My Journey to becoming a Managed Care Consultant

After graduating from college, I found myself thrown into the great unknown without a clue as to what I wanted to do for the rest of my life. Through an internship, I met a man who was married to the supervisor of a health network; her department had an opening for an Eligibility Analyst and I quickly made my entry into the health care world. I must admit that the Health Insurance industry found me, not the other way around.

Back in those days, doing eligibility meant that I would get printouts of members who were active that month and would sit for hours making tick marks on who was eligible and who wasn’t. I would then term those not on the list, add those who were, and make changes to those who needed updating. After a couple years of this (and rapidly diminishing eyesight), I was able to load eligibility electronically, which saved time so I could help out in other areas of the business as well.

As the claims volume grew, so did the need for a system that could process claims more efficiently. After the new claims system was purchased, I was chosen to be on the team involved in the conversion. During the kickoff meeting, I met four consultants who were hired to analyze our business process and advise the best approach to set up the new system. They knew everything about the system and were invaluable to the implementation. Those four consultants changed the course of my career, as I realized that I wanted to be a consultant so I could make a difference, too.

After over 12 years of Eligibility, Provider Maintenance and Provider Contracting, I took a leap of faith and joined HCIM as a Client Services Consultant. Now, I implement and configure claims management systems in addition to working on benefits, contracts, Providers, enrollment, fee schedules, and anything else that the client needs assistance with. Recently, a client was experiencing an abnormal amount of claims pending in the system, so I helped to determine the problem and recommended how to resolve the issue. I’m currently working on a project where the client is bringing up a new line of business.

I’ll be celebrating two years with HCIM this month and I must say that I couldn’t have found a better company to work for and I truly love what I do. I’ve found a career that challenges me and allows me to help people with the same frustrations that I used to have. I’ve come a long way and I have HCIM and those four consultants to thank for it.

Amy Sipe
Client Services Consultant at HCIM

About HCIM

Since 2000, HealthCare Information Management, Inc. (HCIM) has delivered expert consulting services and robotic automation tools for small to mid-sized healthcare payer and managed care organizations. Our concierge consulting services include everything from core claims system procurement to go live, including configuration, migration, upgrades, reporting, benefits and fee schedules, user training, and project resourcing. We also offer strategic consulting in the areas of value based payments, population health, medical management, medical loss analysis and recovery, care management, provider contract modeling, data analytics, and business process reengineering/analysis.