Provider Engagement Administrator

• Feb 2023 - Present

Acts as a liaison between Tier I providers (hospital systems, large multi-specialty groups, providers on value-based contracts and/or those with complex contracts) and the health plan. Manages Network performance through a consultative/account management approach. Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc. Evaluates provider performance and develops strategic plan to improve performance. Performs detailed HBR analysis. Facilitates provider training, orientations, and coaches for performance improvement within the network and assists with claim resolution. Show less

Director Of Managed Care

• Aug 2019 - Mar 2023

Work with clinical teams to collect all relevant and up-to-date information for patients and assemble individual cases for approval and concurrent insurance reviews. I act as a liaison between the insurance companies and Ohio Trio facilities to extend the length of skilled stay. Responsible for filing requests for all prior authorization & extensions for all insurances that require them based upon plan or insurance contract. Obtain information about patient insurance coverage, benefits, and eligibility. Responsible for maintaining and updating the internal listings of insurance carriers that require authorization. Run system-generated reports verifying procedures by insurances requiring authorization are being captured. Coordinates with each facility on prior authorization & extension activity. Participate in Utilization Review meetings, discussing resident's needs and coverage. Maintains the strictest confidentiality in accordance with HIPAA regulations and clinic requirements. Show less

Clinical Case Manager

• Apr 2015 - Aug 2019

Nurse

• Sep 2012 - Apr 2015

• Maintaining medical records military wide in Composite Health Care System. • Verifying and updating all discrepancy with Defense Enrollment Eligibility Reporting System. • Shipping and Receiving dangerous goods of both Class A and B standards set by Department of Transportation and International Air Transport Association. • Placing orders for specimens that are sent to reference labs for additional testing or research purposes. • Maintaining medical records military wide in Composite Health Care System. • Verifying and updating all discrepancy with Defense Enrollment Eligibility Reporting System. • Shipping and Receiving dangerous goods of both Class A and B standards set by Department of Transportation and International Air Transport Association. • Placing orders for specimens that are sent to reference labs for additional testing or research purposes.

Licensed Practical Nurse

• Aug 2011 - Feb 2012

• Administered oral medications and injections. • Maintained a record of medical intake and patient’s health. • Skilled at Tracheotomy Care, Intravenous and Oxygen Therapy. • Proficient at patient’s vital signs, Nursing Assessment. • Filing charts as well as making follow up appointments for patients • Administered oral medications and injections. • Maintained a record of medical intake and patient’s health. • Skilled at Tracheotomy Care, Intravenous and Oxygen Therapy. • Proficient at patient’s vital signs, Nursing Assessment. • Filing charts as well as making follow up appointments for patients

EPIC abstractor

• Jul 2011 - Nov 2011

• EPIC medical records abstractor, EPIC support for Kettering Health Network. • Maintain a record of medical intake and patient’s heath. • Data organization and input into EPIC Medical Records summer 2009. • Worked as support for physicians as they made the transition to Electronic Medical Records. • EPIC medical records abstractor, EPIC support for Kettering Health Network. • Maintain a record of medical intake and patient’s heath. • Data organization and input into EPIC Medical Records summer 2009. • Worked as support for physicians as they made the transition to Electronic Medical Records.

Medical Biller

• Aug 2007 - Mar 2008

• Billing Emergency Medical Services to Medicare, Medicaid and private insurances. • ICD-9 Coding of Service bills. • Billing Emergency Medical Services to Medicare, Medicaid and private insurances. • ICD-9 Coding of Service bills.