Aetna, a CVS Health CompanyVice President, Operations, MHNet Behavioral Health
Jun. 2008 - Mar. 2017TelecommuteManaged non-clinical operations and supervised new client implementations. Led the MHNet team during system conversions. Reduced call center team size while maintaining performance metrics. Developed and launched employee training programs and resolved a significant claims backlog. KEY FUNCTIONS & SKILLS: operations management, system implementation, training program development, claims management, process improvement SELECT ACHIEVEMENTS
* Cleared a 100K-claim backlog within six months, reducing provider complaints, appeals, and regulatory issues while maintaining compliant claims processing turn-around times.
* Transitioned 12 health plan markets to MHNet's behavioral health management within five years, strengthening customer relationships and upselling additional employee assistant program (EAP) products.
* Established comprehensive employee training curriculum and team, improving service consistency and reducing member and provider complaints by 15-20%.
* Restructured customer service to centralize operations, improve call metrics, and enhance satisfaction, reducing team size by one-third and increasing compliance.
* Revamped provider onboarding and training, significantly decreasing claims issues and improving provider satisfaction and call volumes.
* Implemented 83 regulatory-compliant explanation of benefits (EOB) templates, reducing the risk of regulatory fines, potentially saving up to $1M year over year for a single market.
* Launched an online authorization system, increasing provider acceptance from 5% to 55%, freeing up clinician time, and improving provider satisfaction and claim auto-adjudication.