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Work Background
Molina HealthcareAnalyst, Provider Configuration
Jan. 2024Interpret specific state and/or federal benefits, contracts as well as additional business requirements and convert these terms to claims configuration setup parameters.
• Benefit configuration in Medicaid, Medicare, and Commercial Line of business as well as Quality Assurance, testing validation for production.
• Claim configuration management policies, procedures, and tools. Assist with development of claims configuration standards and best practices.
• Develop clear, concise documentation that describes claims configuration defect trends so that this information can be used to develop workflow requirements
• Responsible for quality and integrity of claims configuration change requests through the use of production validation and audit strategies.
• Responsible for presenting and demonstrating configuration to clients in all Line of Business and final approval.
Community Solutions, Inc. (CSI)Career Counselor/Job Coach, Remote
Jun. 2020 - Sep. 2021New London, Connecticut, United States• Established relationships with employers and businesses, promoting the services provided by CTWorks and delivered follow-up with participants focused on status and efforts.
• Established and maintained one-on-one relationship with designated clients released from incarceration for the purpose of securing employment opportunities on their behalf. • Establish and maintain on-going effective job development marketing strategy for canvassing prospective participant employers. • Maintain accurate documentation of client attendance and performance. · Input client data into the Contractor Data Collection System (CDCS) and maintain, update, and utilize the data as directed. Proficient in PivotTables. • Responsible for the caseload of 60 clients actively searching for employment. With a 60% success rate of matching clients with employment. • Plan and implement regular job development activities which result in a pool of 250+ employers committed to hiring AIC clients.
Sound Community Services, Inc.Recovery Specialist
Sep. 2019 - Oct. 2020New London, Connecticut, United States• Encouraged clients to develop work skills and participate in social, recreational, or other therapeutic activities that enhanced interpersonal skills and helped develop social relationships.
• Referred clients and family members to various community resources/agencies for housing or treatment focused on recovering from mental/physical illness.
• Facilitated house meetings, ensured clients were following sober living structure and rules, and conducted room searches and daily or weekly maintenance and health/safety checks.
• Attends training and certificates to further professional development including Narcan administration, risk management, trauma informed care, CareLogic, Managed Care Organization, HIPAA, and IM+CANS.
The Friendship SchoolIntervention Specialist
Aug. 2018 - Jun. 2021Waterford, Connecticut, United StatesProvided all aspects of assistance in the planning and development of Individual Student Plans, monitored student behavior, and delivered action plans or reprimands per the Student Code of Conduct.
• Facilitated all aspects of staff guidance, coaching, and training on PBIS/SEL programs; created staff/student mentoring initiatives for at-risk students.
• Developed an advisory curriculum in partnership with administrative leadership focused on social and emotional learning; proactively addressed/de-escalated student incidents and behavioral problems.
• Assisted students using software and materials related to math and/or literacy programs; collected and interpreted relevant assessment data to drive instruction.
• Modeled the INSPIRE values; Imagine, Navigate, Seek, Persevere, Integrity, Responsibility, and Empathy
AFSC/Magellan FederalCareer Counselor/Job Coach
Nov. 2017 - Apr. 2019Annville, Pennsylvania, United States• Delivered all aspects of assistance to 400+ service members and their families needing employment, education, or financial education services via direct employment assistance and case management.
• Advised on resume writing and cover letter strategies, assisting over 200 clients in securing suitable jobs in 2018.
• Designed, planned, organized, and offered specific training programs or workshops to help participants maintain or improve job skills on a weekly basis. • Hosted bi-monthly mock interviews and job search workshops, increasing client interview confidence and industry knowledge.
• Connect with local businesses and recruiters to build relationships and increase opportunities for National Guardsmen, Reservists, Dependents, and Veterans multiplying job opportunities for clients by 40%
• Maintain case files and documented actions in SalesForce. Successfully placed 80% of clients.
MedOptionsCredentialing Specialist
Oct. 2016 - May. 2017Old Lyme, Connecticut, United States• Supported the Provider Relations Director, Credentialing Management, Quality Management, and Regulatory Compliance with requested data reporting.
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for 300+ providers in Connecticut.
• Processed provider credentialing information, including verification of data in accordance with policies and procedures, to support network development and credentialing processes. Exceeded production goals by 99% while maintaining quality.
• Identified, obtained, verified, and updated database with providers’ credentialing information.
• Compiles and maintains current and accurate data for all providers using CAQH applications or WellCare applications.
• Assisted in managing customer accounts via phone/email/Salesforce cases to ensure representatives were compliant with mandated guidelines multi-tasked to maintain documentation during peak document seasons.
US ArmyHuman Resources Specialist
Aug. 2007 - Mar. 2016Webster, NYDelivered HR, personnel, and administrative support including partnering in the oversight of all strength management and strength distribution actions, records management, policy/procedure advisement, and the readiness, health, and welfare of all soldiers. Reviewed in-processing packets and enlistment documents, initiated personnel records jackets, and processed incoming soldiers. • Received, analyzed, processed, and maintained personnel information files and supporting documentation; prepared, updated, and entered cycle control documents.
• Coordinated administrative tasks on personnel accountability, management, evaluations, awards, promotions, and reductions; performed audits of personnel files.
• Advised on daily performance and guided alternatives and possible solutions; processed military awards; screened/updated promotion packets for semi-centralized promotion boards.
• Advised management on various policy changes to increase efficiency and accountability; analyzed data and created correspondence, forms, and various reoccurring/one-time reports.
US ArmyNursing Assistant/Healthcare Specialist
Aug. 2007 - Feb. 2016Bamberg, GermanyNURSING ASSISTANT, USAG Bamberg Germany (2011-2013)
Provided all aspects of nursing assistance to patients and physicians, including infection control, patient care support, health promotion and maintenance, patient education, pain management, and acute/critical care, with a focus on women's health.
• Assisted with multiple invasive procedures and surgical procedures; recorded blood pressure, pulse, respiration, temperature, height, and weight; measured intake and output.
• Monitored intravenous fluids, obtained routine lab specimens, and performed standard tests.
IMMUNIZATION/ALLERGY SPECIALIST (Y8), Bamberg, Germany (2010-2016)
HEALTH CARE SPECIALIST (68W), Bamberg, Germany (2007-2016)
Delivered all aspects of outpatient care and treatment, while assisting with inpatient care and treatment under the supervision of physicians, nurses, and physician assistants, including support with diagnostic procedures and preventive health care.
• Prepared patients, operating rooms, equipment, and supplies for surgery.
• Took and recorded vitals, obtained/prepared specimens for testing, and updated patient information; provided patient support during procedures and initiated arrangements for follow-up care.
• Conducted immunizations on children and adults; administered allergy tests and shot follow-up; selected instruments, set up equipment, and provided instruments to physicians during procedures.
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