Experience

Health Integrated, Inc.

• United States
• Medical Practices

• Supervisor, UM Intake

  • Apr 2016 - Present

  Oversees Intake staff in order to assure accurate and timely distribution and assignment of work to the clinical teams (prior authorization requests, referral requests, hospital notifications or claims), and acts as liaison for the clinical teams in order to ensure the uninterrupted team workflow. Supervision of personnel functions for the Medical Management Intake Coordinator team, including reporting of production goals, monitoring of attendance and punctuality, providing routine performance… Show more Oversees Intake staff in order to assure accurate and timely distribution and assignment of work to the clinical teams (prior authorization requests, referral requests, hospital notifications or claims), and acts as liaison for the clinical teams in order to ensure the uninterrupted team workflow. Supervision of personnel functions for the Medical Management Intake Coordinator team, including reporting of production goals, monitoring of attendance and punctuality, providing routine performance feedback, leading departmental meetings, administering disciplinary measures, and participating in annual performance evaluations, Coordinates work across teams to ensure functional department workflow, as well as ensuring consistent application of company personnel policies for the Intake Coordinator team within Medical Management Ensures report generation for productivity and activity tracking is accurate and complete Reassigns work for team as required Answers telephone and email questions from clinics and acts as liaison for the geographic team related to clinical issues and assigns as appropriate Ensures effective identification of cases to improve member's health and increase cost savings Acts as liaison to other departments to ensure uninterrupted team/department flow Performs other duties and participates in projects as assigned Maintains letter templates and forms Develops and maintains team Desk Procedures Supports Quality improvement efforts Monitors and reports attendance, turn-around time (TAT), productivity & quality of work for administrative team of intake coordinators Ensures daily assignment of work duties of the administrative team meets team requirements for data entry, TAT, and facilitates work assignments to clinical queues Works for rapid and effective resolution of claim irregularities and customer service issues

• Client Service Representative

  • Nov 2015 - Present

  Responsible and accountable for providing customer service and supports to all clients, primarily by answering and responding to all inbound calls from providers regarding inpatient services. The calls primarily include general intake for Inpatient admissions, accurately selecting the appropriate members; verifying member eligibility; locating and verifying providers and processing referral notifications accurately and ensuring all required data elements are captured with special attention to… Show more Responsible and accountable for providing customer service and supports to all clients, primarily by answering and responding to all inbound calls from providers regarding inpatient services. The calls primarily include general intake for Inpatient admissions, accurately selecting the appropriate members; verifying member eligibility; locating and verifying providers and processing referral notifications accurately and ensuring all required data elements are captured with special attention to being HIPAA compliant as well as admin tasks generated from the call are performed in this position.



Strokers and Studio 26

• Club Owner/Promotions Team Manager

  • Dec 2009 - Aug 2015

  Responsible for the day to day operations and staffing of the venue to include hiring staff, maintaining inventory, marketing and advertising the venue, customer satisfaction, ensuring profitability and compliance with the Health Department and Department of Business and Professional Regulations. Responsible for the day to day operations and staffing of the venue to include hiring staff, maintaining inventory, marketing and advertising the venue, customer satisfaction, ensuring profitability and compliance with the Health Department and Department of Business and Professional Regulations.



HealthPlan Services

• United States
• Insurance
• 200 - 300 Employee

• Acting Account Resolution Specialist/Customer Service

  • Jan 2014 - Oct 2014

  Claims and billing expert capable of handling escalated issues, approving exceptions and/or writing responses on behalf of the carrier and HPS management team. Handled escalated calls, assisted with training and worked closely with management and the Voice of the Customer Unit to define problems and facilitate Process Improvement. Claims and billing expert capable of handling escalated issues, approving exceptions and/or writing responses on behalf of the carrier and HPS management team. Handled escalated calls, assisted with training and worked closely with management and the Voice of the Customer Unit to define problems and facilitate Process Improvement.



Amerigroup Corporation

• Spain
• Real Estate

• Claims Supervisor

  • Jan 2009 - Nov 2009

  Provided leadership and day-to-day direction for production-related claims activities across all markets within the claims department, including: claims processing and payment, management reporting and management and development of staff. Developed and implemented policies, procedures and processes that ensured the timely payment of claims in accordance with contractual, State and Federal requirements. Provided leadership and day-to-day direction for production-related claims activities across all markets within the claims department, including: claims processing and payment, management reporting and management and development of staff. Developed and implemented policies, procedures and processes that ensured the timely payment of claims in accordance with contractual, State and Federal requirements.



Coventry Health Care formerly Concentra

• Operations Supervisor II

  • Dec 2003 - Jul 2008

  Supervised and trained a staff of 40-45 colleagues responsible for the intake and assignment of referrals/specialty referrals including Crisis and Catastrophic Referrals (Referral Entry Unit), ASM Direct Reports (Direct Reporting), mailing of invoices and managing exceptions relating to invoice processing (Invoice Print Unit), review and approval of case documents (Case Document Approval Unit) relating to Field Case Management reports, provided after hours support for Field Case Managers… Show more Supervised and trained a staff of 40-45 colleagues responsible for the intake and assignment of referrals/specialty referrals including Crisis and Catastrophic Referrals (Referral Entry Unit), ASM Direct Reports (Direct Reporting), mailing of invoices and managing exceptions relating to invoice processing (Invoice Print Unit), review and approval of case documents (Case Document Approval Unit) relating to Field Case Management reports, provided after hours support for Field Case Managers, identified inconsistencies and addressed with workflows to prevent. Hired and trained new employees to support field staff and the CMO Operations. Created and managed reports that provided statistical information to Senior Leaders and field staff. Show less Supervised and trained a staff of 40-45 colleagues responsible for the intake and assignment of referrals/specialty referrals including Crisis and Catastrophic Referrals (Referral Entry Unit), ASM Direct Reports (Direct Reporting), mailing of invoices and managing exceptions relating to invoice processing (Invoice Print Unit), review and approval of case documents (Case Document Approval Unit) relating to Field Case Management reports, provided after hours support for Field Case Managers… Show more Supervised and trained a staff of 40-45 colleagues responsible for the intake and assignment of referrals/specialty referrals including Crisis and Catastrophic Referrals (Referral Entry Unit), ASM Direct Reports (Direct Reporting), mailing of invoices and managing exceptions relating to invoice processing (Invoice Print Unit), review and approval of case documents (Case Document Approval Unit) relating to Field Case Management reports, provided after hours support for Field Case Managers, identified inconsistencies and addressed with workflows to prevent. Hired and trained new employees to support field staff and the CMO Operations. Created and managed reports that provided statistical information to Senior Leaders and field staff. Show less



