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Work Background
Centene CorporationSupervisor, NSU Denials
Jul. 2024Austin, Texas, United States
Centene CorporationAppeals Specialist
Mar. 2022 - Jul. 2024
Superior HealthPlanMember Advocate
Oct. 2020 - Mar. 2022Austin, Texas, United States
Centene CorporationQuality Improvement Analyst G&A
May. 2018 - Dec. 2018Austin, Texas
Envolve HealthQuality Improvement Analyst
Sep. 2017 - May. 2018Austin, TexasPrepare State Fair Hearing Packets for Health Plans and adjust results as needed.
• Perform ongoing measurement, analysis, and monitoring of business process and member outcomes data sets.
• Perform ongoing quantitative and statistical analysis of Cenpatico performance data to include HEDIS measures, service utilization and member/provider complaint trends.
• Develop HEDIS measures, service utilization and all quality report extraction specifications.
• Develop and update quarterly, annual and ad hoc reports including analysis and narrative for NCQA accreditation and Health Plan deliverables
• Perform other performance and process improvement activities as needed.
• Trainer and assist in the process improvement projects as needed.
CenpaticoGrievance and Appeals coordinator
May. 2012 - Sep. 2017• Prepare determination letters for members/providers and ensure that letters meet specific NCQA requirements and compliance timeframes.
• Ensure that determinations, appeals, and retrospective reviews are documented appropriately.
• Gather, research, and process retrospective review requests within designated timeframes.
• Identify, analyze, and report provider trends regarding denials, appeals, and retrospective reviews.
• Assist in the preparation for audits of adverse determination and appeals.
• Gather, analyze and report verbal and written member and provider grievances and appeals within designated timeframes.
• Prepare response letters for member/provider grievances and appeals.
• Maintain files on individual appeals and grievances.
• Ensure physician reviews for appeals are conducted by an appropriately licensed behavioral health professional not involved in the original denial.
• Communicate with members, providers, and other departments.
Baker & TaylorCopy cataloger
Sep. 2009 - Mar. 2012Reno, Nevada
Data Entry, scanning and attaching of barcodes of books, DVD, Blu-Rays and CDS to customer’s library databases and websites. Follow the Library customer’s instructions on how to catalog and classify books, DVDs, Blu-Rays and CDs and print proper labels.
Additionally, I was assigned to train new hires, lead 3-5 catalogers in new projects and assist other catalogers in questions or concerns they may have for their markets.
Law office of Lawrence B. Bernard, EsqLegal Assistant/ Paralegal
Aug. 2004 - Apr. 2007Reno, Nevada• Prepare, Draft and process legal documents and papers, such as summonses, subpoenas, complaints, appeals, motions, and pretrial agreements.
• Mail, fax, or arrange for delivery of legal correspondence to clients, witnesses, and court officials.
• Receive and place telephone calls.
• Schedule and make appointments.
• Make photocopies of correspondence, documents, and other printed matter.
• Organize and maintain law libraries, documents, and case files.
• Assist attorneys in collecting information such as employment, medical, and other records.
• Attend legal meetings, such as client interviews, hearings, or depositions, and take notes.
• Draft and type office memos.
• Review legal publications and perform database searches to identify laws and court decisions relevant to pending cases.
• Submit articles and information from searches to attorneys for review and approval for use.
• Complete various forms, such as accident reports, trial and courtroom requests, and applications for clients.
• Supervise the everyday processes of the entire office and other staff.
Silver Legacy Resort CasinoCasino Reservations Agent part time
May. 2004 - Aug. 2004Reno, Nevada• Mail, fax, or arrange for delivery of correspondence and reservation confirmations.
• Receive telephone calls for room and show reservations.
• Make photocopies of correspondence, documents, and other printed matter.
• Also responsible for filing reservation confirmations.
National council for juvenile & family court judgesReceptionist part time- temp
Mar. 2004 - Aug. 2004Reno, Nevada• Answering and greeting visitor inquiries about the company and its products and services and direct visitors to their destinations.
• Mail, fax, or arrange for delivery of correspondence.
• Receive and place telephone calls.
• Schedule and make appointments.
• Make photocopies of correspondence, documents, and other printed matter.
Silver Legacy Resort CasinoRoom Reservations Agent
Dec. 2002 - Jan. 2004Reno, Nevada• Mail, fax, or arrange for delivery of correspondence and reservation confirmations.
• Receive telephone calls for room and show reservations.
• Make photocopies of correspondence, documents, and other printed matter.
• Also responsible for filing reservation confirmations.
CircusMidway games operator
Jan. 2002 - Dec. 2002Reno, Nevada• Receive and return bank from Supervisor at appropriate times. • Receive money from customer to play their game, make change and give prizes as appropriate. • Maintain proper security of money belt. • Provide excellent customer service. • Operate games according to the rules of the Midway Games Manual. • Stock and/or repair merchandise when assigned. • Maintain proper grooming and dress standards. • Clean game at the end of shift and assist with trash duty. • Direct problems to the Supervisor. • Help maintain a safe work environment. • Performs all other job related duties as requested.
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