Violeta Bunger
Heiskell,TN
Summary
With eleven years of diverse experience spanning operations, data support, provider relations, network development, contracting, and healthcare marketing, and event planning, I bring a wealth of skills to the table. Highly organized and independent, I excel in coordinating tasks across multiple projects with efficiency and creativity. Detail-oriented and energetic, I thrive under pressure, strategizing and prioritizing effectively to meet tight deadlines. As an articulate communicator, I effortlessly engage with team members at all levels, fostering strong relationships and rapport. A proficient problem solver, I identify opportunities for improvement, and streamline processes to enhance efficiency. With a professional background spanning diverse cultures, I bring a global perspective to my work. Experienced in navigating regulatory mandates, I ensure team compliance while driving success. Additionally, my fluency in Spanish enhances my ability to connect with a broader audience, and navigate multicultural environments seamlessly. Hardworking employee with customer service, multitasking, and time management abilities. Devoted to giving every customer a positive and memorable experience.
Overview
17
17
years of professional experience
Work History
Project Expert II
Elevance, Carelon
01.2023 - Current
- Led the LTACH to SNF process, saving the company over $20 million annually by optimizing workflows and reducing inefficiencies
- Collaborates with cross-functional teams to deliver business projects from design to completion
- Analyzes complex business needs to recommend optimal process improvements
- Creates workflows, test plans, and user training materials to address business requirements
- Leads process improvement initiatives, driving efficiency and organizational change management
- Acts as a subject matter expert to provide guidance and resolve software-related queries
- Conducted comprehensive research and data analysis to support strategic planning and informed decision-making.
- Worked effectively in team environments to make the workplace more productive.
- Managed time effectively to ensure tasks were completed on schedule and deadlines were met.
- Conducted testing of software and systems to ensure quality and reliability.
Project Leader
Elevance, Louisiana
01.2021 - 01.2023
- Managed the Health Plan attestation process end-to-end, increasing the review of clinical guidelines by 50%
- Translated business needs into actionable requirements for IT teams to ensure alignment with project goals
- Developed and managed end-to-end processes for compliance reviews and policy implementation
- Coordinated resources for compliance reviews and vendor engagement to achieve process improvements
- Delivered user training, developed documentation, and conducted system testing
- Prioritized tasks and assignments to maintain project momentum and meet critical deadlines.
- Conducted regular meetings with stakeholders to review project objectives, status updates and potential risks.
- Managed the day-to-day operations of projects including tracking progress, resolving issues and making adjustments as necessary.
- Facilitated communication between project stakeholders to align expectations and project goals.
Business Analyst II
Elevance, Tennessee
01.2019 - 01.2021
- Analyzed business application software requirements and collaborated with IT to ensure implementation aligned with business needs
- Developed project plans, coordinated resources, and managed timelines for client-facing projects
- Acted as a liaison between business and IT teams to address system configuration and enhancement needs
- Conducted user acceptance testing and claims analysis to ensure accuracy and efficiency
- Conducted research and resolved state complaints and independent disputes, preparing comprehensive documentation for state partners
- Created informative, actionable, and repeatable reporting that highlighted relevant business trends and opportunities for improvement.
- Identified needs of customers promptly and efficiently.
- Managed and led meetings and workshops with multiple departments to solidify requirements.
- Evaluated business processes for improvement opportunities through automation or streamlining.
Senior Claims Resolution Analyst
Elevance, California and Virginia
01.2014 - 01.2019
- Investigated and resolved claims issues by analyzing systems and processes
- Conducted claims and trend analysis, recommending new processes to minimize errors (e.g., Reduce claim errors by 20% through process improvements)
- Performed user acceptance testing to validate system enhancements
- Collaborated with internal teams to resolve issues within tight deadlines and provided training on new workflows
- Investigated complex claims by gathering information from various sources to assess validity.
- Analyzed claims data to determine coverage and liability, ensuring accurate decision-making.
- Participated in claims audit processes to ensure compliance with internal and external standards.
- Researched and investigated insurance policies to ensure accurate claim payments.
- Managed workload effectively to ensure timely processing of claims within designated deadlines.
- Participated in meetings with senior management teams concerning performance metrics associated with claims resolution goals.
- Followed all company procedures to keep data confidential.
Provider Administrator
United Healthcare
Albuquerque, New Mexico
01.2013 - 01.2014
- Researched and resolved pricing and configuration issues within claims payment systems
- Analyzed provider fee schedules and ensured accuracy in claims processing
- Coordinated efforts with internal departments to meet deadlines and resolve state and federal complaints
- Supported departmental activities by providing clerical assistance.
- Responded promptly to customer complaints in a professional manner.
- Answered incoming calls and responded to customer inquiries.
- Maintained positive working relationship with fellow staff and management.
- Provided general administrative support to staff members.
- Coordinated with IT department to resolve technical issues and maintain computer systems.
