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Work Background
NuPhase Health ServicesProgram Administrator-Mental Health/SUD
Mar. 2023 - Jan. 2024Phoenix, AZSkills: MRT-Domestic Violence Bringing Peace to Relationships · Brief Intervention Tools-BITS
NuPhase Health ServicesMental Health Program Administrator
Mar. 2023 - Jan. 2024On-site• Assist in the development of program budgets and resource allocation
• Collaborate with the program director, behavioral health technicians, and providers to develop program plans, objectives, and timelines
• Facilitate effective communication between clients, providers, and staff
• Serve as a liaison between program staff and external partners and vendors
• Track and manage program resources, including personnel, equipment, and budgetary allocations
• Monitor and identify program needs and issues, along with risks that may implement the delivery of care
• Evaluate the program for needed improvements and gather feedback on effectiveness from staff and clients.
• Build positive relationships with other programs and facilities to assist needy clients better.
• Host group sessions with regards to resources and helping clients and providers achieve new goals and allocates during their sobriety
Connections Health SolutionsProvider Network Manager
Oct. 2021 - Mar. 2023Phoenix, Arizona, United States• Establish, manage, and maintain processes and systems to provide routine services to members, including contract management and credentialing.
• Create and implement NOC standards, procedures, and processes for KPIs.
• Develop and implement provider network management strategies and contracts for the organization.
• Supervised a team of 3-4 employees under my direct leadership, with training and development for successful credentialing policies and networking with all major insurance companies along with Medicaid and Medicare.
• Implement and monitor supervision of new credentialing software. • Create policies and procedures for successful steps in networking and credentialing
• Collaborative efforts with the billing, contracting, and denial managers on daily policies
• Assist with planning and development in new regions and create effective strategies, policies, and procedures
• Project manager for many new services and policies assigned by the Director of Revenue Cycle Management
• Build and maintain positive relationships with vendors and internal personnel.
Fresh Start Resource CenterBehavorial Health Professional
Mar. 2021 - Dec. 2021Mesa, Arizona, United StatesMaster of Science in Mental Health within the community.
TriWest Healthcare AllianceNetwork Contract Manager
May. 2019 - Mar. 2021Phoenix, Arizona Area
United Concordia DentalLead Provider Data Management Analyst
Mar. 2016 - Apr. 2019Harrisburg, Pennsylvania AreaProvider Credentialing, Maintenance and Mandates
Broad-Path Health Care SolutionsClaims Processor II
Jul. 2014 - Mar. 2015• Manage and process medical claims using external and internal resources of the Aldera Medical software.
• Validate information on all medical claims received. Thoroughly review and analyze claims for incorrect information. Claim adjudication and configurations, refunds, accumulator (OOP and Deductible) adjusting. • Verify member policy and insurance coverage for billed services. Update and revise provider information. • Investigate and determine if services billed are payable under the members contract.
The Jacobson GroupProvider Customer Service
Jan. 2014 - Jul. 2016Remote/Work From Home• Answer routine provider and member calls with regards to, health care policies, claims, benefit, and eligibility information for provider services. Educate and inform providers regarding the different health insurance plans/coverage for members. Provide information regarding basic health care reform for plans and services
• Implement and review policy and guidelines.
• Provide details regarding claims, explanation of benefits, billing questions, and appeals and grievance information. • Provide assistance with research projects and compile statistical data into database. • Assist in the development of clinical reports and presentations.
• Research via Facets for various services and services available to the members
Broad-PathAppeals Analyst
May. 2013 - Jan. 2014TelecommuterReview Medicare claims that require additional attention or concern from the provider or beneficiary.
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