M. Hope Helms has over 15 years of experience in healthcare, with a focus on provider relations and project management. She is currently the Provider Relation Team Lead at Highmark Blue Shield, where she directs a team that maintains Highmark's provider network. Previously she held roles as a Professional Provider Relations Representative and Business Analyst at Highmark. She has strong skills in customer relationship management, project management, and using various software programs.

1. M. Hope Helms
Summary of Qualifications
 Highlyorganizedwithexcellentprojectmanagementskillstosetprioritiesandensure schedules
and deadlinesare met.
 Possessing skills in: customer relationship, team building, project management, critical thinking and
problem solving, and communication across all levels of an organization
 Experience with Microsoft Word, Excel, Access, PowerPoint, Visio, Crystal Reports, Quick Test Pro,
Lifecycle Requirements, and Business Flow Analysis
Professional Experience
Nov. 2010 – Present Highmark Blue Shield Camp Hill, PA
Provider Relation Team Lead – Responsible for directing and leading the activities of the Provider Relations staff
in maintaining a robust, statewide network of providers through recruitment, personal orientation and interactive
training.
 Work with end users and Business Process Managers to identify full requirements, identify policies and
procedures, resolve reimbursement issues, and increase provider efficiencies.
 Work with multiple business partners for scheduling of presentations, timelines, identify deliverables and
meet scheduling limitations
 Represent provider relations on corporate initiatives for multiple projects and initiatives.
 Foster existing relationships with strategic provider entities through ongoing written and in person
communication.
 Introduce new program initiatives in order to onboard entities in these new programs.
 Serve as regional point of contact for pay for value programs, such as PCMH and STARS
 Represent Highmark at corporate events including black tie, golf outings, fundraising events and client
initiation events.
 Develop program reporting specific to provider needs in order to display transparency to clientele and
business partners.
June 2008 – Nov. 2010 Highmark Blue Shield Camp Hill, PA
Professional Provider Relations Representative – Responsible for front line management of relationship between
Highmark and the provider communities within central PA.
 Provided training and education, network management, issue resolution and recruitment in order to
develop business relationships with network providers, vendors and third party administrators.
 Served on multiple teams and committees in order to support strategic initiatives and provide business
growth and development.
 Worked with specific provider groups to resolve billing and claims issues as well as provider
reimbursement issues.
 Established best practice guidelines in order to operate with timeliness and efficiency.

2. April 2002 – June 2008 Highmark Blue Shield. Camp Hill, PA
Business Analyst – Act as liaison to the IT department to develop efficiency gains and process
improvements for the organization
 Support new to Blue implementation of Penn State University, Hershey Medical Center, The Hershey
Company, and other dedicated National accounts.
o Participated on the new-to-Blue implementation team. Created call flows, work flows, and
department guidelines. Participated in benefit quality reviews and on-line EOB reviews.
o Provided support related to High Deductible Health Plan Spending Accounts and worked with
eBDS and PFPC to reach resolutions.
o Provided on-going support to the claims processing and customer service units within CRNDA
o Supported professional, institutional and BlueCard processes and adjustments
o Utilized Cognos/Impromptu reporting tool to write and run queries in an effort to proactively
identify claims processing trends
o Worked closely with various areas within Highmark when analyzing and problem solving.
o Supported Systems Quarterly Releases.
o Identified and documented potential problems on the CR EPN database, provided data critical to
the resolution of the issues.
 Provided on-going support of dedicated account processing and servicing.
 Supported additional new to Blue account implementations.
 Coordinated Plan to Plan workshops provided by BCBSA to Highmark
 Participated in Provider Network sessions in Eastern and Western Regions
 Conducted BlueCard Host aged claim research initiatives
 Attended the Inter-Plan Programs Annual Meeting held by BCBSA in Chicago
 Supported Systems Quarterly Releases
 Supported both Customer Service and Claims Processing units
April 2001 – April 2002 Highmark Blue Shield. Camp Hill, PA
Supervisor – Drive service level performance and assist in the management of a customer focused, inquiry intense
service team.
 Managed staff of 20-25 customer service representatives dedicated to resolving Home and Host BlueCard
inquiries.
 Ensured section met the overall performance goals pertaining to the BlueCard BCBSA PTMs and MTMs.
 Demonstrated strong project management skills while maintaining administrative functions of supervisory
role.
 Addressed and corrected deficiencies in the day to day operations of the section.
 Recruit, interview, train, and evaluate employees on the required performance objectives
Education
Associate in Arts Degree, Gulf Coast State College, Panama City, FL
Continued education by successfully completing various courses through Highmark University. Courses completed,
but not limited to the following:
 Achieving Communication Effectively (ACE)
 Pathways to Career Success
 Quality Tools and Techniques
 Business Writing
 Kepner-Tregoe Problem Solving and Decision Making
 Facilitation Skills