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Click here or scroll down to respond to this candidateCandidate's Name
PHONE NUMBER AVAILABLEEMAIL AVAILABLEExperienceRising Phoenix NutritionOwner/Operator Provide education to individuals geared around a healthy lifestyle; including healthy food choices, exercise recommendations, and support. Provide excellent customer service to all exhisting and new clients. Provide support for business growth; maintains relationships and seeking new to build clientele Able to market business providing an increase in sales and revenue SAEG Ventures LLC, Tampa, FL (Remote)Sole Contractor-Remote (March 2020-Current) Generate Medicare and Medicaid Quality reporting for Clients such as: HEDIS Gap Report, Individual Practitioner Performance Report, Possible Monies Missed Review. HEDIS Supplemental Data Submission Claims Reconciliation Research related to Projects, Upcoming Incentive & Quality uPrograms, and Business Grants. Anthem, West Des Moines, IAGrievance & Appeals Rep II-Remote (Aug 2019-June 2021) Field member grievances via phone: Provide status, instructions, and resolution. Review Quality of Care: issues regarding member care both physical and mental. Track multiple states regarding Critical Incidents: PEGA, Quality of Care Tracker, and excel spreadsheet. Report Quality of Care issues to DHS for review. Assist in state reviews regarding possible negligent care from providers towar i ds members. Collaborate with leadership to determine the w.1efficient work flows to maintain management of work volume within each state worked in the central region. Conduct executive decisions for problem solving issues. Liaison between member and professional and non-professional peers to bring resolution. Inform medical review team of cases needing further review. Conduct training of new hires across all applicable systems and departments involving grievance Organize and maintain the Central Region (7 states) SharePoint: i.e. training, workflows, department policies and procedures, letters, forms, etc. Anthem, West Des Moines, IACommunity Based Case Manager-Remote (July 2018 Aug 2019) Conducted training of new hires across all applicable systems and departments involving case management. Involved in Anthems leadership program HYPE (Healthcare Young Professional Exchange) Scheduled and coordinated person centered support plan meetings, admission meetings for members with cost savings in mind. Exceptional leadership and communication skills. Collaborated with care team to provide clinical resources and medical care for members. Conducted detailed assessments of members personal health goals and care plans. Provided psychological and emotional support resources to members as well as family members dealing with chronic or acute illnesses. Examined and discussed funding issues with patients and family members. Anthem, West Des Moines, IAMedical Management Specialist (2017 2018) Assisted Case Managers in authorizing services members need to obtain personal health goals Fielded member and care team concerns and delegated accordingly. Researched billing inquiries and denials for reprocessing. Candidate's Name
PHONE NUMBER AVAILABLEEMAIL AVAILABLE Built and approved member cases and authorizations in company database (FACETS).Lead and assisted various projects in a time sensitive environment for audit and reporting purposes to the state using various programs.Tradehome Shoes, Fort Dodge, IAAssistant Manager (2016 2017) Trained 7-8 sales associated to sell products within the store Interviewed/hired new employees Created and maintained weekly schedule Achieved and maintained 30% store gains, monthly, through personal sales Attracted and secured clientele from prior store loss Demonstrated excellent customer serviceGeneral Nutrition Company (GNC), Fort Dodge, IASales Associate (2016 2017) Lead sales associate Educated customers on store products to help maintain a good healthy regimen Lead team in new accounts while helping to maintain and exceed store goals Maintained daily balanced cash register Demonstrated excellent customer serviceAnthem, West Des Moines, IAGrievance & Appeals Liaison (2015 2016) Answered calls from members regarding an appeal with a current decision regarding denial of their benefit or for their concerns regarding local physicians Researched members benefits for a customer satisfactory decision Conducted executive decisions for problem solving issues Acted as liaison between member and professional and non-professional peers for best resolution of members concern Presented cases needing medical review from the nurses on our team Obtained critical incident information for reporting purposes to the state EducationSouthern New Hampshire UniversityBachelor of Arts in Management, Concentration in Logistics & Operations Kaplan University, Urbandale, IA 2004-2005Associate of Applied Science for Medical Assisting Kaplan University, Urbandale, IA 2004-2005Medical Transcription Certificate |
