SHERRY BAILEY

• Lead the provider clinical intake team to support efficient utilization management operations for Medicare and Medicaid programs.
• Monitor and evaluate authorization intake workflows and service-level performance to enhance operational efficiency using Genesys and Verint platforms.
• Facilitate alignment with leadership to maintain compliance with utilization management regulations and operational benchmarks.
• Optimize scheduling and workflow distribution to ensure efficient case processing and meet productivity objectives.
• Facilitate monthly team huddles and operational meetings aimed at driving performance improvement and ensuring compliance with initiatives.
• Develop comprehensive training modules and provide individualized coaching to ensure adherence to operational standards and improve service quality.
• Evaluate error trends and timeliness reporting to identify process gaps and drive continuous improvement initiatives.
• Support leadership in enhancing employee skills through retraining efforts and effective departmental communication strategies.
• Serve as a key resource for teams, delivering operational insights and clarifying processes to enhance collaboration.
• Analyze compliance performance metrics and error-tracking data to identify trends and facilitate corrective action initiatives.
• Investigate workflow issues, process gaps, and operational concerns while partnering with leadership to develop and implement solutions.
• Assist management with policy implementation, process updates, and regulatory compliance initiatives.
• Collaborated with management to streamline policy implementation updates and enhance adherence to regulatory compliance standards.
• Collaborate with multiple departments to ensure consistent application of procedures, standards, and workflow expectations.
• Recognized as a trusted resource for operational guidance, process clarification, and team support.
• Support risk-reduction efforts by identifying operational vulnerabilities and recommending process improvements.
• Support utilization review processes to ensure compliance with healthcare regulations and standards.
• Develop training materials for staff on best practices in utilization management procedures.
• Monitor case management operations, ensuring timely reviews and appropriate authorizations.

• Facilitated effective care delivery by leading operational initiatives and offering expert guidance within utilization management operations.
• Directed compliance-focused utilization management processes to uphold regulatory requirements.
• Managed and optimized inpatient and outpatient pre-authorization queues, facilitating efficient case progression while ensuring compliance with regulatory standards.
• Coordinated peer-to-peer review requests to improve collaboration and streamline escalation management for timely issue resolution.
• Processed approval denial reversals and Quality Improvement Organization (QIO) appeal correspondence with a focus on accuracy and compliance.
• Served as primary liaison for designated markets, facilitating operational support and addressing specific requirements.
• Developed and executed training sessions for new associates, contributing to continuous staff development efforts.
• Partnered with leadership to streamline workflows, ensuring consistent operational service standards.

• Coordinated and managed provider communications to ensure timely processing of authorization requests and support care coordination initiatives.
• Executed processing of approval denial and reversal letters for pre-service authorization requests.
• Coordinated compliance reporting and operational documentation activities, enhancing accuracy and efficiency in processes.
• Enhanced patient care delivery by coordinating interactions between providers and various service departments.

• Coordinated and managed inbound authorization intake calls, addressing inquiries related to Medicare, Medicaid, and employee healthcare plans across multiple care levels.
• Compiled and organized clinical intake information to enhance efficiency in authorization processing.
• Coordinated training sessions and onboarding activities to ensure new associates received essential knowledge and resources.

• Coordinated communication between patients and providers, ensuring efficient handling of inquiries related to specialty medication programs.
• Achieved timely benefits verification for prior authorizations, enhancing patient access to necessary treatments. Streamlined copay assistance enrollment, improving patient financial support. Implemented efficient financial assistance screenings for high-cost medications, boosting affordability for patients.
• Facilitated enrollment of patients in copay assistance programs for Humana growth hormone, hemophilia, and insulin prescriptions.
• Monitored and analyzed adverse events, submitting detailed reports to FDA for Novo Nordisk's regulatory adherence.
• Coordinated customer account resolutions and provider support efforts to ensure seamless operations.
• Contributed to creation and refinement of operational documentation and call center scripts to enhance service delivery.

Graduated: March 2026

• Honoree of Magna Cum Laude
• 3.86 GPA

Graduated: May 2020

• 3.89 GPA