Nicole Haywood
Public Provider Reimbursement Analyst at ForHealth Consulting at UMass Chan Medical School- Claim this Profile
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Bio
Credentials
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Health Connector Navigator
Massachusetts Health ConnectorSep, 2015- Oct, 2024
Experience
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ForHealth Consulting at UMass Chan Medical School
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United States
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Business Consulting and Services
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200 - 300 Employee
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Public Provider Reimbursement Analyst
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Nov 2017 - Present
Generates revenue for the state of Massachusetts by managing the Department of Developmental Services enrolled consumers Medicaid eligibility. Generates revenue for the state of Massachusetts by managing the Department of Developmental Services enrolled consumers Medicaid eligibility.
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MAXIMUS
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Australia
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Advertising Services
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1 - 100 Employee
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Client Service Representative {Medicaid Application/Enrollment Specialist}
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Jul 2017 - Sep 2017
• Answered inbound/made outbound calls in a call center environment • Entered consumer data/demographic information into Medicaid health insurance application • Updated member demographic and contact information • Referred callers to correct resource; notate system on each call • Answered inbound/made outbound calls in a call center environment • Entered consumer data/demographic information into Medicaid health insurance application • Updated member demographic and contact information • Referred callers to correct resource; notate system on each call
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AppleOne Employment Services
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United States
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Staffing and Recruiting
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700 & Above Employee
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Medicaid Enrollment Specialist
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Nov 2016 - Jul 2017
• Answers inbound calls in a call center environment • Enters data/demographics information into Medicaid health insurance applications • Updates member demographics and contact information • Notates system for every answered call • Answers inbound calls in a call center environment • Enters data/demographics information into Medicaid health insurance applications • Updates member demographics and contact information • Notates system for every answered call
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Caring Health Center
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United States
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Hospitals and Health Care
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1 - 100 Employee
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Affordable Care Act Navigator
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Nov 2014 - Jun 2016
• Entered enrollment information into Medicaid health plans and provided education regarding Qualified Health plans (QHPs), Advanced Premium Tax Credits and Cost Sharing Reductions • Documented statistics and demographic data on the customers that were assisted daily • Responsibilities included: Affordable Care Act outreach and education events, conducting eligibility screenings, providing and facilitating enrollment services, faxing all requested and required verification documents to relevant entities, handling inbound calls and making outbound calls • Completed MA state Navigator training courses and passed Navigator certification exam, complied with all continuing education and re-certification requirements, provided courteous, professional and confidential assistance to all clients seeking health insurance coverage • Conducted marketing and outreach within targeted neighborhoods regarding health insurance eligibility and options through the MA Health Connector. Facilitated enrollment into Medicaid health plans and provided education regarding Qualified Health plans (QHPs), Advanced Premium Tax Credits and Cost Sharing Reductions • Followed up with clients to troubleshoot appeals and disputes, completed training and attended quarterly meetings to assure strong expertise in public and private health insurance eligibility, application/ enrollment process and updates to regulation • Handled sensitive/personal information with an understanding and respect for client confidentiality; ensured that follow-up was completed to capture client referrals and outcomes • Achieved performance targets in working closely with the other Navigators, Masshealth -Medicaid and MA Health Connector partners to identify and overcome challenges Show less
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Health New England
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United States
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Insurance
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200 - 300 Employee
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Health Services Coordinator
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Dec 2013 - May 2014
• Acted as a primary resource of contact for providers relating to service requests and corresponded with members/providers as to decision(s) made regarding requests for services • Assisted Case Managers with research and correspondence related to service requests • Approved/denied service request on Health Service Coordinator level and forwarded authorizations needing clinical review to nurse clinical reviewer • Generated approval/denial letters and faxed them to members/providers • Corrected authorizations in order for health claims to pay and process accurately. Interacted daily with member services, claims, and members/providers regarding authorization statuses; forwarded health claims through claim system to reprocess Show less
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Trans Courier Systems
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United States
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Freight and Package Transportation
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1 - 100 Employee
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Courier (Contractor)
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Jul 2011 - Oct 2013
• Daily duties included driving, recording time and mileage on a log sheet, calling into the office to report arrival/departure times for morning and afternoon route • Responsible for picking up, delivering, and transferring auto parts between multiple Advance Auto Part locations. • Daily duties included driving, recording time and mileage on a log sheet, calling into the office to report arrival/departure times for morning and afternoon route • Responsible for picking up, delivering, and transferring auto parts between multiple Advance Auto Part locations.
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Tricare Service Advocate
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Jun 2005 - Apr 2011
• Responsibilities included educating, explaining, and registering beneficiaries into the Tricare health insurance benefit program • Interacted with insureds providing face to face customer service in a medical facility/office environment, accepted enrollment forms and faxed them to the enrollment department for processing • Located Tricare network medical doctors and facilities via internet for beneficiaries, provided marketing materials and briefings for all military/retired military members; educating them about their health insurance benefits • Responsible for verifying health insurance eligibility/benefits to members and medical office staff, researching medical claims and making sure health insurance claims processed correctly in accordance to the beneficiaries corresponding health plan • Worked closely with the enrollment/claims department and military personnel; resolved billing and collection issues for members and medical office staff Show less
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Education
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2019 - 2020
Commonwealth of Massachusetts Executive Office of Health and Human Services
MasSP Certificate, Aspiring Supervisor Program -
2012 - 2013
Holyoke Community College
Communication and Media Studies
Community
