Kristy Lowry
Midlothian,VA
Summary
GOAL – To work in a Healthcare environment where I can fully utilize the skills I have acquired during my professional career. Highly motivated to improve existing talents and challenge myself with new opportunities.
Overview
21
21
years of professional experience
Work History
Director, Member Administrative Services
Curana Health
07.2020 - 01.2025
- Manage Enrollment, Eligibility and Billing for 32 Health Plans
- Oversaw development, implementation and updating of systems to reflect change in annual benefits
- Perform annual system validation/testing to ensure reflection of benefit updates
- Support internal partners with HEDIS, ODAG, One Third Financials, and Program Audits
- Proven knowledge of Medicare Chapter 2 Enrollment and Disenrollment and Medicare Marketing guidelines.
- Perform daily monitoring of eligibility via Daily Transaction Reply Reports (DTRRs) to ensure compliance with CMS guidelines
- Monitor vendor activities/KPIs to ensure SLAs are met, issuing CAPs as required
- Report out weekly/monthly transaction and fulfillment audit results
- Facilitate implementation of HPMS memos
- Plan, direct, and implement Enrollment and Eligibility quality assurance programs
- Serve as primary escalation point of contact for complex enrollment, eligibility, billing and low-income subsidy questions from internal and external partners
Manager, Operations
Curana Health
01.2016 - 06.2020
- Managed all operation projects to meet CMS required timeliness, and ensure quality control
- Prepare documentation and participate in CMS ODAG and Program Audits
- Implemented Mailroom Operations for seven Health Plans, increasing to 32
- Implemented Call Center Operations for seven Health Plans, increasing to 32
- Establish policies and procedures for CMS’ monthly Enrollment Validation Data (EDV) audits
- Work intimately with the Compliance Dept to ensure quality, accuracy and timely metrics were met for letters and daily transaction reply reports
- Perform retroactive adjustments in enrollment, disenrollment, reinstatements, and state and county codes
- Identify opportunities for process improvement
Clinical Business Analyst
Xerox State Healthcare, LLC
07.2014 - 12.2015
- Develop prior authorization rule parameters based on clinical documentation
- Test prior authorization rules to ensure requirements are met
- Coordinate changes with clinicians ensuring all changes are tested and documented
- Liaison between client and internal staff
- Analyze and interpret business and clinical outcomes
- Perform ad hoc analyses in support of quality assurance activities and customer inquiries
- Test new and existing software to confirm that applications are complete and efficient
Manager, Operations
Xerox State Healthcare, LLC
01.2009 - 06.2014
- Managed all operation projects to meet required deadlines, and ensure quality control
- Oversaw requests, reports, processes, and mailings for ten Medicaid plans
- Supervised the daily activities of the Operations department
- Interacted directly with clients, physicians, pharmacists, and patients
- Supervised and coached all operations staff
- Worked with other departments to ensure resolution to known issues
- Lead efforts to research and resolve data issues
- Developed schedules for all deliverables ensuring all deadlines and Service Level Agreements (SLAs) were met
- Continuously evaluated processes to identify opportunities for improvement
- Worked with external vendors to negotiate best possible price for requested services
- Contributed to revenue forecasts
- Contributed to implementation processes where I am the Subject Matter Expert (SME)
- Assisted with application testing
- Conduct training sessions for new employees
- Create requisitions, purchase orders, and code invoices for payment
Associate Account Manager
Xerox State Healthcare, LLC
01.2007 - 01.2009
- Established working relationships with new clients and maintained an ongoing rapport with existing clients
- Assisted with the account implementation process and participated in communicating recommendations from Program Assessments, Network Rankings, etc.
- Worked intimately with the audit team to ensure timely results
- Main point of contact for clients
- Coordinate with all internal departments to deliver contracted services and assist clients with questions
- Monitored contracts and timeframes for deliverables, coordinated with Account Management team, and audit to ensure all deadlines are met
- Coordinated account status reports and client communications
- Responsible for the management and coordination of activities related to account implementation and data integration processes for audit clients
- Responsible for managing internal processes for multiple clients
- Work to ensure client satisfaction, service delivery, client retention, and contract compliance for all accounts
- Communicate (in person, in writing, and/or by phone) on an ongoing basis with clients, keeping them informed on recommendations for interventions/audits, the status of deliverables, the outcomes of interventions/audits, the status of new account implementation measures, and other pertinent items
- Develop/edit/review monthly client status reports, outcomes reports, and final audit reports
Sr. Project Coordinator
Xerox State Healthcare, LLC
02.2004 - 01.2006
- Managed the Lock in Program for two Medicaid clients
- Interacted directly with Medicaid staff regarding the lock-in program
- Internally coordinated projects, design and maintain project planners to ensure goals were being met
- Validated pharmacy and medical data for new and existing clients
- Managed the preparation of Direct Mail audit folders
- Reviewed and monitored reference tables that were being loaded to all company servers
- Reviewed and monitored claims data being loaded to company servers for client data validation
Skills
- Medicare benefits knowledge
- Enrollment and eligibility expertise
- Policy implementation
- Process improvement
- Client relations
- Excel & Word proficiency
- Wipro’s Member360 proficiency
- Citra's EZCAP proficiency
- TriZetto’s Enrollment Administration Manager (EAM) proficiency
- Health Claims Processing Product: QNXT proficiency
- Effective communication
- Self-starter
- People management
- Operations management
- Rules and regulations
Timeline
Director, Member Administrative Services
Curana Health
07.2020 - 01.2025
Manager, Operations
Curana Health
01.2016 - 06.2020
Clinical Business Analyst
Xerox State Healthcare, LLC
07.2014 - 12.2015
Manager, Operations
Xerox State Healthcare, LLC
01.2009 - 06.2014
Associate Account Manager
Xerox State Healthcare, LLC
01.2007 - 01.2009
Sr. Project Coordinator
Xerox State Healthcare, LLC
02.2004 - 01.2006
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