Anthony Matthew Prescotte
Anaheim,CA
Summary
To pursue a career that will enable me to apply my knowledge, skills and experiences with a company that provides room for growth and personal career development.
Overview
24
24
years of professional experience
Work History
Lead Provider Network Account Coordinator
LA Care
Los Angeles, CA
10.2023 - Current
- I manage daily & monthly reports for our department
- Managed daily log to ensure timely approval of PIFs.
- I coordinated with different departments to balance Account Manager workloads and meet deadlines.
- For our Account Managers, I manage one of their reports for their one on one with our director
- Maintained 440 DN crosswalk to support efficient provider management.
- Collaborated with providers/groups to facilitate submission of CPPA applications and updates, including locations and contact information.
- I audit each Therefore PIF from Account Manager to make sure the correct information is submitted
Provider Network Account Coordinator II
LA Care
Los Angeles, CA
11.2018 - 10.2023
- I manage Reports for Provider Termination, Location Updates & Re-Credentialing
- I audit each PIF from Account Manager to make sure the correct information is being submitted
- I organized Account Manager workloads by prioritizing incoming requests from different departments.
- Created and submitted Group/Provider PIF through DocuSign, ensuring all Provider credentialing paperwork was included
- Complete Provider Inventory report monthly for Management
- Generated weekly report for management to provide insights on team performance.
- Compiled monthly provider inventory report for management, detailing active providers and service status.
- Developed training materials, including Table of Contents and comprehensive training binder for PNM Account Coordinator role
Provider Data Management Coordinator
Altamed
Los Angeles, CA
11.2017 - 10.2018
- Loading Contracted/Non-Contracted/LOA Providers into EZCAP and ensuring data is added accurately.
- Updating EZ-CAP when request is received relates to Provider Demographics (i.e. Address updates, Phone number and Fax updates along with Provider Specialties and etc.).
- Updated EZ-CAP with provider demographic information, including address, phone, fax, and specialties, upon receiving requests.
- Supported provider-related projects to improve operational efficiency.
- Ensured efficient handling of provider loads and updates to support team productivity.
- Resolved high-priority and escalated issues concerning provider demographic changes.
- Handled daily claim reports (TPCF) by verifying and correcting provider assignments.
MHI Associate Member Advisor
Molina Healthcare, Inc.
Long Beach, CA
04.2012 - 10.2017
- Outbound calls as assigned, to encourage Molina members to remain with the plan or to schedule an in-person meeting with a Member Advisor and/or attend a scheduled event
- Conducted outbound calls to motivate Molina members to continue their plans or arrange meetings with Member Advisors.
- Proactively identified and researched leads in Salesforce to schedule appointments for Molina Sales Reps, enhancing outreach efforts.
- Handled inbound calls from marketing campaigns, engaging prospects to facilitate meetings with Molina Sales Reps for benefit enrollment.
- Organized and managed appointment scheduling to facilitate member enrollment processes. for enrolling members.
- Assist with Molina office standards in accordance with HIPAA and Clinical Telephone Services
- Data entry of member demographic and provider information updates
- Consistently met or exceeded monthly sales goals, contributing to a high conversion rate of appointments to enrolled members with Molina Healthcare.
- Received an award for Outstanding Achievement for having the highest Conversion Rate on my team for the year 2016.
MHI Membership Accounting Reconciliation Rep
Molina Healthcare, Inc.
Long Beach, CA
01.2009 - 04.2012
- Conducted quality control audits to verify accuracy and compliance of incoming and outgoing data with regulatory requirements
- Review regulatory memos to identify procedural, regulatory and/or technical changes which are likely to have an impact on the team's work
- Document process workflows and Policies and Procedures
- Developed production and management reports to communicate process status and identify areas for improvement
- Monitored automated processes continuously to pinpoint gaps and enhance reconciliation procedures
- Work with IT staff to automate portions of established reconciliation procedures
- Analyzed enrollment data reports from CMS and contractors to identify trends.
- Identify potential enrollment and data discrepancies
- Identify and respond to information requests from CMS and contractors
- Serve as the backup to generate enrollment data files, QA the files with other Departments, and submit to CMS and its contractors.
- Monitored and documented status of appeals to ensure timely resolutions.
- Ensured accuracy of resolved issues to maintain quality control.
- Present reports to management
- Completed TRRs for all states within the Molina company
MHI Membership Enrollment & Accounting Rep
Molina Healthcare, Inc.
Long Beach, CA
11.2007 - 01.2009
- I make sure enrollments are enrolled for Nevada, Utah and Healthy Advantage. Checking members' eligibility, making sure they are eligible with Molina. Entering applications into the state Spreadsheet, QNXT, submitting to CMS, and mailing out letters. Each month I enroll over a hundred members.
- Developed and implemented a new file system for the department.
- Ensured timely enrollment for Nevada, Utah, and Healthy Advantage by verifying member eligibility with Molina, entering applications into state spreadsheet and QNXT, submitting to CMS, and mailing out letters, enrolling over 100 members monthly.
- Ensured timely verification of Medicaid status for Utah, Nevada, and Healthy Advantage to facilitate accurate member enrollment.
- Verified and updated member addresses in CMS MARX upon receiving return mail, ensuring accurate records in QNXT and facilitating prompt re-delivery of correspondence to members.
- Processed TRR and re-con letters for all states to ensure accurate communication with members regarding their enrollment status.
- Reviewed and updated claims to maintain accuracy and support effective processing.
Department Support Associate
Universal Care
Signal Hill, CA
05.2002 - 03.2006
- Performed administrative duties including answering incoming calls, filing, faxing, and copying to support daily operations.
- Verified member eligibility using state programs and systems. through various programs such as CSC and AEVS Eligibility system through the state.
- Data entry of enrollment application for Healthy Families. Medical and Medicare programs.
- Maintained accurate inventory of Medicare supplies
- Maintained inventory of Medicare supplies to ensure availability for member needs.
- Executed data entry for enrollment applications in Healthy Families, medical, and Medicare programs to facilitate accurate member registration.
Education
High School Diploma -
Lakewood High School
General Study Courses
Long Beach City College
Skills
- Provider credentialing processes
- Credentialing software
- PIF audits
- EZ-CAP
- QNXT
- Medicaid software
- Salesforce
- DocuSign
- Report creation
- Workflow coordination
- Network management
- Microsoft Office
- C360
- Qcare
- MAPD Auto enrollment engine
- Problem resolution
- Team management
- Team development
- Problem-solving
- Teamwork
- Relationship building
- Problem-solving
- Teamwork
Timeline
Lead Provider Network Account Coordinator
LA Care
10.2023 - Current
Provider Network Account Coordinator II
LA Care
11.2018 - 10.2023
Provider Data Management Coordinator
Altamed
11.2017 - 10.2018
MHI Associate Member Advisor
Molina Healthcare, Inc.
04.2012 - 10.2017
MHI Membership Accounting Reconciliation Rep
Molina Healthcare, Inc.
01.2009 - 04.2012
MHI Membership Enrollment & Accounting Rep
Molina Healthcare, Inc.
11.2007 - 01.2009
Department Support Associate
Universal Care
05.2002 - 03.2006
High School Diploma -
Lakewood High School
General Study Courses
Long Beach City College