Hardworking individual focused on completing work efficiently to exceed targets. Dedicated to business success, customer service, and quality of work. A skilled team player also works well independently to handle challenging tasks. Motivated to learn and grow and able to take on multiple projects and complete them at the highest standards. Has a strong ability to multi-task and work in a fast-paced environment with great time management skills as well as the ability to prioritize and problem solve. A self-starter with the ability to efficiently complete all job duties with minimal supervision. Strong communication skills with the ability to pay strong attention to details.
Overview
8
8
years of professional experience
Work History
Contracting Manager
Retreat Behavioral Health
04.2020 - Current
Responsibilities include but are not limited to facilitating all contracting activities for new and existing payer contracts seeking opportunities to expand our current and new contracts and negotiating rate increases with all insurances
Managing and maintaining all payer contracting information and databases for all 12 Retreat locations
Serving as the point of contact with all insurance contacts and responsible for maintaining Retreat’s relationships and communication with all payers
The Contracting Manager position requires exceptional organization and communication skills to effectively and efficiently complete all duties promptly
Working closely with various departments within the organization, including the Billing, Administration, and Retreat’s executive leadership team
Responsible for managing 3 credentialing employees to make sure they are credentialing all current 70+ providers including all new providers for each state and location and making sure the CAQH portal, NPI registry, and all provider portals are updated
Assisting the billing/claims department with any claim denials that pertain to the facilities and individual providers
Also responsible for maintaining multiple spreadsheets as well as completing numerous projects for upper management and communicating updates during meetings
Offering ideas on how to grow the company and expanding the current services offered and offering opportunities and ideas to grow as a company.
Patient Care Coordinator
Retreat Behavioral Health
12.2018 - 04.2020
Managing a caseload of 25+ patients
Meeting with each patient regularly to discuss aftercare plans and offering recommendations based on treatment needs and working closely with the family to set up the best aftercare plans that will assist with the patient’s success once they are discharged
Initiating and upholding consistent communication with the patient's referral source
Perform thorough written documentation of all interactions and development of patients' stay
Coordinating with other facilities, outpatients, and therapists to set up the continuum of care
Also, working closely with sober living homes and setting patients up with the best sober living options in their area [Throughout Florida] Communicating with the patient’s therapist and treatment team to address issues and concerns regarding the patient, family and aftercare
Working closely with the patient’s insurance to make sure current and aftercare treatment plans meet their expectations
Assessing, implementing, and coordinating all options regarding patients' discharge planning
Assist in the process of applying and fulfillment of FMLA, Short Term Disability and Medical Absence needs of patient
Maintain a symbiotic relationship with the Clinical team to ensure the most appropriate care of the patient
Demonstrate knowledge of the patient's medical necessities while planning discharge, in cooperation with the medical team
Provide all financial counseling for current patients
Provide a clear and comprehensive explanation of insurance authorizations, denials, etc.
To the patient and if need be, family or designated person, by the patient
Handling of all required medical record processes for residential patients
Continuous monitoring and evaluation of patient during stay up to point of discharge
Then ensure the patient has a thorough understanding of their specific aftercare plan.
Administrative Clinical Aide
Retreat Behavioral Health
01.2016 - 12.2018
Managed a team of about 40+ Clinical Aides to ensure day-to-day operations ran smoothly for each shift, including morning, evening, and overnight shifts
Worked closely with the patients to make sure their needs were met and assisted the clinical and nursing team with day-to-day operations
Created a handbook that details the rules, procedures, and requirements for each position within the clinical aide department and made sure the rules and procedures were followed
Met with each member of the clinical aide team weekly to discuss any issues or concerns they may have and also discuss ideas that would benefit the department as well as other departments within the company
Also discussed any concerns regarding quality of work and if needed gave out warnings and write-ups and worked closely with HR to make sure the quality of each member’s work was up to par
Went over the handbook, policy, and procedures with each employee and updated and edited the handbook and policy and procedures as needed
Trained all of the new Clinical Aides on all roles on every shift and checked in daily to make sure they felt comfortable performing those tasks/roles.
Education
High School Diploma -
Fallston High School
Marine Biology -
Coastal Carolina
01.2013
Skills
Organization
Decision making
Leadership
Efficiency
Teamwork
HIPPA Training
Organizational skills
Writing Skills
Research
Communication skills
Microsoft Excel
Microsoft Office
Microsoft Word
Microsoft Outlook
Administrative experience
Adobe Acrobat
CAQH
Time Management
References
Personal: Samantha Gardner, 305-979-1781
Supervisor: Matthew Moyer, Director of Managed Care Contracting and Credentialing, Retreat Behavioral Health, 484-269-4415
Current Employee that reports to me: Amanda Merced:754-265-0976
Executive Director and VP of the Northeast Region at Retreat Behavioral HealthExecutive Director and VP of the Northeast Region at Retreat Behavioral Health