in project planning and client relationship management. Proven track record in enhancing claim payment accuracy and streamlining contract implementations. Adept at mentoring teams and resolving complex issues, driving significant improvements in operational efficiency and client satisfaction. I would be the perfect fit for final signoff of provider contract implementation and key metrics including loading of contract by effective date and obtaining 100% quality assurance/accuracy of pre-production claim testing.

Overview

29
29
years of professional experience

Work History

Auto Adjudication, Senior Project Manager

CVS Healthcare
05.2019 - Current
  • Directed changes to project scope and cost and implemented appropriate change management processes to keep project on track. As a senior project manager, I help increase claim payment accuracy and improve experience through solutions that work and measure configuration quality. I configure triggers and HRL's languages to improve claim pricing and auto adjudication.
  • Mentored junior project managers and team members to enhance their skills and career growth. I am an Business Intent Review SME for the HRP BIR Contract Validation Team. I partner with network by assisting with their contract set up issues or claim issues. I do this by performing BIR and analyzing any issues and getting to the root of the problem. These issues sometimes gets resolved before the claims comes in.
  • HRP Contract Mailbox (SME)-Provide approvals to HRP financial comments, provide direction and advice on contract set ups. If necessary, handle complex calls with network, PDS and SCM support.
  • I have severed on multiple projects as a project manager and monitored and handled these projects in a timely manner.

Aetna, Contract Consultant Unit

Aetna
05.2016 - 05.2019
  • Conducted comprehensive contract audits to ensure compliance with regulations and identify potential areas of risk, leading to proactive mitigation strategies. As a CCU for the SE region, I reviewed all Pre Signature and Post Signature Reviews. I reviewed all documents on the document tab in SCM which can be amendments, CSF's and all provider type schedules. I have audited chargmasters, Cola's, renegotiation's and provider data rosters including location forms.
  • Developed strong working relationships with clients through regular communication and proactive problem-solving approaches. I was an Network Liaison Market Lead for Northeast Region where I have worked with multiple network management to improve contract streamline.

Aetna, Market Aligned Project Leader (MAPL)

Aetna
10.2013 - 05.2016
  • Established strong relationships with clients, fostering trust and open communication throughout the entire project lifecycle.
  • As a project leader for multiple rework claim projects, these projects were in dept of researching and resolving multiple claim issues and getting the claims reworked within 30 days. This can be resolved with meetings across departments or simply finding trends and getting them fixed as soon as possible and provide training if necessary.

Prudential/Aetna/Claim Processor/ECHS/BIR

Prudential/Aetna
01.1997 - 10.2013
  • Improved client satisfaction by ensuring timely and accurate processing of requests.
  • Implemented new workflows to streamline the processor role, resulting in improved performance metrics.
  • Provided outstanding customer service by promptly addressing inquiries and resolving issues.
  • Claim processor for ACAS/HMO claims
  • Rework processor and 2nd and 3rd look for high dollar claims
  • Customer Service in Electronic Handling Correspondence System (ECHS)
  • Business Intent Review for ACAS and HMO claims (This was the first BIR team for Aetna)

Education

Multiple Management Courses - Business

Florida Community College of Jacksonville
Jacksonville, FL

Project Management Certificate - Project Management

Charter Oak of Arizona
Phoenix, AZ
07-2015

Skills

  • Project planning
  • Scope management
  • Client relationship management
  • Project plan development
  • Claim Processing experience
  • Network Operations experience
  • Contract implementation experience
  • CSF (Contract Submittal Form) knowledge

Languages

English

Timeline

Auto Adjudication, Senior Project Manager

CVS Healthcare
05.2019 - Current

Aetna, Contract Consultant Unit

Aetna
05.2016 - 05.2019

Aetna, Market Aligned Project Leader (MAPL)

Aetna
10.2013 - 05.2016

Prudential/Aetna/Claim Processor/ECHS/BIR

Prudential/Aetna
01.1997 - 10.2013

Multiple Management Courses - Business

Florida Community College of Jacksonville

Project Management Certificate - Project Management

Charter Oak of Arizona

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