MOLLY TIGHE

mollyrtighe@gmail.com       952-250-7385      www.linkedin.com/in/mollytighe

 

HEALTHCARE OPERATIONS PROFESSIONAL

Create Process Enhancements that Produce Operational Efficiencies and Metric Improvements within Organizations

 

Logical and creative problem solver who is dependable, accountable, and follows through on commitments. Understand and anticipate end-user needs and requirements. Highly adaptable professional known for a positive attitude and team-centered work ethic.

 

Areas of Expertise include: Process Improvement | Report Building | User Access Administration | Electronic Medical Records Management | Credentialing | Troubleshooting

 

PROFESSIONAL EXPERIENCE

 

TARGET, CLINIC TEAM (2013-2016)

Lead Healthcare Specialist

Served as administrator of Target Clinic’s electronic medical record and billing system – user access, table maintenance, ad-hoc-report building and clearing claims in hold status. Managed application and renewal process for facility licenses for 79 clinics in 6 states.

·               Achieved 50% reduction in response time to field team questions by creating notification process and monthly metrics for HQ team and leaders.

·               Led project team and collaborated with key stakeholders, creating detailed checklist of more than 100 tasks required for opening new clinic locations.

·               Tracked and coordinated weekly payments for operational clinic expenses, ensuring vendors were paid appropriately and timely.

 

TARGET, CLINIC TEAM (2008 – 2013)

Senior Credentialing Specialist

Developed credentialing process for practitioners to guarantee payer forms were approved quickly and ensure maximum reimbursement.

·               Recreated clinic report and presented metrics at weekly meetings, allowing team to make decisions and take action where appropriate.

·               Developed a database for practitioners’ information and application tracking, creating efficiencies in the credentialing process.

·               Ensured 400 practitioners kept all applicable licenses current by developing mail-merged email reminder messages.

·               Researched new-graduate licensing processes and created process-flow document, illustrating complexities and assisting recruiters in determining appropriate practitioner start dates.

 

HENNEPIN COUNTY – METROPOLITAN HEALTH PLAN (2006 – 2008)

Credentialing Specialist

Established recredentialing process for contracted practitioners and managed vendor relationship.

·               Compiled data for quality management quarterly report, supporting final report creation and dissemination.

·               Served as program coordinator for United Way campaign for employees, raising over $15,000 for programs.

 

UNITED BEHAVIORAL HEALTH (2000 – 2006)

Recredentialing Supervisor

Hired and supervised team of 6 recredentialing coordinators.

·               Developed and implemented procedures, ensuring network of 50K practitioners remained in compliance with NCQA Standards.

·               Identified, created, and facilitated departmental education for new hires and retraining sessions, guaranteeing performance expectations were met.

 

Quality Assurance Coordinator (Concurrent Role)

Identified, investigated, and reported on professional concerns in practitioner credentialing files.

·               Performed quality assurance on 100 practitioner files per week, confirming NCQA Credentialing Standards were met.

·               Prepared practitioner credentialing files for 35 different audits each year, securing delegation contract renewals and NCQA Accreditation.

 

EDUCATION

 

Working towards Mini MBA in Healthcare Certificate

St. Thomas University, Minneapolis, MN

 

Bachelor of Science (BS), Health Administration

Winona State University, Winona, MN

 

Supervision & Management Certificate Program

Normandale Community College, Bloomington, MN

 

 

VOLUNTEER LEADERSHIP EXPERIENCE

 

HOPKINS AREA JAYCEES

-13-year Board Member and Project Chairperson

-Lifetime Achievement Statesman Award from Minnesota Jaycees