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Ghi Group Health Incorporated - Manager Applications Resume Example

Christopher Lopez
XX XXXXXXX XXXXX XXXXX, Bedminster, NJ 07921
Ph: XXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXX
Professional Summary

Seasoned manager with more than 20 years of experience in fast-paced business environments. Track record of achieving exceptional results working with government organizations and other professionals to manage people, processes, systems and customers.  Excellent interpersonal and communication skills. 

Skills
  • Strong Leader
  • Motivational
  • Administration and Management
  • Organizational Efficiency
  • Persuasion
  • Quality Control Analysis
  • Critical Thinking
  • Excellent Microsoft Office Skills
Experience
Manager - Applications / Electronic Data Interchange (EDI) Aug 2008Present GHI (Group Health Incorporated) / EmblemHealth New York, NY

Major Accomplishment: Efficiently and effectively implemented the federally authorized Early Retiree Reinsurance Program (ERRP), hiring 65 employees, training, managing and ultimately dismantling program at its conclusion.

  • Manage 14 direct reports that assist Plan Sponsors with their individual RDS (Retiree Drug Subsidy) application and to ensure all electronic data sets sent via Mainframe or through a secure web browser are received and processed.
  • Work with over 180 EDI Vendors transmitting cost and data files via Main Frame or through a secure Web Site.
  • Verify that all users of the RDS program have been verified according to CMS (Centers for Medicare and Medicaid Services) guidelines.
  • Work directly with CMS on cases involving Plan Sponsor's changes of name or ownership.
  • Provide monthly status reports to CMS detailing the program's activities.
  • Oversee work to staff to ensure that all Service Level Agreements (SLA) are met.
  • Work with budget allocations to determine Full Time Employee positions.
  • Prepare and deliver employee Performance Management Evaluations.
Consultant May 2005Aug 2008 Dental Direction Services, LLC Bedminster, NJ

Major Accomplishment:  Created this consulting role to improve the quality and productivity of processes in the client's business environment.

  • Interviewed dental personnel and conducted on-site observation to ascertain unit functions, work performed, and methods, equipment, and personnel used.
  • Documented findings of study and prepared recommendations for implementation of new systems, procedures, or organizational changes.
  • Conducted presentations at national dental events.
  • Trained staff on new equipment and procedures designed to minimize cost and maximize productivity.
  • Served as the exclusive consultant to DenteMax which is a PPO network consisting of over 70,000 members. 
Electronic Claims Coordinator Apr 1998May 2005 MetLife Bridgewater, NJ

Major Accomplishment: Provided personalized and professional service to dental practices by increasing their productivity, providing memorable customer service and lowering operational costs.

  • Worked with over 50 dental vendors whom provide services on behalf of their clients.
  • Responsible for increasing MetLife's dental electronic claim volume.
  • Created and maintained reports to show electronic claim percentages.
  • Participated in national dental seminars promoting and enrolling dentists for electronic claims.
  • Worked with electronic clearinghouses to oversee e-claim processing.
  • Responsible for increasing MetLife's electronic claim volume from 18% in April 1998 to 50% in May 2005.
Advanced Business Systems Analyst Aug 1996Apr 1998 EDS - Electronic Data Systems Newark, NJ
  • Responsible for ensuring medical claim system availability for NASCO (National Accounts Service Company) a consortium of Blue Cross/Blue Shield companies.
  • Served as liaison between EDS technical facilities and clients for system issues.
  • Utilized JCL to submit financial billing reports via NDM to outside vendors for processing.
  • Generated Ad Hoc reports for specific client requests.
Implementation Analyst Sep 1995Aug 1996 NEIC (National Electronic Information Corporation) Secaucus, NJ
  • Enrolled Providers, Vendors and Payors in the Electronic Remittance Advice program (ERA).
  • Utilized the ANSI 835 Transaction to interact between the Vendor and Payor systems and their technical staff.
Business Systems Analyst Jun 1989Sep 1995 MetLife Bridgewater, NJ
  • Worked with small and large group clients on benefit plan installation.
  • Test, maintain, and monitor computer programs and systems, including coordinating the installation of computer programs and systems.
  • Develop, document and revise system design procedures, test procedures and quality standards.
  • Provide staff and users with assistance solving computer related problems, such as malfunctions and program problems.
Assistant Manager - Government Programs Jun 1988Jun 1989 Blue Cross/Blue Shield of New Jersey Newark, NJ
  • Supervised 18 employees in the Medicaid Prescription Processing and Inquiry Department.
  • Developed and implemented department performance reports.
  • Assisted in data collection and presentation for Medicaid Program contract submission.
Education
Bachelor of Arts : Business Administration May 1985 Queens College Flushing, NY
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Resume Details

This is a real resume for a Manager Applications in Bedminster, New Jersey with experience working for such companies as Ghi Group Health Incorporated, Emblemhealth, Dental Direction Services. This is one of the hundreds of Manager Applications resumes available on our site for free. Use these resumes as templates to get help creating the best Manager Applications resume.

Previous Companies:

  • GHI Group Health Incorporated
  • EmblemHealth
  • Dental Direction Services

Previous Job Positions:

  • Manager Applications
  • Electronic Data Interchange
  • Consultant
  • Electronic Claims Coordinator
  • Advanced Business Systems Analyst

Schools:

  • Queens College

Level of Education:

  • Bachelor of Arts

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