AYAN SUGULLEH
Minneapolis
Overview
11
11
years of professional experience
1
1
Certification
Work History
Freelance Project Manager
Bespoke Enterprise LLC
Minneapolis
02.2019 - 05.2023
- Acted as the primary point of contact for project stakeholders, including clients, team members, and management
- Designed and delivered engaging project presentations to stakeholders, utilizing advanced features in Microsoft PowerPoint to create impactful and informative slides
- Effectively managed client requirements, vendor relationships, and marketing deliverables to support client's strategic objectives and priorities
- Led the development of compelling social media content and collaborated with graphic designers to ensure visually appealing client posts
- Developed and implemented an intake process for clients, streamlining and optimizing their operational efficiency and effectiveness
- Monitored and assessed the effectiveness of the implemented intake process, continuously identifying areas for improvement and implementing strategic adjustments to optimize performance.
Audit Analyst (Contractor)
Prime Therapeutics
Mendota Heights
11.2018 - 01.2019
- Responsible for external audit and accreditation processes within BM operations as directed by CMS and NCQA
- Primary point of contact for internal and external business partners regarding audits, client delegation agreements
- Conducted monthly claims monitoring audits to ensure claims are correctly adjudicated within government regulations and guidance
- Lead the Client, external audit or accreditation reviewer through prime business processes, conducted research as necessary to respond to questions and address any concerns raised.
Business Project Specialist (Contractor)
Cigna
Bloomfield
11.2016 - 02.2018
- Provided strategic support in resolving enrollment and financial errors, ensuring accuracy and reconciliation of discrepancies within the Individual Insurance Segment
- Conducted thorough research and analysis to identify and rectify transactions errors, leveraging data validation techniques across multiple systems, and directing corrective measures
- Oversaw the distribution of assignments among team members and designated departments, effectively allocating resources to optimize productivity and ensure seamless workflow management
- Corresponded with vendors to verify and rectify open errors that could potentially impact customers' access to healthcare services.
Case Management Liaison
Connecticut Children's Medical Center
Hartford
08.2015 - 06.2016
- Designed and implemented comprehensive quality assurance (QA) protocols for the Utilization Review and Clinical Documentation teams, ensuring adherence to industry standards and driving continuous improvement in operational efficiency and regulatory compliance
- Conducted rigorous analysis of QA findings, generating detailed reports that provided actionable insights for senior management to evaluate performance and make informed decisions
- Led the strategic management of data analysis and delivered impactful presentations to the Utilization Committee, offering innovative solutions to address departmental challenges and optimize processes
- Assumed responsibility for overseeing all critical indication reports pertaining to the Financial Counseling and Case Management departments, employing a data-driven approach to enhance decision-making and drive positive financial outcomes
- Directed the coordination and placement of psychiatric patients into appropriate outpatient and inpatient residential programs, orchestrating the compilation of comprehensive patient chart information and facilitating pre-authorization processes for optimal patient care and treatment continuity.
ER Patient Service Rep/Financial Counselor
Connecticut Children's Medical Center
Hartford
04.2013 - 08.2015
- Developed and deployed department QA, as well as individualized retraining of current employees
- Managed scheduling, responsible for creating monthly staffing grid
- Developed procedural protocol for the department's new electronic financial assistance program
- Interviewed, recruited, and trained new employees
- Managed patient escalation cases
- Collected accurate demographic, guarantor and financial data for Emergency Department, Inpatient and Outpatient cases and Physician Practice Office appointments
- Verified all required insurance and billing information and uses the proper payer plan codes.
Medicaid Spend Down Specialist (contractor)
Xerox Government
East Hartford
09.2012 - 04.2013
- Caseworker for Medicaid recipients that were placed on spend down after their yearly redetermination was completed and were determined to be over income for the program
- Obtained unpaid medical bills from clients, as well as coordinating with medical facilities to determine their financial liability
- Calculated total medical bills to meet their preset spend down limit
- Coordinated benefits with clients to provide them with the most advantageous opportunities regarding their medical coverage.
Education
General Credits -
University of Connecticut
05.2010
High School Diploma -
IIS International School
11.2004
Skills
- Project Management
- Process Improvement
- Web Design
- Adobe Creative Suites
- Canva
- Figma
- Video Editing
- HTML/CSS
- Microsoft Office Suite
- Data Analysis
- Business Analysis
- Healthcare Knowledge
- EPIC EHR System
- Medicaid/Medicare
- Communication Management
- Quality Management
- CRM's
- Sharepoint
- Claims/Denial Management
- Financial Counseling
- Python
- Crypto Knowledge
- Marketing Management
- Influencer Marketing Knowledge
- Customer Service
- Tableau
- Resource Allocation
- Schedule Management
- Root Cause Analysis
- Productivity Improvement
Certification
- PMI-CAPM Certification, 2023
- Lean Six Sigma Black Belt, 2024
- PMI Generative AI Certificate, 2024
- Product Analytics Micro-Certification (PAC), 2022
Timeline
Freelance Project Manager
Bespoke Enterprise LLC
02.2019 - 05.2023
Audit Analyst (Contractor)
Prime Therapeutics
11.2018 - 01.2019
Business Project Specialist (Contractor)
Cigna
11.2016 - 02.2018
Case Management Liaison
Connecticut Children's Medical Center
08.2015 - 06.2016
ER Patient Service Rep/Financial Counselor
Connecticut Children's Medical Center
04.2013 - 08.2015
Medicaid Spend Down Specialist (contractor)
Xerox Government
09.2012 - 04.2013
General Credits -
University of Connecticut
High School Diploma -
IIS International School
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