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Click here or scroll down to respond to this candidateCandidate's Name
PHONE NUMBER AVAILABLEEMAIL AVAILABLESUMMARYExperienced healthcare professional with expertise in the areas of managed care, provider relations, customer service, community engagement, territory management, Medicaid, and the behavioral health insurance industry.SKILLSKnowledge of Microsoft Word, Excel, Access, PowerPoint, Outlook, Facets system, SalesforcePROFESSIONAL EXPERIENCEBeacon Health Options October 2019 -August 2022Developed and maintained a relationship with the Childrens Medicaid Providers and Foster Care 29-I program.Initiated Single case agreements (SCAs) requests by taking data from inquiry requests, resolving issues, and responding to questions regarding the request.Followed up protocols to conduct the proper provider/member checks, gathered the appropriate provider documentation, coordinated with the clinical team to authorize the treatment, assisted with provider data entry and rate loading.Oversaw the administration and tracking of all assigned SCAs and coordinated with other teams as needed to facilitate completion of requests.Performed complete investigations and conducted the necessary follow through on all inquiries regarding SCA requests. This includes inquiries related to initial requests, exception requests and follow up requests.Researched and accurately responded to inquiries regarding the status of SCAs.TruHearing Account Manager March 2019-October 2019Managed a book of business of clients with moderate complexity and potential for growth.Supported the Sales Directors and Directors of Account Management in their region to increase membership, and health plan awareness.Presented to educate health plan sales agents, brokers, customer service teams and members about the TruHearing partnership in place with the health plan.Engaged directly with health plan members to answer questions at benefit fairs, wellness events, and other member-facing events held by the health plan.Worked with the Sales & Account Management teams across departments, which included marketing, implementation, provider relations, and finance functions.Worked remote from the TruHearing headquarters in Utah and was required to travel regularly to sites throughout the United States with a primary focus in the eastern region.Blue Shield of NENY Provider Contracting & Practice Consultant 2016-2019Developed and maintained relationships with physicians and their office staff with the goal of promoting or collaboration of corporate strategic initiatives.Responsible for developing, contracting, improving and maintaining relationships with provider organizations within their assigned territory.Managed fee schedule requests from providers and reviewed cost impact analysis to provide recommendations to management.Identified potential problems in the provider community, recommended solutions and plan of action and reported them to management.Coordinated responses, researched, developed and implemented corrective action plans and reporting as necessary to government and regulatory audits.Blue Shield of NENY Provider Relations Consultant 2014-2016Developed and maintained relationships with physicians and their office staff.Participated in the deployment of innovative strategies to engage the provider network in delivery of quality care.Assisted with the implementation of company strategies including marketing, cost containment and communicating corporate messaging.Blue Shield of NENY Customer Service Representative Part-time 2012 - 2014Responded to subscribers, members, providers, facilities, groups and other inquiries via telephone, written correspondence, or lobby walk-ins.Took ownership of problems and established relationships with all customers via telephone, written correspondence or lobby walk-ins.Represented the company in a professional, competent and helpful manner.Took personal responsibility in incorporating and maintaining the principles and tools of the team environment in all interactions with internal customers.Proactively contributed to team goals and assisted other areas within the department and companyEducationMildred Elley Business School, Albany, NYParalegal Degree 1992 |
