Experience

CenterPoint Human Services

• Government Relations
• 1 - 100 Employee

• • Aug 2012 - Present

  Provide professional, reliable, and credible adminstrative support for the Utilization Management department. Receives requests for authorization services submitted via a web portal. Conducts a pre-review screening of non-urgent requests to determine if required documents are present. If all documents are present and forwards request to Utilization Review Specialist for a clinical review. Conducts other related activities that do not require clinical evaluation or interpretation. Registers consumer enrollment data and ensures payer sources, e.g. Medicaid, Medicare, insurance, State funds are in the consumer's eligibility record according to MCO funding structure. Show less

• • Jun 2004 - Jul 2012

  Parcel the Medicaid RA, submit payment requests for network providers who bill under Centerpoint's provider number and distribute the RA after the check is issued to the appropriate provider after each Medicaid checkwrite in a timely and accurate manner. Maintains an incoming network provider claims log for paper claims, send acknowledgement of receipt and complete all pre-claims processes e.g. verifiying authorization, funding source, etc in a timely manner. Process consumer enrollments submitted via ProviderLink and ProviderPoint. Verifying all data elements, cross-referencing the consumer in IPRS, verifying funding source, in addition to requesting additional information from providers. Show less



Behavioral Health Resources, Novant Health

• Winston-Salem, NC

• Administative Support

  • Nov 1997 - Mar 2004

  Provided provessional, reliable, and credible administraive support for the Manuaged care and Provider Relations departments. Ensured and maintained the integrity of all master documents. Created, organized and updated spreadsheets and other databases that are used for internal and external reporting. Generated reports that monitored the effectiveness of process for the initial client credentialing. Coordinated and administered credentialing and recredentialing prcess for Partners National Health Plan and Blue Cross Blue Shield and Providers. Executed timely administration of payroll. Maintained time and attendance data. Key liason for external customers, out of service area health plans and behavioral health provider network. Selectred to assist with special projects as Quatlity Improvement and NCQA compliance. Show less