Cheap Tickets-Cendant Travel

• Workforce Analyst-Resource Planning and Management

  • Nov 2000 - Dec 2002

  Scheduled all lunches, breaks, meetings, Holidays, training, project time, Department events and time off utilizing eWorkforce Management. Notify management of any issues or trends with staff attendance. Ensure Real Time Adherence (RTA) system is utilized to provide reports for the Managers and Quality Team. Worked with managers to forecast volumes, call arrival patterns, and review staff requirements when new support is added or when the support environment changes. Created, generated, and… Show more Scheduled all lunches, breaks, meetings, Holidays, training, project time, Department events and time off utilizing eWorkforce Management. Notify management of any issues or trends with staff attendance. Ensure Real Time Adherence (RTA) system is utilized to provide reports for the Managers and Quality Team. Worked with managers to forecast volumes, call arrival patterns, and review staff requirements when new support is added or when the support environment changes. Created, generated, and maintain reporting as needed, interacting with management as appropriate. Maintained the department emergency contact list and other similar materials as required. Show less Scheduled all lunches, breaks, meetings, Holidays, training, project time, Department events and time off utilizing eWorkforce Management. Notify management of any issues or trends with staff attendance. Ensure Real Time Adherence (RTA) system is utilized to provide reports for the Managers and Quality Team. Worked with managers to forecast volumes, call arrival patterns, and review staff requirements when new support is added or when the support environment changes. Created, generated, and… Show more Scheduled all lunches, breaks, meetings, Holidays, training, project time, Department events and time off utilizing eWorkforce Management. Notify management of any issues or trends with staff attendance. Ensure Real Time Adherence (RTA) system is utilized to provide reports for the Managers and Quality Team. Worked with managers to forecast volumes, call arrival patterns, and review staff requirements when new support is added or when the support environment changes. Created, generated, and maintain reporting as needed, interacting with management as appropriate. Maintained the department emergency contact list and other similar materials as required. Show less



Verizon Wireless

• United States
• Retail
• 1 - 100 Employee

• Activations, WFM, Team Leader

  • Oct 1996 - Dec 1999

  Responsible for monitoring and analyzing the call volume, arrival patterns, and Service Level performance,on a national and regional basis, for the Consumer, Business and Multilingual call centers located in Texas, California and Florida. Responsible for identifying call volume trends and averages on a monthly, quarterly, and seasonal basis, and must capture, store and report historical statistics (Service Level, occupancy, forecast accuracy, etc.) Established and maintained communication… Show more Responsible for monitoring and analyzing the call volume, arrival patterns, and Service Level performance,on a national and regional basis, for the Consumer, Business and Multilingual call centers located in Texas, California and Florida. Responsible for identifying call volume trends and averages on a monthly, quarterly, and seasonal basis, and must capture, store and report historical statistics (Service Level, occupancy, forecast accuracy, etc.) Established and maintained communication channels regarding events that impact call workload. Responsible for coordinating training plans and providing dates and times to local and national trainers. Coordinated requests for office meetings, fire drills, etc. and oversaw daily schedule conflicts, adherence issues, and occupancy concerns. Assisted with troubleshooting staffing and/or system issues in a large team force management environment. Utilized IEX and CMS workforce management software packages to monitor real-time adherence and recommended changes to meet service and cost goals. Responsible for analyzing historical reports on workload, and providing reports and updates to regional management on workload trends and resource requirements. Show less Responsible for monitoring and analyzing the call volume, arrival patterns, and Service Level performance,on a national and regional basis, for the Consumer, Business and Multilingual call centers located in Texas, California and Florida. Responsible for identifying call volume trends and averages on a monthly, quarterly, and seasonal basis, and must capture, store and report historical statistics (Service Level, occupancy, forecast accuracy, etc.) Established and maintained communication… Show more Responsible for monitoring and analyzing the call volume, arrival patterns, and Service Level performance,on a national and regional basis, for the Consumer, Business and Multilingual call centers located in Texas, California and Florida. Responsible for identifying call volume trends and averages on a monthly, quarterly, and seasonal basis, and must capture, store and report historical statistics (Service Level, occupancy, forecast accuracy, etc.) Established and maintained communication channels regarding events that impact call workload. Responsible for coordinating training plans and providing dates and times to local and national trainers. Coordinated requests for office meetings, fire drills, etc. and oversaw daily schedule conflicts, adherence issues, and occupancy concerns. Assisted with troubleshooting staffing and/or system issues in a large team force management environment. Utilized IEX and CMS workforce management software packages to monitor real-time adherence and recommended changes to meet service and cost goals. Responsible for analyzing historical reports on workload, and providing reports and updates to regional management on workload trends and resource requirements. Show less