Tracia Scarlett
Hollywood,FL
Summary
Dynamic leader with a strong ability to resolve critical issues in fast-paced environments, complemented by a proven track record of building and nurturing high-performing teams. Expertise in motivating staff to collaborate effectively and achieve ambitious targets, fostering a culture of excellence and accountability. Possesses analytical acumen and technical proficiency, enabling success in data-driven settings while leveraging critical thinking skills to drive strategic decision-making. Committed to continuous improvement and delivering exceptional results through innovative problem-solving approaches.
Overview
12
12
years of professional experience
Work History
Business Analyst
Centene Corporation
2023.12 - Current
- Processes job data corrections, reinstatement of benefits while meeting time agreement for health plans.
- Evaluates data, establishes a course of action for escalation and submits responses to case creators for review without falling out of the SLA.
- Support business initiatives through case investigation for member escalation cases that come from health plans, customer service, Department of Insurance, brokers, and other entities.
- Research and Monitor discrepancies from state payments for accuracy of payments.
- Identify and analyze user requirements, procedures, and problems to improve existing processes.
- Perform detailed analysis on assigned projects, recommend potential business solutions, and assist with implementation.
- Assist with projects as assigned by health plan for trending enrollment analysis, inventory, or other enrollment issues.
- Compiles and reviews all reports and forecast future enrollment activities.
Supervisor Referral
Centene - Sunshine Health
2021.12 - 2023.12
- Manage day to day workflow of staff, ensuring regulatory adherence to the product development life cycle
- Support the implementation of measurable, repeatable, scalable, and predictable processes related to organizational goals and drive continuous improvement to enable the department to scale efficiently and effectively.
- Coordinates the implementation of technological functions to providers specifications.
- Review data to determine operational impacts and needed actions; elevate issues, trends, areas for improvement and opportunities to management and assist with state and provider complaints /EPSDT
- Utilize corporate and industry standard project management tools and techniques to effectively manage projects
- Identify opportunities to increase efficiency, improve service levels and to ensure regulatory compliance through enhanced operations.
- Act as Primary Analyst for assigned project and proactively identify topic and analysis
Lead Referral Specialist
Centene - Sunshine Health
2018.07 - 2021.12
- Lead sub-projects and smaller initiatives.
- Travel/Manage to oversee cross training team members in different locations
- Collaborate as the point of contact for Members, Providers, Internal and External departments, Stakeholders, and Vendor Relations to extract data for identification of program members and to report program outcomes
- Develop reports and statistical data to other department designees with deliverables for management.
- Identify information gaps through needs analysis methodology and develop appropriate training programs, including the selection or design of appropriate training aids.
Referral Specialist
Centene - Sunshine Health
2016.12 - 2018.07
- Responsible for answering incoming provider calls for Utilization Management Department
- Providing status updates for existing authorizations
- Creating shells for Inpatient or Outpatient authorization request via the phone or assignments in FileNet within established time frames.
Supervisor Prior Auth
United Health care
2014.03 - 2016.09
- Oversee the day-to-day training functions to include scheduling, curriculum development
- Providing direction, Monitoring of staff performance and skillsets for consistency and improvement for all lines of business
- Provider Resolution Specialist for Medicaid and Medicare line of business
- Develop, communicate, implement, and maintain production and quality standards
- Manage multiple projects through full project life cycle process including requirements gathering, creation of project plans and schedules, obtaining and managing resources, managing budget, and facilitating project execution, deployment, and closure.
- Validates and test new capitation implantations are functional.
- Communicates and identify issues /concerns across corporate departments
Education
Associate of Science - Healthcare Administration
Miami Dade College
Miami, FLSkills
- Process optimization
- Team leadership
- Training and development expertise
- Microsoft Office
- Data implementation
- Project management
- Data Resolution Specialist
- Business Development
- Care Management expert
- EPSDT knowledgeable
- Data Analytics
- HEDIS knowledgeable
- Operations Management
- Strategic Planning
- Problem Solving
- Inventory Analyst
- Policy Enforcement
- Project Management
- Contract Management
- Process Monitoring and Improvement
- Financial Management
- Complex Problem-Solving
- Business Administration
- Waste Reduction
- Business Planning
- Power BI
- Risk Adjustment
Timeline
Business Analyst
Centene Corporation
2023.12 - Current
Supervisor Referral
Centene - Sunshine Health
2021.12 - 2023.12
Lead Referral Specialist
Centene - Sunshine Health
2018.07 - 2021.12
Referral Specialist
Centene - Sunshine Health
2016.12 - 2018.07
Supervisor Prior Auth
United Health care
2014.03 - 2016.09
Associate of Science - Healthcare Administration
Miami Dade College