Ambitious Senior Account Manager with a tenacity for increasing profits and maintaining client relationships through persuasion and fantastic communication. Dedicated to innovation, forward-thinking and modern sales techniques used to cultivate a productive workspace and long-lasting client and customer relations. Detailed Senior Account Manager offering experience in delivering client-focused solutions and successfully managing multiple projects. Excellent critical thinking, problem-solving and communication skills.
Overview
14
14
years of professional experience
Work History
Senior Analyst Account Manager
Aetna Better Health of New Jersey
08.2021 - Current
Acts as the primary resource for assigned, high profile providers or groups (i.e., local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs
Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination
Performs credentialing support activities as needed
Educates providers as needed to ensure compliance with contract policies, parameters and plan design
Meets with key providers periodically to ensure service levels are meeting expectations
Manages the development of agenda, validates materials, and facilitates external provider meetings
Conduct standard provider recruitment, contracting, or re-contracting activities and assist with more complex contracting and discussions as needed by business segment.
Member Advocate/Housing Support
Aetna Better Health of New Jersey
01.2020 - 08.2022
Handled Nursing Facility members’ transitions into the community by providing services which include ordering of furniture, personal items and grocery purchases
Communicated with vendors and suppliers to ensure a safe and successful transition for members
Responsible for identifying permanent housing options as well as obtaining, developing and maintaining a database of housing resources, conducting individual visits with members in need of housing referrals, advocacy, follow-up, and assistance with housing applications including Housing Choice Vouchers, and project-based housing
Worked closely with Property Managers, Lease Agents, Landlords, OCCO Nurses, Housing Authorities and DCA Reps for member support with housing and Section 8 vouchers
Attended IDT transition meetings to ensure all housing services were in place for members’ safe transition into the community
Worked closely with the homeless population for crisis intervention and to provide temporary housing as needed
Collaborated with local community organizations including Foodbanks and Board of Social Services
Collaborated with Case Managers by assisting with home and vehicle modifications
Worked directly with State Medicaid Support Teams and affiliations
Managed and supported PPP program authorizations and monthly reports
Collaborated with State Liaison for OCCO approvals
Acknowledgment of State Guide Plans for PLAN of Care, NJ Choices Assessments
Team Lead Care Management Associate MLTSS Division
Authorizations for Custodial members, PCA, MDC and HDM services.
Educated patients and families on healthcare options and financial support resources.
Collaborated with healthcare professionals to facilitate high-quality comprehensive care.
Care Management Associate MLTSS
Aetna Better Health of New Jersey
06.2017 - 01.2020
Provides support services to team members by answering telephone calls, taking messages, researching information, and assisting in solving problems
Accountable for assisting and extending support to the MLTSS RN/MLTSS Care Specialist working in the field
This position supports members based in the Community, Group Homes, Assisted Living and Long-Term Care settings
Collaborates with the long-term care member/family, physician, and all members of the healthcare team, internal and external to this organization
Direct Advocate for MLTSS members and families
Ensure timely member follow up
Interacts and communicates effectively with the managed long-term support and services member during telephonic contact
Assist with scheduling and coordination of Service needs identified in the member s Plan of Care
Assist with implementation and facilitation of services for managed long-term support and services care members
Manages and supports PPP program Authorizations, monthly reports
Outreach support to all members of MLTSS
Collaborates with State Liaison for OCCO approvals
Acknowledge of State Guide Plans for PLAN of Care, NJ Choices Assessments, option counseling, and care plans
Team Lead Care Management Associate MLTSS Division
Authorizations for Custodial members, PCA, MDC and HDM Services.
Senior Patient Care Technician
St. Peters University Hospital
04.2010 - 01.2015
Effectively implemented all aspects of care liaison systems for young adult and Geriatrics patient population
Supported patient and representatives in organizing appointments, medication renewal and prior authorizations
Provided accurate, appropriate, and timely response to troubleshoot issues and complaints resolution
Collaborated with staff on various patient care functions such as billing and coding, scheduling of tests and procedures
Maintained information and reporting information regarding policies and procedures for: JACHO and HIPPA policies
Communicated and trained on JACHO and HIPPA as needed
Assisted MD and APN with patient care as needed, including preparation of examination rooms, lab testing
Vital signs, venipuncture, vaccines and injections
Provided input to assist in selection and implementation of Electric Medical Record Programs, internal communications and phone system.
Supported patient admissions, discharges, and transfers to promote team productivity.
Education
BA-Public Heath/Social Worker -
Cappella University
Medical Assistant -
Rutgers University
01.2015
Associate of Science -
Ocean County College
01.2013
Skills
Network Management
Project Management
Knowledge of Business Operations
Technical Understanding
Performance Monitoring
Client Relationship Management
Accomplishments
Internal Promotion
Accomplishments And Skills
Award of Excellence in Patient Care (Daisy Award) 2012