Tracy Lilja
Myrtle Beach,SC
Summary
Collaborative leader with dedication to partnering with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic settings, while encouraging company growth.
Overview
23
23
years of professional experience
Work History
Lead Provider Information Management Rep
Highmark Blue Cross Blue Shield
11.2021 - Current
- Ensures compliance encompassing provider file management for business audits by NCQA, CMS, DOH regulations and internal entities
- Responsible for contract administration, contract generation, and reviewing signed contracts for the development of provider networks
- Provide quality customer service for provider inquiries
Senior Member Engagement Guide, Member Engagement Guide
Highmark Blue Cross Blue Shield
06.2017 - 11.2021
- Empower members to make informed decisions by evaluating the most appropriate type of provider for members' unique needs, assess which providers are in-network and ensure that the members are fully informed of the tools and resources available to transition to AHN or other community providers
- Reduced hospital admissions and ED visits by relationship building and partnering with members (including those clinically acute like oncology and transplant) to identify the best care to meet their needs, while educating on Clinical & Wellness Programs, such as Blues on Call, Disease Management
- Programs, Health Coaches, and Wellness Coaches
- Participate in the development of sales strategies with the Organization's Sales Team, as well as executing those strategies in sales situations by influencing member buying decisions to purchase supplemental Lines of coverage
- Educate members about access to comprehensive clinical care and demonstrate the quality of care and advanced outcomes of partner network providers
- Cultivate seamless processes which promote time saving call efforts and preparation time of Clinical
- Services Team, increasing time utilization and quality talk time
- Involved in creating and developing MECA Health Informatics Tool in preparation for Well360 Clarity
- Product Rollout
- Conduct analysis and provide input and enhancements of Get Next Best Work Tool, driving change implementation for streamlining processes
- Developed a team based strategic initiative, which resulted in $70 million care shift to Allegheny Health
- Network
- Selected from team to work with client C-Suite Executives, to assist with personal or employee care needs because of exceptional customer service and thoughtful approach provided..
Navigator
Gateway Health
03.2015 - 05.2017
- Utilized motivational interview techniques to build relationships with Medicare & Medicaid members in an effort to provide member's with best coaching experience
- Served as resource coordinator, that provided health education, especially regarding preventive screenings, as well as a bridge to in network providers and community resources
- Conducted assessments to determine best approach to member’s specific needs
- Outreached to members providing them with preventive health education and benefits explanation.
Community Liaison
Redstone Highlands
01.2013 - 03.2014
- Of the senior living community to all referral sources, promoted community and support through sales process
- Meet weekly to review resident’s healthcare in order to determine appropriate level of care within community.
Sales Consultant
Wireless Zone
01.2012 - 01.2013
- Support customers through wireless sales process
- Simplify and educate on complex products by doing customer presentations and tutorials.
Search Coordinator
Aviation Search Group
01.2010 - 01.2012
- Establish relationships with job seekers, while uncovering their career aspirations.
Management Assistant
Enterprise
08.2008 - 01.2010
- Customer Service, and problem solvingWorked with staff to provide a customer centric experience
- Met or exceeded expectations of customers based on customer feedback.
Pharmaceutical Sales Representative
InVentiv Health - Boehringer Ingelheim
01.2007 - 01.2008
- Developed and adapted innovative approaches to penetrate the market and increase market share
- Partnered with primary care doctors and specialists to provide clinical solution to their patients.
Sales Consultant
AT&T Wireless
03.1998 - 01.2007
- Supported customers through wireless sales process
- Simplified and educate on complex products by doing customer presentations and tutorials.
Education
Masters of Science - Nutrition & Integrative Health
Maryland University of Integrative Health
Health Coach Certification - undefined
Institute of Integrative Nutrition
Bachelors Degree - Human Resource Mgt
Geneva College
Skills
- Customer/Provider Needs Assessments
- Detail Oriented
- Quality Control
- Customer Retention
- Outreach Initiatives
- Process Knowledge
- Professional Relationships
Timeline
Lead Provider Information Management Rep
Highmark Blue Cross Blue Shield
11.2021 - Current
Senior Member Engagement Guide, Member Engagement Guide
Highmark Blue Cross Blue Shield
06.2017 - 11.2021
Navigator
Gateway Health
03.2015 - 05.2017
Community Liaison
Redstone Highlands
01.2013 - 03.2014
Sales Consultant
Wireless Zone
01.2012 - 01.2013
Search Coordinator
Aviation Search Group
01.2010 - 01.2012
Management Assistant
Enterprise
08.2008 - 01.2010
Pharmaceutical Sales Representative
InVentiv Health - Boehringer Ingelheim
01.2007 - 01.2008
Sales Consultant
AT&T Wireless
03.1998 - 01.2007
Masters of Science - Nutrition & Integrative Health
Maryland University of Integrative Health
Health Coach Certification - undefined
Institute of Integrative Nutrition
Bachelors Degree - Human Resource Mgt
Geneva College
Similar Profiles
Nyah LevineNyah Levine
Pediatric Behavioral Health Coach & Case Manager at Highmark Blue Cross Blue ShieldPediatric Behavioral Health Coach & Case Manager at Highmark Blue Cross Blue Shield
Pamela GibbsPamela Gibbs
Customer Service Advocate at Highmark Blue Cross Blue ShieldCustomer Service Advocate at Highmark Blue Cross Blue Shield
Henrietta BrownHenrietta Brown
Business Process Analyst at Highmark Blue Cross Blue ShieldBusiness Process Analyst at Highmark Blue Cross Blue Shield