Experience

Christian Brothers Services

• United States
• Non-profit Organizations
• 100 - 200 Employee

• Team Lead

  • Mar 2019 - Present

• Claims Examiner

  • Nov 2017 - Mar 2019



Joliet Oncology Hematology Associates Ltd

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Managed Care Credentialing

  • Oct 2017 - Nov 2017



Molina Healthcare

• Oak Brook, IL

• Utilization Management, Supervisor

  • Oct 2015 - Oct 2017

  Provide support and direction in Utilization Management processing operations for non-clinical staff Coordinate work flow within department to insure team members meet metrics Manage PTO, remote and rotating schedules Manage and maintain turn around time for prior authorization requests per internal, state, and CMS/NCQA guidelines Manage non-clinal staff of 20 employees Held weekly one-on-one and staff meetings, quarterly coaching sessions to promote growth within the team Create and revise policies and procedures and training documentation for department processes Maintain online knowledge base and SharePoint site Design and oversee mentoring program for top performers with new employees Provide direction and training for Utilization Management claims processes Audit Utilization Management Claims for accuracy and timely payments to providers



Insurance Program Managers Group

• United States
• Insurance
• 1 - 100 Employee

• Director Benefit Administration/Team Lead

  • Aug 1999 - Oct 2015

  Provide support and direction in daily claim processing operations. Manage workload assignments, claim production, turnaround times, and quality levels. Manage vacation schedules. Resolve claim issues and direction for customer service. Facilitate the release of over dollar authority claims. Handle pre-determinations and grievances. Provide claim system training for all new claim analysts and on-going department training. Facilitate the loading/processing of all client PBM invoices. Maintain appropriate tracking and application of client refunds, voids and stop payments. Maintain call-tracking system. Assist with facilitating high levels of Claim Cost Containment. Develop recommendations for cost control. Provide direct client communication. Handle CMS requests.