Experience

Lakeview Center Inc

• United States
• Mental Health Care
• 1 - 100 Employee

• Contract and Credentialing Analyst

  • Jun 2017 - Present

  CREDENTIALING ————————- Responsible for all aspects of payer provider credentialing and recredentialing at Lakeview Center, Inc. Ensure that all staff who provide patient care are credentialed with the appropriate commercial health plans, Medicare and Medicaid. Maintain up-to-date data for each provider in credentialing databases and online systems. Provide monthly provider reporting to all payers, as required by the contract. Audit health plan directories for current and accurate provider information. CONTRACTING ————————- Responsible for the negotiation, review and execution of commercial payer contracts for Lakeview Center, Inc. Additionally, responsible for ongoing contract maintenance, contract renegotiations and contract renewal. Conduct annual review of each contract to identify opportunities for improved or additional service reimbursement. Maintain fee schedules and service coverage guidelines for all payers, including Medicare and Medicaid. Track, research and resolve payer or service coverage issues for program areas. Responsible for the maintenance and accuracy of agency contract database, which outlines key contract terms, data elements and other pertinent information needed to effectively manage the contract. Show less



The Friary of Lakeview

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

• Admissions and Intake Coordinator

  • Jun 2016 - Jun 2017

  Initiate pre admission screenings by obtaining and reviewing personal information from caller for financial obligations, medical/mental health necessities, substance use history, treatment history, legal obligations, and family support. Preparing cost estimates for client treatment. Negotiation and management of client payment arrangements, as applicable. Responsible for the assessment of inpatient treatment eligibility as determined by the criteria for admission, insurance policies, etc. Prepare all intake documents and complete client intake and admission into treatment, ensuring that all clinical intake forms were completed and signed. Review intake(s) with therapists and Executive Program Director at daily staff debriefings. Responsible for accurate census recording of services and bed days for record and claiming. Responsible for obtaining insurance authorizations for all applicable coverage and for appropriate level of clinical care. Conducted utilization reviews for admissions, continued stays and discharges. Show less

• Compliance Auditor

  • Nov 2015 - Jun 2016


IGATE

• Morocco
• Professional Training and Coaching
• 1 - 100 Employee

• Department Manager

  • Apr 2002 - Sep 2014

  • Managed and successfully led a team of 16 members • Accountable for delivering within contractual service level agreements for over 10 separate insurance clients • Responsible for the daily tracking, measuring and monitoring of employee activities to ensure that inquiries were completed, solutions were provided and policies and procedures were followed • Processed policy administrative functions for Long Term Care and Medicare Supplement insurance policies • Maintained training plans and identified skill gaps to ensure each staff member was adequately and fully trained • Managed eTime payroll system for individual team members. • Participated in the corrective action of employees, when necessary, by completing performance improvement plans and ensuring that expected progress and goals were met during the improvement plan • Assisted in implementation of new clients • Bank reconciliation • Debiting and crediting of agent commission accounts • Maintained policy and procedure manuals for clients • Monitored employee production through workflow monitors • Performed regular audits on production work Show less