KATHLEEN S.

COLEMAN
858-692-2715
kathleenscoleman@gmail.com

Professional Summary
Dedicated professional with over 10 years of experience in Managed Care and Medi-Cal lines of business.
Currently seeking a challenging position that provides opportunities for the application of leadership and
training skill sets, while also offering opportunity for growth within the healthcare industry.

Education and Training

 SUNY Geneseo – Childhood and Special Education Major
 Arizona State University – Organizational Leadership BA – December 2018
o Member of The Honor Society of Phi Kappa Phi
o Maintained 4.0 GPA

Professional Experience

Children’s Physicians Medical Group, Inc. –

Associate Director, Member Services & UM Operations – 2016 – Present
 Extensive involvement in, and leadership of, operational improvement projects for multiple lines of
business.
 Developed strong working relationships with a variety of other leaders within the organization, and with
partner organizations.
 Responsible for leadership and oversight of multiple functional areas for three distinct organizations,
including Member Services, Appeals and Grievances, Culture and Linguistics, and Utilization
Management Operational functions.
 Strategic leadership and oversight for multiple organizations, including Rady Children’s Health
Network, CHOC Health Alliance, Rady Children’s MSO, and California Kids Care Pilot Program.
 Key leader in the successful implementation of a pilot program for delivery of pediatric care to a
medically fragile population under Rady Children’s Hospital – San Diego.
 Maintained compliance with NCQA, DHCS, and DMHC guidelines for authorization processing,
delivery of culturally and linguistically appropriate services, and appeals and grievance processing.
 Mentored and developed new leaders, including the transition from staff to leadership for multiple team
members.
Customer Service Manager – 2014 – 2016
 Responsible for leadership and management of two teams, totaling 25+ employees, with direct reports
including Supervisor and Team Lead level employees. Team responsibilities included customer service
and prior authorization processing for pediatric managed care populations.
 Provided employee development and training, including creation and implementation of new employee
training program, training manual, quality monitoring and metrics, and leadership development for
Supervisor and Team Lead level employees.
 Statistical analysis of phone and employee performance, including direct reporting to CEO, with
extensive Microsoft Excel use. Development of staffing models, efficiencies, and process improvement
using a variety of performance metrics.
  Management of operational transitions: Paper based system to paperless operations, including RightFax
and web portal submission of prior authorization requests using EZ-Net; Telephone system transition
from Toshiba system to Cisco system.
 Continuation of all Supervisory tasks listed below.
Customer Service Supervisor – 2010 – 2014
 Responsible for leadership and management of 8 person team that provided customer service and prior
authorization processing to a pediatric managed care population.
 Statistical analysis of phone and employee performance, included creation of Excel spreadsheets to
monitor trends and growth within the department.
 Organized and led large group presentations for outside office staff on multiple topics, including use of
the provider web portal, prior authorization submission, and guidelines on working with the group.
Included creation and use of PowerPoint presentations.
 Extensive involvement in Utilization Management tasks, including creation and maintenance of
authorization processing guidelines, member communications (denial, modification, approval, and
pending notifications), maintaining DMHC/DHCS guidelines for timely communication of decisions to
both providers and members, and creation and maintenance of guides provided to contracted offices
regarding prior authorization requirements.
Customer Service Team Lead – 2008-2010
Customer Service Representative – 2008

Preferred Care (MVP Healthcare, Inc.) –

Data Verification Specialist – 2005-2007
 Responsible for verification of data submitted on standard claim forms for medical insurance, including
CMS and UB forms. Included data entry, 10-key entry, and verification of extracted data from scanned
images. Maintained all department standards for productivity and accuracy.

References Available Upon Request