Valerie J. Hereford

Administrative oversight with end-to-end responsibility of centralized credentialing verification organization in support of State of Georgia Medicaid program in different geographic areas. . Directly Manage CVO Provider enrollment, Credentialing activities as well as remote dedicated call center team supporting state of Georgia provider community fielding questions, inquiries involving enrollment, credentialing and required documents needed to complete credentialing and provider applications.

Seamless delivery using daily reports to meet operational service level agreements. Directly responsible for subcontractor/vendor delivery performance with key metrics of data transfer with a variety of processes including credentialing status of provider enrollment applications within strict service level agreements.

Collaborate cross functionality within organization on various activities to include process improvements, system enhancements and quality. Exceptional delivery to meet daily operational service level agreements as well as business objectives defined by and in collaboration with the State of Georgia Medicaid

Selected Attributes/Contributions
• Continuously create effective professional relationships with Client (State of Georgia), team and vendor.
• Interact daily with outside vendor to meet or exceed 51-day SLA requirement including credentialing results.
• Manage remote Contact center meeting or exceeding SLA agreement of 95% or higher of calls answered within required timeframe while meeting or exceeding quality measures of 90% as well as daily service levels set forth by work force management which include adherence, average handle time, abandonment rate.
• Monthly presentation provided to client to portray MTD results creating transparency of service levels and impact as well as introduce and discuss new ideas, options for opportunity to create process improvements. Share and discuss action plan and implementation measures while getting buy in to move forward with change.
• Participate as SME in weekly Credentialing meeting in support of Credentialing committee for review and discussion of weekly files

Developed enhanced and created workflow processes along with standard 0perating procedures and performance measures within challenging SLA driven environment. Directly responsible for creating positive engaged employees within a productive work environment that delivered exemplary quality results.
Lead and developed department Supervisors and staff members to create productive work environment conducive to personal growth and employee satisfaction. Coached mentored and supported team based on observation and or data received from quality resources.
Oversaw daily operations of multiple levels of staff and multiple functions across business unit.

Selected Attributes/Contributions

• Exceeded and/ or Met Service level agreements of 7-day turnaround of enrollment applications
• Maintained Quality score of 98% or better
• Main point of contact regarding special projects to successfully meet specific project timelines
• Oversaw recruitment and fulfillment of hiring needs within 60-business day window
• Participated in strategic planning regarding new business with sales team by joining phone conferences or on-site meetings showcasing results driven operation.
• Supervised operations staff and kept employees compliant with company policies and procedures.
• Developed systems and procedures to improve operational quality and team efficiency.
• Led hiring, onboarding and training of new hires to fulfill business requirements.
• Established positive and effective communication among unit staff and organization leadership, reducing miscommunications, and missed deadlines.
• Analyzed and reported on key performance metrics to senior management.

Responsible for providing product application support as defined by the Business Requirement of clients while exercising specialized knowledge of the MCO (Managed care Optimizer) software.

Evaluates and test issues while utilizing strong problem-solving skills by analyzing problems and level of issues while providing recommendations and or corrective action to a resolution. Independently plans and conducts analysis to identify extent of issue by testing and collaborating with other departments within MCO. Partnered with users and conducted live meetings as necessary to train and evaluate product use while viewing their internal processes to determine action recommending, training or documenting as a possible enhancement to meet customer needs. Utilize internal case management system to track customer issues, problems and request for service.

Selected Attributes/Contributions

· Project Management

· Strong trouble shooting skills

· Excellent written /verbal communication

· Analytical and Research skills and Reporting

· Team supporter

• Provided technical support to customers, troubleshooting technical issues and providing solutions.
• Created and implemented maintenance plans for customer accounts to secure customer satisfaction and reliability.