Summary
Overview
Work History
Education
Skills
Timeline
Generic

Alisia Edmondson

Redding,CA

Summary

Dedicated Supervisor, Intake Specialist skilled in streamlining processes and optimizing efficiency. Skilled in analyzing workflows, identifying bottlenecks, and implementing strategic changes which enhanced overall team morale. Established excellent communication and interpersonal skills. Created strong relationships with both team members and stakeholders, fostering a positive and collaborative work environment. Fostering open communication and establishing trust and encouraging diverse perspectives. Familiar with industry standards and requirements. I’ve shown continuous improvement, and the ability to surpass expectations. Managing duties to facilitate smooth workflow and operational efficiency.

Overview

23
23
years of professional experience

Work History

Supervisor Intake Specialist

Centene/Health Net
10.2022 - Current
  • Supervise day to day activities of the Intake Specialists including work flow, training, hiring, etc
  • Ensure deliverables reported to the State entity occurs within established time frames
  • Respond to State inquiries in a timely manner per department procedure
  • Implement work processes ensuring establishment of and continuity of services for Members through the assessment process
  • Assist subcontractors, Members and/or internal customers with cases pertaining to referral and assessment questions, issues and authorizations
  • Reconcile standardized reports in a timely manner per department procedure
  • Review and process assessment letters, maintain logs, and coordinate decisions to external or internal personnel per plan procedures
  • Facilitate ongoing process meetings with external partners and stakeholders
  • Audit reporting related to authorizations, correspondence and clinical record-keeping to ensure compliance with department procedure
  • Address provider complaints utilizing established procedure.

Lead Referral Specialist

Centene/Health Net
07.2021 - 10.2022
  • Assist with internal and external questions/emails with cases pertaining to referral issues and authorizations
  • Send out standardized reports in a timely manner per department procedure
  • Review and process HNU Research Errors, maintaining accurate error logs
  • Coach Referral Specialist on identified errors and ways to improve errors
  • Coaching Referral Specialist on speed and accuracy tips and tricks
  • Facilitate ongoing Referral Specialist 1:1 training
  • Facilitate ongoing Preceptor training
  • Participating in Preceptor Process improvement panel
  • Complete monthly Audits of Referral Specialists in a timely manner
  • Address Referral Specialist questions in group chat.

Referral Specialist I

Centene/Health Net
08.2018 - 07.2021
  • Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations
  • Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list
  • Route to appropriate staff when needed
  • Verify member eligibility and benefits
  • Answer phone queues and process faxes within established standards
  • Data enters authorizations into the system using Trucare, Unity, OMNI and ABS
  • Maintain over and above production.

Referral Specialist I

Healthcare Support Services
04.2017 - 08.2018
  • Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations
  • Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list
  • Route to appropriate staff when needed
  • Verify member eligibility and benefits
  • Answer phone queues and process faxes within established standards
  • Data enters authorizations into the system using Trucare, Unity, OMNI, and ABS.

Program Support Assistant

Turning Point Community Programs
05.2017 - 12.2017
  • Responsible for a wide variety of advanced administrative and secretarial duties, providing support to the program coordinators, clients and management while maintaining the management of the front office and drop-in center
  • Support charts and filing of all necessary paperwork and medical records
  • Assist with the enrollment process and paperwork as required
  • Perform multiple word processing tasks utilizing Word and Excel
  • Provide typing services to the program which includes, but not limited to memos, reports, and client correspondence
  • Maintain orderly files and medical records
  • Monitor and order office supplies and forms
  • Coordination of doctor, therapy, and case manager appointments
  • Processed billing for the following purchases: client doctor appointments, drop-in center visits and client phone calls
  • Provide receptionist duties, including but not limited to promptly answering all telephone calls, screen calls, routing to the appropriate staff member, taking accurate messages
  • Maintain and assist staff in using office equipment
  • Assist clients in accessing services
  • Collect and distribute agency mail
  • Provide support to program coordinators, management and others as assigned
  • Enforce the policies and procedures of Turning Point Community Programs
  • Attend all staff meetings unless approval for non-attendance is secured by the Program Director or Office Manager
  • Take monthly team meeting minutes
  • Any special projects as requested.

UM Office Support/Call Center Receptionist

Sutter Gould Medical Foundation
09.2009 - 02.2013
  • Using excellent customer service skills, answer incoming lines in order to assist patients, physicians offices, Visiting Nurses, and other patient support agencies in a personal, efficient, and organized manner
  • Use Call Center standard operating procedures and protocols to register new patients, update patient demographics, schedule, reschedule, cancel and verify appointments
  • Verify patient insurance
  • Using SGMF messaging policies, accurately enter patient telephone messages into the computer and electronically route messages to the appropriate pool in the Electronic Health Record (eHR)
  • Regularly communicate with internal customers to meet the patient's needs
  • Maintain professionalism, courtesy, and confidentiality always
  • This position requires the ability to repetitively answer a high volume of phone calls each day
  • Work with other team members to achieve Call Center and organizational goals to provide quality patient service.

Administrative Assistant II/III

Stanislaus County Human Services Agency
05.2000 - 05.2006
  • Answer phones to provide information to internal customers
  • Take and relay messages and explain policies and procedures
  • Coordinate communication between management and employees, CFO, Property Manager, and the residents and assist to resolve issues
  • Filing
  • Process incoming documents
  • Perform a variety of data entry tasks, entering information into appropriate computer programs
  • Compose, scan, type and proofread a variety of correspondence and documents including but not limited to, forms, reports, letters, memoranda record and take notes
  • Organize, develop, maintain, and monitor a variety of manual and electronic records and files
  • Sort and distribute incoming and outgoing mail
  • Other duties as assigned.

Education

Diploma -

Livingston High School
06.1989

Skills

  • Process Improvement
  • Data Analytics
  • Operations Management
  • Business Development
  • Staff Management
  • Strategic Planning
  • Inventory Control
  • Processes and Procedures
  • Staff Discipline
  • Goal-Oriented
  • [Software] Experience

Timeline

Supervisor Intake Specialist

Centene/Health Net
10.2022 - Current

Lead Referral Specialist

Centene/Health Net
07.2021 - 10.2022

Referral Specialist I

Centene/Health Net
08.2018 - 07.2021

Program Support Assistant

Turning Point Community Programs
05.2017 - 12.2017

Referral Specialist I

Healthcare Support Services
04.2017 - 08.2018

UM Office Support/Call Center Receptionist

Sutter Gould Medical Foundation
09.2009 - 02.2013

Administrative Assistant II/III

Stanislaus County Human Services Agency
05.2000 - 05.2006

Diploma -

Livingston High School

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Alisia Edmondson