Summary
Overview
Work History
Education
Skills
Timeline
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Magalie St Fleur

Owings Mills,Maryland

Summary

My core background throughout the past 22 years deals with assistance in the field of health and providing great service to our members and providers. Specializing in business analyst skills and performing in leadership roles. Previous manager payment integrity. Keeping a solid history of achievement in the Healthcare industry, I was able to obtain the opportunity to supervise over 5-10 employees daily with health documentation and claims processing. Successfully reaching deadlines daily for audit purposes and Fiscal reasons.

Overview

18
18
years of professional experience

Work History

Manager Payment Integrity

VNS Health
08.2017 - 04.2025
  • Managed and motivated employees to be productive and engaged in work.
  • Accomplished multiple tasks within established timeframes.
  • Maintained professional, organized, and safe environment for employees and patrons.
  • Developed and maintained relationships with customers and suppliers through account development.
  • Developed a strong company culture focused on employee engagement, collaboration, and continuous learning opportunities.
  • Improved safety procedures to create safe working conditions for workers.
  • Achieved departmental goals by developing and executing strategic plans and performance metrics.
  • Built high-performing teams through effective recruitment, onboarding, and talent development initiatives.
  • Managed budgets effectively, ensuring optimal financial performance while investing in necessary resources for business growth.
  • Improved marketing to attract new customers and promote business.
  • Developed and executed marketing strategies that effectively communicated brand values, increasing brand recognition.
  • Increased market share with strategic business development efforts, expanding into untapped markets.
  • Achieved significant cost savings by renegotiating contracts with key vendors, without compromising service quality.
  • Conducted market research to identify customer needs and adjusted product offerings accordingly, increasing customer satisfaction.
  • Improved customer satisfaction scores by overhauling customer service protocols and training staff in customer engagement techniques.
  • Developed comprehensive risk management plan, minimizing potential disruptions to business operations.
  • Organized professional development programs for staff, leading to improved performance and skill sets.
  • Managed budget allocations to prioritize spending on high-impact projects, optimizing resource utilization.
  • Established team priorities, maintained schedules and monitored performance.
  • Evaluated employee performance and conveyed constructive feedback to improve skills.
  • Defined clear targets and objectives and communicated to other team members.
  • Improved staffing during busy periods by creating employee schedules and monitoring call-outs.
  • Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.
  • Established performance goals for employees and provided feedback on methods for reaching those milestones.
  • Successfully managed budgets and allocated resources to maximize productivity and profitability.
  • Developed detailed plans based on broad guidance and direction.
  • Identified and communicated customer needs to supply chain capacity and quality teams.
  • Planned, created, tested and deployed system life cycle methodology to produce high quality systems to meet and exceed customer expectations.

Quality Assurance Analyst

Affinity Health Plan
07.2014 - 06.2017
  • Daily transitions with modern applications, modify 50-100 contracts including documents meeting company guidelines
  • Report to executives simultaneously to help track and determine priority of reported defects to ensure required modifications are implemented in a timely manner
  • Document each application test project, describing findings and recommendations (multiple task projects weekly)

Claims Auditor

Affinity Health Plan
05.2013 - 07.2014
  • Provide reports to Management for quality control and decision-making ensuring that all State and Federal regulations and business guidelines are met.
  • Assist the Claim Department to resolve different levels of claims issues (10-20 daily), and recommended related training opportunities that improves claim payment results

Claims Resolution Specialist

Affinity Health Plan
02.2007 - 05.2013
  • Meeting deadlines and achieving periodic goal for claims department by reconcilement of over 100+ inquiries
  • Assuring timely and accurate process procedures of over 150 claims daily in accordance with the NYS Prompt Payment Law as well as responding to over 10-15 providers telephone calls, over 30 written inquiries, and 40-55 appeals regarding claim payments
  • Solely responsible in 2010 for saving the organization over 250k by actively and aggressively requesting refunds from providers due to overpayments, incorrect provider affiliations, benefits or procedures not covered or member not eligible for dates of service.

Education

Bachelor of Health Science -

Mercy College
06.2008

Associate Business Administration - undefined

Monroe College
06.2001

Skills

  • Skills:
  • Microsoft Applications
  • Team leadership
  • Healthcare research
  • Healthcare coding
  • Effective time management
  • Strategic delegation
  • Collaborative team development
  • Medical terminology expertise
  • Medical coding expertise
  • Revenue classification
  • Database management expertise
  • Dell product knowledge
  • Effective communication
  • Emdeon expertise
  • Health and safety specialist
  • Experience with Optum
  • Community-focused mindset
  • Medicare compliance knowledge
  • Facets
  • Proclaim
  • APR
  • DRG
  • APG Methodology
  • PAS rates
  • Medicaid/Medicare rates
  • HCPCS
  • ICD10
  • Interests:
  • Providing Professional Services
  • Financial budget management
  • Leadership in supervision

Timeline

Manager Payment Integrity

VNS Health
08.2017 - 04.2025

Quality Assurance Analyst

Affinity Health Plan
07.2014 - 06.2017

Claims Auditor

Affinity Health Plan
05.2013 - 07.2014

Claims Resolution Specialist

Affinity Health Plan
02.2007 - 05.2013

Associate Business Administration - undefined

Monroe College

Bachelor of Health Science -

Mercy College

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