Requests
0
Keep in touch with meI'm using Intch to connect with new people. Use this link to open chat with me via Intch app
Work Background
Centene CorporationSupervisor, NSU Denials
Jul. 2024Austin, Texas, United States
Centene CorporationAppeals Specialist
Feb. 2022 - Jul. 2024
Superior HealthPlanMember Advocate
Oct. 2020 - Feb. 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
Feb. 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.
Intch is a Professional Networking App for the Future of WorkSee more people like Tanya on Intch
300k+ people
130+ countries
AI matching
Get Intch if you'd like to
520595 people
17
Assistant manager
16
Customer service specialist
17
Sr Director, Customer Support
149897 people
17
Sr Director, Customer Support
17
IT Tier 1 Support @ University Hospital of the West Indies
16
Actor