484-886-8129 (C) http://www.linkedin.com/in/sandymacchioni smad0928@westpost.n et PROFILE Results driven highly effective business leader with a dedication to outstanding customer service is seeking an opportunity to bring quick recognizable results to your team. Through effective root cause analysis, quickly determine how best to solve the most complex of problems using multiple tools and techniques to del iver the most efficient results. Bring a creative yet pragmatic approach to prob lem solving focusing on the delivery of high quality results while also demonstr ating fiscal responsibility. Demonstrated success developing and implementing bo th strategic and tactical plans to support the corporate vision and strategies. AREAS OF EXPERTISE Strategic Planning Operations / Claims Mergers / Acquisitions / Integration Total Quality Management Project Management (large scale initiatives) Leadership Development Customer Service Excellence Staff Management & Development Data Analysis PROFESSIONAL EXPERIENCE
INDEPENDENCE BLUE CROSS
1998 to 2010 Independence Blue Crossis Southeastern Pennsylvania's largest health insurer. Director, Integration Sr. Project Lead, Integration Planning Corporate Strategy Planning, (2007 to 2010) Selected by Senior Independence Blue Cross leadership to lead the integration pl anning efforts with specific responsibility for the claims processing function. As Director I reported to the matrixed Project Leadership, managing a team of fo ur direct reports and numerous cross divisional reports. Assessed existing claim s delivery model of both organizations in order to identify both synergies and g aps to develop the best-integrated processing model allowing for the efficient a nd effective processing of claims. * Developed and documented the new model leveraging both organizations and indus try best practices to define the end state processing model for the new organiza tion. * Identified millions of dollars in synergy savings which would be achieved thro ugh the implementation of the new processing organizational model. * Communicated to all stakeholders through various presentation techniques alway s on time and with impeccable quality even given the very aggressive deadlines r equired for the project. Director, Claims Operations, Accounts Receivable (2001 to 2007) Reported in to Senior Director and Vice President. Managed team of two Managers, four Supervisors, and numerous Business Support Analysts with span of control o f over 120 employees in delivery of high quality service to all of providers in the tri-state area including the Professional, Facility and Ancillary providers. Conducted root cause analysis to identify the barriers preventing the timely pr ocessing of claims * Developed and implemented strategic and tactical plans to substantially improv e the claims process experience for the providers. Reducing provider accounts r eceivables by sometimes as great as 50% * Managed a budget of 8.6 Million * Designed and implemented provider profile to monitor their on-going claims sub mission performance and processing outcomes which resulted in opportunities to e ducate the providers and substantially reduce their aged receivables by 30-50%. * Improved significantly provider satisfaction and contract re-negotiation resul ts. Presented frequently to healthcare providers in order to educate them on var ious statistical approaches to problem solving. Customer feedback revealed dep artment exceeded expectations regularly. Overall Provider Satisfaction increased by 10-20%. Director, Claims Operations continued * Designed, developed and implemented an Adjustment Inventory Management softwar e system which was able to transform paper claim inquiries into electronic forma ts delivered to an examiner's desktop resulting in increased productivity by 40% which is substantial savings in the millions of dollars in operating costs. Manager, Claims Operations, (1998 to 2001) Responsible for management of Medicaid enrollment, claims processing and member services in a multi-state area. Managed team of 80 direct reports and three supe rvisors. * Established benchmarks for processing and quality standards supporting the Med icaid business. * Consistently exceeded all operational performance measures. * Received the Winner Circle Award, Independence Blue Cross, 1999, 2003 - "Best of the Best" Award, Independence Blue Cross
COMPSERVICES, INC. 1997 to 1998
Manager, Claims Operations
* Built from ground zero, a medical claims processing department supporting Work er's Compensation administration. * Implemented claims processing system determining resource requirements necessa ry to be successful as well as establishing and managing a budget ensuring the s ystem was installed on time and with defined cost parameters. * Coordinated all resources required to ensure the success of the implementation . Provided highest level of decision making related to all operational processes .
EDUCATION / PROFESSIONAL DEVELOPMENT
Physician Assistant Certificate, Pennsylvania State University, Hershey, PA 19 82 Bachelor of Science, West Virginia Wesleyan College, Buckhannon, West VA 1980
PROFESSIONAL AFFILIATIONS Academy of Healthcare Management, Independence Blue Cross "Blue Pac" Member, 1999, 2002, 2003