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Denise J.

Operations Manager | Healthcare

Profile

Operations manager with healthcare systems expertise and a Masters in Healthcare Administration. Successfully leads teams and people management as well as implements or improves processes and procedures necessary to achieve efficiency.

Key Skills & Competencies

Proven accomplishments in service delivery, claims, office management, program planning, project management, policy development and conflict resolution. Analytical thinker with great Leadership and interpersonal skills

Professional Experience

Doral Health & Wellness, Brooklyn, NY | 9 months
Director of Employee Health
Tapped to implement employee programs, benefits, and perks to increase morale and employee satisfaction ratings.
• Rapidly rolled out a program in 30 days for immediate impact, with a Free Fitness app, Discounts on day to day supplies, electronics, entertainment and more, access to same day tele-visits.
• Spread health awareness and ran a successful employee challenge.

32BJ Health Fund, NY, NY | 18 years
Operations Manager
Progressively promoted 4 times to oversee surgical programs and their enrollment.
• Conducted analysis of claims data to identify processing issues or identify high cost services.
• Participated in implementation meetings.
• Gather necessary compliance documentation to address appeals, request to submit to the board of trustees for review.
• Hired, interviewed, and managed staff.
• Updated summary plan description booklet.

Supervisor - Provider Services and Medical Management
Directed the work of 13 representatives who initiated authorization requests, two specializing in union member support and responding to participating provider requests.
• Managed the team's workflow on initiating authorization requests.
• Drove the change management to operating as a union member healthcare resource, initiating and monitoring status of authorization requests.
• Led team to success, met annual quota for enrollment into Chronic Care, surgical programs and Patient Centered Medical Homes.
• Trained and transitioned staff to new Patient Advocate roles.
• Implemented new policies and procedures for staff.

Triage Coordinator - Senior Triage Coordinator
• Initiated authorization requests for medical procedures and services.
• Promoted for consistently being a support to peers.
• Handled escalated issues with research to resolution and also supported manager as needed.

Community Experience

Education

Masters in Healthcare Administration
Bachelors in Business administration healthcare system management

Other Experience/Awards/Publications

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