Claims Resolution Analyst
Elevance
Albuquerque, New Mexico
01.2011 - 01.2013
- Investigating and resolving claims issues, including incorrectly paid claims
- Analyzing systems and processes in member enrollment, provider information management, benefits configuration, and claims processing
- Assisting in reviewing state or federal complaints related to Long Term Services and Support claims
- Coordinating internal departments to resolve issues within strict timelines
- Regular interaction with network providers and health plans to manage customer expectations and communicate risks
- Conducting claims and trend analysis, ensuring accurate documentation and obtaining necessary approvals
- Recommending new processes to reduce claims errors
- Conducting user acceptance testing to ensure new contracts are loaded correctly and system modifications are accurate
- Reviewed coordination of benefits status for member data
- In-depth research to identify additional sources of medical coverage
Collections Representative
HME SPECIALISTS, LLC
Albuquerque, New Mexico
01.2010 - 01.2011
- Compiling and maintaining manual tracking logs on MS Excel for insurance billing
- Assisting management in automating document control tracking systems
- Researching and processing correct completion of 303s, CMNs, AOBs, and RXs
- Coordinating with other HME Specialists departments for proper documentation
- Collaborating with customers, nursing facilities, and physician’s offices for billing documentation
- Entering data into Brightree for data report compilation
- Participating in e-learning programs
- Assisting as a backup customer service representative
- Verifying insurance benefits/eligibility and obtaining authorization
- Making new setup patient packets
PFS Billing Specialist
PRESBYTERIAN
Albuquerque, New Mexico
01.2008 - 01.2010
- Acted as point of contact for team questions in relation to job processes and documentation changes
- Assisted in initial onboard training for 3 new hire classes, totaling 50+ representatives
- Provided analysis of production breakdowns to management for review
- Reviewed team quality errors to determine accuracy issues and conducted additional training as needed
Education
Bachelor’s Degree - Healthcare Management
Southern New Hampshire University
Durham, NH01.2020
Associate Degree - General Studies
Southern New Hampshire University
Durham01.2015
Medical Billing and Coding Certificate Program - Health Insurance and Re-imbursement, Medical Terminology, Anatomy and Physiology
Washington Online Learning Institute
01.2010
Skills
- Microsoft Word
- Excel
- PowerPoint
- SharePoint
- FACETS
- MACESS
- CACTUS
- PEGA
- VISIO
- AZURE
- Maces
- WGS
- SQL
- Smartsheet
- Operations Management
- Program & Project Management
- End-to-end process improvement
- Claims Analysis
- Data Management
- Database Maintenance
- Proficient in credentialing software systems and databases
- Data Analysis & Reporting
- Project Planning and Coordination
- Decision Support
- Assists with User Acceptance Testing
- Quality Improvement
- Knowledge of regulatory requirements and compliance standards in healthcare
- Six sigma yellow belt
- Health Plan implementation & special projects
- Workflow development
- Documentation and Guidelines
- System Upgrades and Releases
- Process improvement
- Workflow optimization
- Critical thinking
- Decision-making
- Remote office availability
- Data entry
- Calm under pressure
- Flexible and adaptable
- Computer skills
- Time management
- Project management
- Customer relationship management
Accomplishments
- 09/2023, Agility - For creating a Smartsheet to track a wide variety of task and projects.
- 08/2022, Partner to Win Impact Award - For contributions to improving FQHC/RHC configuration errors.
- 04/2022, Partner to Win Impact Award - For end-to-end process implementation which created change at the state level.
- 09/2021, Lead with Purpose and Heart – For contributions to positive change within the Health Plan.
- 05/2020, Mission-driven Performance For getting the Central Region State Provider Complaint Tracker running, providing feedback on questions and issues, and helping to clean up data for reporting and maintenance needs.
- 02/2020, Champion of Change – For executing and championing new processes and crafting the overall responses to TennCare in a short amount of time.
Languages
Spanish
Professional
References
References available upon request.
Timeline
Project Expert II
Elevance, Carelon
01.2023 - Current
Project Leader
Elevance, Louisiana
01.2021 - 01.2023
Business Analyst II
Elevance, Tennessee
01.2019 - 01.2021
Senior Claims Resolution Analyst
Elevance, California and Virginia
01.2014 - 01.2019
Provider Administrator
United Healthcare
01.2013 - 01.2014
Claims Resolution Analyst
Elevance
01.2011 - 01.2013
Collections Representative
HME SPECIALISTS, LLC
01.2010 - 01.2011
PFS Billing Specialist
PRESBYTERIAN
01.2008 - 01.2010
Bachelor’s Degree - Healthcare Management
Southern New Hampshire University
Associate Degree - General Studies
Southern New Hampshire University
Medical Billing and Coding Certificate Program - Health Insurance and Re-imbursement, Medical Terminology, Anatomy and Physiology
Washington Online Learning Institute
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