Mollie Higgins
Oakdale,PA
Summary
Business-savvy innovator with hands-on experience in emerging technologies and passion for continuous improvement. Skilled in identifying opportunities for technological enhancements and implementing effective solutions. Adept at leveraging new tools and methods to solve problems and enhance productivity. Excels in adapting to fast-paced environments and driving technological advancements.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Director Business Enablement
UnitedHealthcare
04.2018 - Current
- Enhanced team collaboration through regular communication, goal setting, and performance evaluations.
- Implemented innovative solutions to solve complex problems, resulting in increased productivity and streamlined operations.
- Developed and implemented marketing strategies to promote program awareness and participation.
- Consistently exceeded key performance indicators by adapting quickly to changes in program needs.
- Leveraged data analytics insights for informed decision-making in critical areas such as sales forecasting, budgeting, or personnel management.
- Spearheaded successful product launches that resulted in increased brand visibility and customer acquisition.
Program Director
UnitedHealthcare
08.2015 - 03.2018
- Led cross functional team of Program Managers servicing UnitedHealthcare core operational business teams in successful implementation of strategic and regulatory organizational initiatives
- Developed Claim Rules Engine program from ground up, laying out framework, and defining roles
- Set and administered $60M yearly budget with no overages
- Directed design and execution of business transformation initiatives to drive performance, profit optimization and growth opportunities
- Monitored program performance to identify areas for improvement
- Coordinated efforts among multiple departments to ensure seamless execution of complex projects from inception through completion
- Scheduled and supervised staff meetings to discuss new ideas and update participants on program details and milestones.
- Recruited and trained staff and volunteers to upgrade collective team skills.
Manager, Provider Relations & Service Advocacy
UnitedHealthcare
11.2012 - 07.2015
- Lead a team of 60+ Hospital Facility Advocates to ensure the overall provider experience with UHC remains competitive across industry leading levels
- Monitor end-to-end Provider Service model, including claim and issue response quality, with a Primary focus on Tier 1 Platinum providers
- Set team direction and adapt departmental plans/priorities to address business and operational challenges
- Lead monthly UHN staff, Health Plan and Market Segment team meetings; ensuring critical topics, MBOs, metrics, education and remediation plans are discussed and acted upon
- Collaborate with the Platinum Provider Service team to identify trends, opportunities and reinforce adherence to Platinum Provider Service Model (PPSM) processes and goals
- Managed and motivated employees to be productive and engaged in work.
- Accomplished multiple tasks within established timeframes.
Senior Hospital Facility Advocate
UnitedHealthcare
09.2010 - 10.2012
- Executed full-range of provider relations and service interactions within UHG, including working end-to-end provider claim and call quality resolution
- Identified root-cause & solved complex claim related issues; and worked with appropriate internal service organization to monitor claims issue status and resolution
- Performed provider training & education on fundamental UHN program initiatives, policies & protocols, reimbursement policies, EDI & online provider portal enhancements
- Performed and conducted up to 10 contract load audits
- Engaged Network to drive system updates & corrections directly linked to claims payment discrepancies
- Worked effectively with fellow team members to coordinate effective solutions to any question or concern.
- Delivered friendly service and offered expert support in every interaction.
Senior Network Account Manager
UnitedHealthcare
04.2008 - 08.2010
- Executed and led negotiations with assigned Hospital providers; worked with relevant business segments in negotiation decisions impacting legal/regulatory requirements, contract standards & cost targets
- Evaluated and negotiated contracts from 50 to 100 annually in compliance with UHN contract guidelines and reimbursement structure standards
- Developed and contributed to negotiation strategies that directly impacted financial performance including but not limited to UCRT performance goals, affordability, cost-containment, ACO targets & risk-shared relationships
- Collaborated with Health Care Economics to build out provider modeling and pricing activities for negotiations
- Increased client satisfaction by building strong relationships and addressing their needs promptly.
- Maintained high client retention rate by providing exceptional customer service and anticipating client needs.
Education
BACHELOR OF ARTS - BUSINESS/PSYCHOLOGY, Sociology & Economics
University of Pittsburgh
Pittsburgh, PA05.2006
Skills
- Excellent communication
- Decision-making
- Business development
- Analytical thinking
- Process improvement
- Industry knowledge
- Business strategy
- Collaborative leader
- Highly motivated
- Strong relationships
- Brand awareness
- Informed decisions
- Adapting to dynamic environments
- Strategic planning
Certification
- SNAM Level I Certification
- SNAM Level II Certification
- CORE Contracting Certification
- Agile Certification - Business & Technology
- Value-Based Negotiation Certification
- Provider Service - Facility & Physician Advocate Hybrid Role Certification
- 2013 Employee of the Quarter Honor Recognition for Outstanding Performance in the Northeast Sector
- 2018 Service Hero Recognitions & Recipient - Top 10% performers among 100k+ employees
Timeline
Director Business Enablement
UnitedHealthcare
04.2018 - Current
Program Director
UnitedHealthcare
08.2015 - 03.2018
Manager, Provider Relations & Service Advocacy
UnitedHealthcare
11.2012 - 07.2015
Senior Hospital Facility Advocate
UnitedHealthcare
09.2010 - 10.2012
Senior Network Account Manager
UnitedHealthcare
04.2008 - 08.2010
BACHELOR OF ARTS - BUSINESS/PSYCHOLOGY, Sociology & Economics
University of Pittsburgh
- SNAM Level I Certification
- SNAM Level II Certification
- CORE Contracting Certification
- Agile Certification - Business & Technology
- Value-Based Negotiation Certification
- Provider Service - Facility & Physician Advocate Hybrid Role Certification
- 2013 Employee of the Quarter Honor Recognition for Outstanding Performance in the Northeast Sector
- 2018 Service Hero Recognitions & Recipient - Top 10% performers among 100k+ employees
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