Davonda Rodgers

l Coordinates the delivery of re-determination files/dispute resolution documents and reconsideration/dispute resolution decisions from and to the external entities.

l Builds a reconsideration/dispute resolution case file from evidence submitted and received and analyzes each case to ensure it meets the requirements for a valid reconsideration/dispute resolution request as mandated by Centers for Medicare and Medicaid Services (CMS) or other customer entities.

l Analyzes and makes decisions based on medical vs. non-medical case type, appeal/review categories, validity of appeal/dispute resolution request, and dispute resolution settlement documentation.

l Inputs appropriate data regarding reconsiderations/dispute resolution cases into the applicable required systems.

l Responds to reconsideration/dispute review requests from appellants/patients/providers.

• Assisted clients with daily living needs to maintain self-esteem and general wellness.
• Prepared nutritious meals for clients, supporting their overall health and dietary needs.
• Facilitated medication management for clients, ensuring proper dosage and timely administration.
• Educated families on available resources related to caregiving responsibilities; facilitated connections to local support groups when needed.
• Demonstrated flexibility in adapting to changing client needs, providing consistent, high-quality care amidst evolving circumstances.
• Developed trusting relationships with clients through active listening skills and empathetic communication techniques.
• Offered emotional support during challenging times by providing compassionate conversation and understanding presence during difficult situations.
• Collaborated with healthcare professionals to ensure optimal care for clients, maintaining effective communication channels.

l Coordinate the delivery of redetermination files and dispute resolution documents.

l Build a reconsideration/dispute resolution case file from submitted evidence.

l Analyze each case to ensure it meets CMS requirements for valid requests.

l Make decisions based on medical vs. non-medical case types and appeal categories.

l Input data regarding reconsiderations and dispute resolution cases into required systems.

l Respond to reconsideration/dispute review requests from appellants, patients, and providers.

l Route or respond to inquiries about the reconsideration/dispute resolution.

• Reduced wait times for specialist appointments by diligently following up on pending referrals.
• Built professional relationships with service providers.
• Enhanced patient satisfaction by promptly addressing inquiries and resolving issues related to referrals.
• Verified insurance benefits and eligibility for [Type] procedures before referring clients.
• Scheduled appointments, including complex specialty appointments and adhered to appropriate protocols.
• Provided the highest level of patient service by problem solving, documenting patient concerns, and identifying appropriate follow-up for patients
• Administered provider referrals to patients based on the ordered medical service and patient’s preferences.
• Documented all contact attempts to schedule the ordered medical service in the patient electronic health record and adhering to department procedures for contact attempts.
• Reviewed work queues to identify unscheduled ordered services and connected with the patient to schedule the appropriate service.
• Created Guarantor accounts verified insurance benefits

• Maintained clean, safe, and well-organized patient environment.
• Attended, participated, and contributed to monthly staff meetings addressing resident needs.
• Assisted residents with daily dental and mouth care, bath functions, and hair care.
• Changed bed linens, dumped trash, and smoothly handled maintenance issues to promote resident comfort.
• Ensured safe living environment, conducting regular safety checks and promptly addressing any violations.
• Strengthened relationships among residents, fostering supportive and inclusive community.
• Assisted residents in preparing for activity and social programs.
• Improved resident satisfaction with prompt and empathetic resolution of conflicts and concerns.
• Coordinated activities and events to create safe, positive and inclusive environment.
• Administered daily Medications and assisted with all ADL Cares