AIMEE CAMMARATA
Philadelphia,PA
Summary
Dynamic Program Integrity Analyst with extensive experience at Community Behavioral Health, excelling in primary source verification and compliance analysis. Proven ability to enhance data integrity and resolve discrepancies efficiently. Strong time management skills complemented by a commitment to maintaining accurate documentation and fostering collaborative relationships across teams.
Overview
18
18
years of professional experience
Work History
Program Integrity Analyst
Community Behavioral Health
Philadelphia, PA
09.2019 - Current
- Managed credentialing workflows in collaboration with healthcare providers and internal teams.
- Maintained accurate databases for provider credentials and status updates.
- Verified documentation against compliance standards and communicated deficiencies to resolve issues.
- Investigated complaints against providers as necessary and reported findings according to established guidelines.
- Collaborated with other departments to resolve any discrepancies or issues identified during PSV process.
- Reviewed applications and supporting documents to verify accuracy of information provided.
- Maintained credentialing database, including updating records as needed.
- Conducted primary source verification of provider credentials.
- Managed end-to-end provider credentialing process, ensuring compliance with industry standards.
- Addressed and resolved discrepancies in provider documentation during credentialing.
Clinical Care Manager
Community Behavioral Health (CBH)
Philadelphia, PA
06.2016 - 09.2019
- Conducts initial and concurrent reviews for admissions into behavioral health care services, using established medical necessity criteria Behavioral Health Rehabilitation Services (BHRS).
- Clearly documents the clinical rationale for each authorization including length of stay.
- Participates in interagency meetings for children and adolescents, either by phone or in person to assist in coordinating access to the most appropriate and least restrictive treatment.
- Meets weekly with the clinical team and respective physicians to review diagnostic criteria, course of treatment and proposed discharge plans. Utilize the CBH Physician in consultation on difficult cases.
- Review clinical packets submitted for clients in need of BHRS services. This includes writing impartial reviews for those cases that are being denied for not meeting medical necessity.
Outpatient Mental Health Therapist
The Wedge Medical Center
Philadelphia, PA
03.2016 - 06.2016
- Conducted outpatient mental health counseling/behavioral health and case management services to children, adolescents and adults with a variety diagnoses.
- Conducted individual counseling sessions using a diverse set of techniques including Cognitive Behavioral Therapy (CBT) and Play Therapy.
- Observed and monitored client behavior and response to treatment.
- Maintained paperwork for each client which include updating release forms, computerized progress notes, treatment plans, and discharge summaries.
Behavioral Specialist Consultant/Mobile Therapist
Child Guidance Resource Center (CGRC)
Havertown, PA
03.2013 - 08.2015
- Responsible for providing mobile therapy services to children and their families within Delaware County.
- Provided comprehensive case management services, including creating treatment plans and connecting clients and families to appropriate resources.
- Guided clients in effective therapeutic exercises integrated from Cognitive Behavioral Therapy (CBT) and Behavioral Therapy.
- Maintained progress notes and documentation for each client on caseload.
- Knowledge of Functional Behavioral Assessments
- Experience working with children on the spectrum
Outpatient Therapist
Northwestern Human Service (NHS)
Sharon Hill, PA
02.2012 - 04.2014
- Conducted outpatient mental health counseling/behavioral health and case management services to children, adolescents and adults with a variety diagnoses.
- Conducted individual and family counseling sessions using a variety of techniques including Cognitive Behavioral Therapy (CBT).
- Observed and monitored client behavior and response to treatment.
- Maintained paperwork for each client which include updating release forms, computerized progress notes, treatment plans, and discharge summaries.
Clinical Appeals Reviewer
United Behavioral Health
Philadelphia, PA
09.2009 - 09.2011
- Researched and reviewed insurance denials for mental health/substance abuse services as well as completed determinations for administrative appeals.
- Accurately documented, researched, and resolved customer service issues.
- Lead reviewer for several key accounts
- Defused volatile customer situations calmly and courteously.
- Managed customer calls effectively and efficiently in a complex, fast-paced and challenging call center environment.
- Met and exceeded service and quality standards every review period.
Intern
Maternal Child Consortium
Bensalem, PA
08.2010 - 12.2010
- Provided outpatient mental health counseling/behavioral health services to clients from low socioeconomic and varying backgrounds.
- Conducted individual and family counseling sessions using a variety of techniques including Cognitive Behavioral Therapy (CBT).
- Maintained paperwork and documentation for each client which included updating release forms, progress notes, and discharge summaries.
Intern
The Wedge Medical Center
Philadelphia, PA
01.2009 - 05.2010
- Maintained an individual caseload of clients ranging in ages from 5 to 65.
- Conducted individual, couples, and family counseling sessions.
- Completed thorough review of all necessary paperwork and documentation for each client and updated when necessary.
Intake Coordinator
United Behavioral Health
Philadelphia, PA
10.2007 - 09.2009
- Managed customer calls effectively and efficiently in a complex, fast-paced and challenging call center environment.
- Provided managed care information concerning eligibility, referrals, insurance verification and authorizations for mental health and substance abuse services via telephonic communication.
- Made triage calls to appropriate departments within the insurance company.
Education
Masters of Education - Counseling Psychology
Temple University
Philadelphia, PA01-2011
Bachelor of Arts Degree - Psychology
West Chester University of Pennsylvania
West Chester, PA05-2007
Skills
- Microsoft Office Word
- Microsoft Office PowerPoint
- Microsoft Office Excel
- Primary source verification
- Time management
- Documentation and reporting
- Data integrity assurance
- Compliance analysis
Timeline
Program Integrity Analyst
Community Behavioral Health
09.2019 - Current
Clinical Care Manager
Community Behavioral Health (CBH)
06.2016 - 09.2019
Outpatient Mental Health Therapist
The Wedge Medical Center
03.2016 - 06.2016
Behavioral Specialist Consultant/Mobile Therapist
Child Guidance Resource Center (CGRC)
03.2013 - 08.2015
Outpatient Therapist
Northwestern Human Service (NHS)
02.2012 - 04.2014
Intern
Maternal Child Consortium
08.2010 - 12.2010
Clinical Appeals Reviewer
United Behavioral Health
09.2009 - 09.2011
Intern
The Wedge Medical Center
01.2009 - 05.2010
Intake Coordinator
United Behavioral Health
10.2007 - 09.2009
Masters of Education - Counseling Psychology
Temple University
Bachelor of Arts Degree - Psychology
West Chester University of Pennsylvania