Amanda Williams

· Maintain all UM letter templates based on health plan requirements, including letter templates for multiple health plans, in multiple languages, which are strictly monitored by regulatory agencies.

· Demonstrate strong professional communication skills while communicating with internal and external customers, including health plan oversight agents, members, clinical staff, and other health care professionals. Assist with committee meetings, including preparation of committee meeting materials, compiling meeting agendas, printing of materials, and preparation of meeting minutes.

· Responsible for appropriate tracking, processing, and response to all Grievances and Appeals. Includes communication with health plan representatives, provider offices, and internal clinical staff in an organized and collaborative manner.

· Perform special projects on a regular basis for a variety of departments and leaders, while ascertaining when various projects would take priority. Perform other related duties as assigned.

· Assist with organizing and preparing for health plan regulatory audits of Utilization Management processes. Includes review and preparation of audit materials in conjunction with Director, UM Operations & Member Services.

· Provide support to clinical team members, including, but not limited to, verification of benefits from the health plan, requesting records from outside offices or organizations, and review of language in outbound communications for clarity and understanding.

· Responsible for compiling outbound communications required under health plan regulations, including notices to members regarding termination of providers, and notices to providers regarding unused authorization requests.

· Responsible for creating cases for members who were recently discharged from the hospital, which includes outbound calls to parents and follow-up calls if needed.

• Maintain Utilization Management letter templates based on health plan requirements
• Respond to health plan correspondence and coordinate production of reports and requests for data
• Responsible for appropriate tracking, processing, and responses to all Appeals and Grievances, which includes communication with provider offices and clinical staff
• Assist with organizing and preparing for health plan regulatory audits
• Responsible for tracking and organizing provider terminations including member notices

• Manage on-call part-time employee contracts and the tracking of their assigned work hours
• Responsible for monitoring project budgets for team related expenses
• Create new systems using timelines, forms, and communication with related departments
• Work cross-functionally to develop and deliver new processes and procedures
• Offer support to internal and external clients
• Support the build out of the event app and website for AVID National Events
• Reconcile expenditures for travel and department expenses for multiple leaders
• Served as Staff Developer Support for AVID Summer Institute, including light travel

• Helped members navigate systems, pay for services and resolve different concerns
• Created successful sales presentations to highlight membership, overcome objections and close sales
• Maintained strict safety standards facility-wide and with every group
• Maintained up-to-date records on member accounts, facilitating accurate billing and reporting processes
• Responsible for all invoicing, accounts receivable and payable
• Prepared daily and monthly logs using Payeezy
• Process payroll and Human Resource documents

• Greeted guests at front desk and engaged in conversation while managing check-in process
• Scheduled, coordinated and confirmed appointments and meetings.
• Received, sorted, and distributed mail correspondence between departments, including parcel packaging, preparation and efficient shipping
• Provided clerical support to company employees including copying, faxing and file management