Experience

Jai Medical Systems Managed Care Organization, Inc.

• United States
• Insurance
• 1 - 100 Employee

• Director of Provider Relations

  • Jun 2017 - Feb 2022

  • Perform duties to act as a liaison between providers, the health plan and corporate including investigating and resolving provider claims issues. Perform training, orientation and coaching for performance improvement within physician practices. • Serve as primary contact for providers serving as a liaison between the provider and the health plan • Conduct monthly meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on-site… Show more • Perform duties to act as a liaison between providers, the health plan and corporate including investigating and resolving provider claims issues. Perform training, orientation and coaching for performance improvement within physician practices. • Serve as primary contact for providers serving as a liaison between the provider and the health plan • Conduct monthly meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on-site and routing to the appropriate party for resolution • Receive and respond to external provider related issues • Initiate entry or change of provider related database information • Recommend changes in pricing systems • Author change requests and oversee through testing and completion. • Investigate and communicate provider changes • Educate providers regarding policies and procedures related to referrals and claims submission; web site education, EDI solicitation and problem solving • Perform Provider orientations (includes writing/updating orientation material when necessary)

• Assistant Director of Provider Relations

  • Mar 2016 - Jun 2017

• Provider Relations Representative

  • Dec 2013 - Mar 2016

  -Vision account team lead and benefit specialist -Responsible for credentialing and recredentialing network providers in compliance with internal policy, State regulations, and Federal accreditation standards -Responsible for provider recruitment, contract implementation, network retention, and management of client relationships -Conduct provider outreach and follow-up -Responding to provider claims/appeals inquires via internet and phone calls -Identifying and remediating… Show more -Vision account team lead and benefit specialist -Responsible for credentialing and recredentialing network providers in compliance with internal policy, State regulations, and Federal accreditation standards -Responsible for provider recruitment, contract implementation, network retention, and management of client relationships -Conduct provider outreach and follow-up -Responding to provider claims/appeals inquires via internet and phone calls -Identifying and remediating operational short-falls and researching and remediating claims -Build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers -Conducting provider site reviews for compliance



CVS Health

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Nationally Certified Pharmacy Technician

  • Jun 2009 - Apr 2014

  -Customer Service -Prescription order processing -Inventory Management -Answer simple questions about prescriptions -Fill prescriptions -Assist the Pharmacist with daily activities -Assist in training new employees -Create and update patient health and insurance information -Communicate with insurance carriers -Customer Service -Prescription order processing -Inventory Management -Answer simple questions about prescriptions -Fill prescriptions -Assist the Pharmacist with daily activities -Assist in training new employees -Create and update patient health and insurance information -Communicate with insurance carriers



Maryland Dental Action Coalition

• United States
• Hospitals and Health Care

• Intern

  • Jan 2013 - May 2013

  Worked under the supervision of the Executive Director and Executive Assistant of the Maryland Dental Action Coalition. Assists the Office of Oral Health with various policy and research projects. Among other oral health projects, this includes data evaluation and analysis. Working to improve student membership recruitment in MDAC, create flyers for recruitment, outreach to student organizations in Maryland, develop/write/edit biweekly newsletter, attend Board of Director and Membership… Show more Worked under the supervision of the Executive Director and Executive Assistant of the Maryland Dental Action Coalition. Assists the Office of Oral Health with various policy and research projects. Among other oral health projects, this includes data evaluation and analysis. Working to improve student membership recruitment in MDAC, create flyers for recruitment, outreach to student organizations in Maryland, develop/write/edit biweekly newsletter, attend Board of Director and Membership Meetings, attend committee meetings, attend special events/conferences, research topics related to public health/dentistry/health literacy. Prepare clear and concise written communications, communicate effectively with diverse groups, operate various computer and standard office equipment; adapt to changing technology; organize and prioritize work; coordinate and assist in variety of projects simultaneously; read, interpret, research, explain and apply health related research to assist with any projects or tasks; establish and maintain cooperative working relationships. Show less Worked under the supervision of the Executive Director and Executive Assistant of the Maryland Dental Action Coalition. Assists the Office of Oral Health with various policy and research projects. Among other oral health projects, this includes data evaluation and analysis. Working to improve student membership recruitment in MDAC, create flyers for recruitment, outreach to student organizations in Maryland, develop/write/edit biweekly newsletter, attend Board of Director and Membership… Show more Worked under the supervision of the Executive Director and Executive Assistant of the Maryland Dental Action Coalition. Assists the Office of Oral Health with various policy and research projects. Among other oral health projects, this includes data evaluation and analysis. Working to improve student membership recruitment in MDAC, create flyers for recruitment, outreach to student organizations in Maryland, develop/write/edit biweekly newsletter, attend Board of Director and Membership Meetings, attend committee meetings, attend special events/conferences, research topics related to public health/dentistry/health literacy. Prepare clear and concise written communications, communicate effectively with diverse groups, operate various computer and standard office equipment; adapt to changing technology; organize and prioritize work; coordinate and assist in variety of projects simultaneously; read, interpret, research, explain and apply health related research to assist with any projects or tasks; establish and maintain cooperative working relationships. Show less



Social Security Administration

• Government Administration
• 700 & Above Employee

• Office Automation Clerk (STEP Program)

  • Dec 2005 - Jun 2009

  -Update employee files -Maintain copies of important documents for employees -Cover phones for fellow administrative assistants -Create binders and portfolios for projects -Schedule meetings and conference room times -Aid co-workers with customer service -Update component’s website -Distribute important information to employees (Flyers, Notifications) -Create template documents and charts/tables -Send emails to appropriate recipients -Maintain employee training… Show more -Update employee files -Maintain copies of important documents for employees -Cover phones for fellow administrative assistants -Create binders and portfolios for projects -Schedule meetings and conference room times -Aid co-workers with customer service -Update component’s website -Distribute important information to employees (Flyers, Notifications) -Create template documents and charts/tables -Send emails to appropriate recipients -Maintain employee training information -Record/Type various meeting minutes Show less -Update employee files -Maintain copies of important documents for employees -Cover phones for fellow administrative assistants -Create binders and portfolios for projects -Schedule meetings and conference room times -Aid co-workers with customer service -Update component’s website -Distribute important information to employees (Flyers, Notifications) -Create template documents and charts/tables -Send emails to appropriate recipients -Maintain employee training… Show more -Update employee files -Maintain copies of important documents for employees -Cover phones for fellow administrative assistants -Create binders and portfolios for projects -Schedule meetings and conference room times -Aid co-workers with customer service -Update component’s website -Distribute important information to employees (Flyers, Notifications) -Create template documents and charts/tables -Send emails to appropriate recipients -Maintain employee training information -Record/Type various meeting minutes Show less



University of Maryland Baltimore County

• United States
• Higher Education
• 700 & Above Employee

• Resident Assistant

  • Aug 2008 - Jan 2009

  -First point of contact with resident issues -Work with residents to create floor/building activities -Listen and provide support -Assist resident in enforcing community standards and policies -Answer questions about the residential life facilities, academics, and campus life -Conduct health and safety inspections -Assist with maintaining the residential environment -First point of contact with resident issues -Work with residents to create floor/building activities -Listen and provide support -Assist resident in enforcing community standards and policies -Answer questions about the residential life facilities, academics, and campus life -Conduct health and safety inspections -Assist with maintaining the residential environment