Tammy L. Rickerson
Kalispell
Summary
Strategic Product Management Advisor with expertise in regulatory compliance and trend analysis to enhance client satisfaction and streamline processes. Skilled in delivering training and managing client relationships, ensuring compliance and operational efficiency. Proven experience in advising organizations on process optimization and performance improvement, committed to driving impactful results aligned with business objectives.
Overview
21
21
years of professional experience
Work History
Product Management Advisor – Regulated Markets
Express Scripts
01.2023 - Current
- Led initiatives for Regulated Markets to develop new capabilities and enhance existing functionality, aligning with strategic goals.
- Served as Regulated Markets business owner for capabilities including data validation audits and DIR reporting, ensuring compliance and operational integrity.
- Analyze trends, develop, and implement recommendations to ensure client needs, compliance metrics, and/or internal support is met.
- Analyzed trends and implemented recommendations to address client needs and compliance metrics, enhancing internal support.
- Communicate strategic recommendations for supported capabilities and execute tactics to deliver the strategic vision.
- Develop and deliver training to clients and internal resources.
- Documented compliance actions for routine guidance, executed routine monitoring, and communicated client impacts.
- Supported internal and external audits as the subject matter expert for specific capabilities.
Senior Account Manager- Health Plan Division
Express Scripts
03.2020 - 01.2023
- Managed the day-to-day client relationship by researching member, claims, and Client Services issues, in addition to resolution of setup, benefit copays, and account structure concerns from the client.
- Tracked operational performance and guarantees, ensuring client satisfaction and contributing to client retention.
- Conducted weekly client meetings for issue management and tracking of operational system updates including Medicare D, Medicaid, and Health Exchange lines of business.
- Proactively pulled surveillance reports and examine data to identify and resolve potential benefit or clinical setup errors.
- Led functional areas through conference meetings ensuring project management and benefit setup accuracy.
- Supported account team with operational system updates, modifications, plan changes, and new installs to enhance service delivery.
- Created custom reports to meet client’s unique requirements while performing quality checks to ensure data accuracy.
- Maintained system reports, logs and quality assurance documentation for auditing purposes.
- Delivered projects on time, adhering to established deadlines.
Provider Network Specialist II
Coordinated Care
09.2017 - 03.2020
- Conducted initial Provider orientations as well as ongoing educational outreach.
- Informed Providers on policies and procedures for referrals, claims submission, credentialing documentation, website navigation, electronic health records, health information exchange, and electronic data interface.
- Engaged Providers and educated them on Patient Centered Medical Home initiatives.
- Strengthened account relationships by investigating, documenting, and resolving provider matters while effectively managing account changes and correspondence.
- Facilitated coordination between Providers and Health Plan to enhance financial and quality performance.
- Investigated, resolved and communicated Provider claim issues and changes.
- Performed detailed HBR (Health Benefits Ratio) analyses, Health Information data Information Set (HEDIS) analyses, and created reports for Provider review to include Provider performance by both quantitative metrics and qualitative factors.
- Created and communicated milestone documents, dashboards and success or improvement metrics.
- Provided information and status updates to Providers regarding incentive agreements.
- Conducted site visits to assess provider facilities and compliance.
- Performed contracting duties, including recommending changes to pricing subsystems.
- Received and effectively responded to external Provider related issues.
Procedures Analyst III- Provider Relations
Premera Blue Cross
10.2014 - 09.2017
- Proactively analyzed, interpreted, and synthesized state and federal mandates, contract changes, and corporate communications for impact to procedures.
- Facilitated work groups to gather process flows and resolve issues hindering procedure development.
- Directed project teams, managing Procedure Team accountabilities and providing updates on procedure and project statuses.
- Managed project-related activities to assure that project and external department goals were achieved.
- Audited completed work items within Provider Relations Team, providing guidance to enhance accuracy and compliance.
- Developed and conducted all training within the Provider Relations Team.
- Conducted training sessions for end users, ensuring effective implementation of redesigned business processes, including provider information and credentialing.
- Performed system testing to validate procedures.
Technical Support Specialist
Premera Blue Cross
09.2013 - 10.2014
- Collaborated with cross-functional teams and engaged with external customers to address provider concerns.
- Researched complex provider issues and provided actionable solutions to the Provider Relations team.
- Conducted system performance audits to ensure transaction compliance, accuracy and timeliness.
- Identified, recommended and implemented process improvements.
- Provided consistent feedback and team training for associates by communicating technical process improvements to positively impact team success.
- Developed and delivered new training materials to enhance team instruction and implement process improvements.
- Created and distributed weekly and monthly reports on provider member terminations to keep stakeholders informed.
- Fulfilled Team Lead duties in their absence to ensure team operations continued smoothly.
Provider Network Representative
Premera Blue Cross
03.2007 - 09.2013
- Educated Providers and their staff in regards to billing, standard credentialing process, contractual requirements, claims and company policies.
- Delivered timely and accurate responses to inquiries from provider offices and internal departments regarding contracts, provider updates, claim issues, and credentialing.
- Processed provider updates and contract requests/changes, consistently exceeding production and quality standards.
- Effectively coordinated with various internal departments to provide resolutions to a multitude of issues.
- Conducted thorough audits of member notification requests and compiled weekly reports with high accuracy.
- Exceeded personal and department goals in quantity and quality through collaborative efforts.
- Actively participated in team building exercises, team meetings, LEAN manufacturing and RPIW report outs.
Customer Service Representative
Premera Blue Cross
05.2005 - 03.2007
- Provided clear answers and direction on complex issues, ensuring resolution of inquiries to customer satisfaction.
- Researched and resolved telephone inquiries related to benefits, claims adjudication, and eligibility, ensuring accurate information delivery to customers.
- Exceeded department expectations for production and quality goals, contributing to overall team success.
Education
GED -
Post Falls High School
Post Falls, ID07-1993
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Skills
- Compliance management
- Data validation
- Trend analysis
- User experience optimization
- Process improvement
- Report generation techniques
- Client relationship management
- Microsoft Office Suite
- Analytical thinking
- Attention to detail
- Strategic communication
- Written communication
- Training and development
- Conflict resolution
References
Personal and professional references available upon request.
Timeline
Product Management Advisor – Regulated Markets
Express Scripts
01.2023 - Current
Senior Account Manager- Health Plan Division
Express Scripts
03.2020 - 01.2023
Provider Network Specialist II
Coordinated Care
09.2017 - 03.2020
Procedures Analyst III- Provider Relations
Premera Blue Cross
10.2014 - 09.2017
Technical Support Specialist
Premera Blue Cross
09.2013 - 10.2014
Provider Network Representative
Premera Blue Cross
03.2007 - 09.2013
Customer Service Representative
Premera Blue Cross
05.2005 - 03.2007
GED -
Post Falls High School