Experience

Georgia Department of Community Health

• United States
• Government Administration
• 300 - 400 Employee

• Program Specialist

  • 1996 - Present

  Supervises unit staff that communicates with and provides written correspondence to internal and external customers. Plans work of assigned staff and provide oversight of their accountability meeting deadlines. Coordinates, manages and monitors completion of assignments within the Customer Service & Resolution Unit involving multiple programs. Guides and encourages each employee supervised to attain maximum performance on the job; provides ongoing feedback throughout the review period. Resolves complicated customer service issues , or direct customer to appropriate agency. Performs complex and comprehensive research and analysis. Recommends modification to and identifies problems with the MMIS. Responds to written and telephone inquiry requests. Written correspondence includes Administrative Reviews, Appeals and reconsiderations. 1996 - Revise existing policy and write new policies for assigned programs to. Function as staff advisor to other program specialists in areas of responsibility and as the primary point of communication with professionals and groups related to programs in area of assignment. Analyze the nature and scope of policy related problems; develop or assist with the development of appropriate measures. Maintains knowledge of current policies and procedures by reading memos, notices and other literature and attending training sessions, meetings, and conferences. Performs complex and comprehensive research and analysis. Recommends modification to and identifies problems with the MMIS. Responds to written and telephone inquiry requests. Written correspondence includes Administrative Reviews, Appeals and reconsiderations. Monitor contract for the Vision Care program. Worked on designing , testing and implementation of new claims adjudication system and the certification of the newly implemented system.



United Health Care

• Case/Disease Management

  • Dec 2005 - Dec 2009

  Provide care coordination, education and health advocate services to members. Assess member needs telephonically. Provide patient education to assist with self-management in collaboration with care managers. Coordinate care with providers and Hospital discharge planners. Coordinate ancillary services according to polices. Interact with medical director on challenging cases, Utilize Plan software to document service gaps or barriers in treatment plans. Responsible for the Emergency calls project.



Gastroenterology Clinic

• Medical Externist

  • Jul 1993 - Jan 1996

  Medical Extern - Performed as medical extern under licensed Physicians' supervision. Recorded patient histories. Performed patient examinations. Evaluated and diagnosed medical conditions, reviewed findings with physician for treatment plan. Responsible providing all medical necessity data/information and obtaining prior approval/pre-certification of procedures with insurance companies medical/surgical review teams. Revised all charts and provided correct procedure / diagnosis codes for billing purposes. Monitored and coordinated care for hospital patients/made daily “rounds”. Translated medical documents from French to English, interpreted for Hispanic patients. Supervised the back office medical staff and responsible for overall oversight of entire office staff in owner’s absence.