Drakara J. Judson
Baton Rouge,Louisiana
Summary
Energetic healthcare professional seeking career advancement opportunities in the managed care field. Equipped with over 7 years of customer service, time management, leadership and account management experience. Looking to utilize education and career assets in a managerial role.
Overview
9
9
years of professional experience
Work History
Senior Provider Network Analyst
Aetna Better Health, CVS Health
05.2022 - Current
- Acts as the primary resource for high profile providers or groups 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
- Optimize interactions with assigned providers and internal business partners to establish and maintain productive professional relationships
- Monitors service capabilities and collaborates cross-functionally to ensure that the needs of constituents are met and that escalated issues related to but not limited to, claims payment, contract interpretation or parameters and accuracy of provider contract or demographic information are resolved
- 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
- Educated providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies and procedures
- Meets with key providers periodically to ensure service levels are meeting expectations
- Manages the development of agenda, validates materials, and facilities external provider meetings
- Conduct standard provider recruitment, contracting, or re-contracting activities and assist with more complex contracting and discussions as needed.
Community Health Worker
Aetna Better Health, CVS Health
06.2021 - 05.2022
- Liaise with members regarding access to care, benefits and identify how to improve their experience with the company and provide preventative care
- Educate healthcare professionals on opportunities for improving and understanding the social determinants of health that may be impacting the member’s health and treatment plan
- Visiting member’s homes to re-educate them on the care plans they were provided to re- duce the probability of future illnesses and/or hospitalizations
- Producing and maintaining client relationships with members of different economic, cultural and language backgrounds
- Assist members to identify socio-economic issues that affect their overall health and develop health/social management plans and goals
- Identify gaps and opportunities to strengthen systems of care within the members com- munity and assists members in utilizing community services, including scheduling appointments with social services agencies, (including transportation vendors), and assisting with completion of applications for eligible programs
- Enter and maintain member records in electronic health record system, compile reports and complete other program documentation in a timely manner (e.g
- Progress notes, letters), and other administrative responsibilities as needed.
- Addressed patient concerns and provided support to vulnerable demographics.
- Worked directly with patient treatment teams and participated in care coordination procedures.
- Managed enrollment, transportation, and paperwork for individuals to take advantage of community resources.
Utilization Management Technician
AmeriHealth Caritas Louisiana
03.2017 - 12.2020
- Communicated with providers to process all incoming authorizations
- Verified patient’s eligibility and benefits
- Prepared and sent authorization letters for the patients and provider
- Accurately answered questions regarding benefits and the plan’s requirements for patients and their care providers
- Partnered with Utilization Management clinician team to efficiently document patients’ medical information
- Developed and maintained positive provider relations
- Met monthly productivity and adherence goals consistently.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
Intern
State of, Transportation and Development
05.2016 - 03.2017
- Updating internal databases with new employment applications, payroll documents, insurance documents and employee contact information
- Responding to staff inquiries regarding Human Resources polices, employee benefits and other Human Resources related matters
- Greets and interacts with employees
- Answers phones
- Retrieves mail daily
- Manages the reception area in the absence of administrative assistant
- Assists in various projects as needed
- Communicated promptly and professionally to all internal employees
- Sorted and organized files, spreadsheets, and reports.
Intern
City of Baton Rouge Human
10.2014 - 05.2016
- Imported applications, payroll documents, insurance paperwork and all other confiden.al employee information into HR databases
- Posting job advertisements to job boards and removing job advertisements from job boards once those vacancies have been filled
- Assisted in meetings with Human Resources recruiters and specialists to continuously create and update Human Resources Recruitment processes
- Help organize and facilitate job fairs for the City of Baton Rouge
- Screening resumes and application forms
- Review and distribute company polices
- Answered current and potential employee questions regarding employment duties and opportunities
- Accurately distributed exams for city job placement by coding process
- Assist with the exam check in process to insure that applicants qualify for the positions they are applying for and that the check in process goes as smoothly as possible
- Various clerical du.es such as answering phones, transferring calls, filing and sor.ng paperwork
- Maintain a satisfied level of customer service with clients both internal and external
Education
Business Administration
University of Louisiana
Monroe, LASkills
Team Building
- Time Management
- Detail Oriented
- Managed care/ Health Insurance Industry
- Medical Terminology
- ICD-10 Codes
- Communication
- Leadership
Timeline
Senior Provider Network Analyst
Aetna Better Health, CVS Health
05.2022 - Current
Community Health Worker
Aetna Better Health, CVS Health
06.2021 - 05.2022
Utilization Management Technician
AmeriHealth Caritas Louisiana
03.2017 - 12.2020
Intern
State of, Transportation and Development
05.2016 - 03.2017
Intern
City of Baton Rouge Human
10.2014 - 05.2016
Business Administration
University of Louisiana
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