Elizabeth Brooke Ray
Delray Beach,FL
Summary
CCM- Certified Case Manager 2018-present
Overview
11
11
years of professional experience
1
1
Certification
Work History
Operations manager
My Bodyworx wellness
10.2023 - 10.2025
- Oversaw Revenue Cycle Management (RCM) operations, including proactive handling of claim rejections and payer denials to optimize reimbursement.
- Managed end-to-end RCM processes with a focus on reducing claim denials and improving first-pass resolution rates.
- Responsible for all credentialing of all providers and the clinic with multiple insurance companies, including Medicare, BCBS, Humana and Aetna.
- Trained office staff on ECW, managed data migration from previous EMR. Set up all scheduling for patients with multiple providers and services, such as Physical Therapy, Chiropractic services, spinal decompression and IV therapy with our ARNP. Resolved patient issues in a timely manner.
- Created weekly and monthly KPI reports along with evaluating denial of claims by verifying coverage, proper CPT codes, and patent demographics. Created encounter reports that generated type of visit with providers and which payer we submitted claims to. Managed cash payments for packages that patients purchased such as Red-Light Therapy and our Chiropractic corrective plans.
- Ran daily Waystar clearing house reports for, electronic claim submissions, VOB’s and denial of any claims that needed to be reprocessed.
- Responsible for all staff issues such as training, scheduling, time off requests and any other staff needs. Created an employee handbook that included: Mission statement, vision of franchise, and values of what’s was expected at My Bodyworx, Brief history and leadership structure. Employment Basics, job title and responsibilities. At-will employment statement, Equal opportunity and non-discrimination policies. Each employee signed a code of conduct that included, punctuality, pay schedule and overtime policies
Clinical Coordinator
MDVIP
02.2021 - 08.2023
- Submits referrals and documentation to designated MCE (medical centers of excellence) facilities adhering to HIPAA and privacy regulations. Ensures follow-up is completed within the specified timeframe in accordance with the MCE process guidelines.
- Initiates and maintains contact with the member and MDVIP affiliated physician or office staff to ensure that all parties are aware of the referral process and each step along the way.
- Provides the member with a thorough explanation of the MDVIP referral process, as well as the selected facilities’ guidelines. Facilities such as UM, Johns Hopkins and MD Anderson and UCLA
- Confirms appointment dates and times prior to the member’s appointment with both the member and the affiliated physician or office, as well as confirms with the member if any additional assistance is needed.
- Coordinates and schedules teleconferences, as needed, between MCE specialty physician and MDVIP physicians.
- Manages chart reviews with specialists as requested by MDVIP physicians. Ensures any pre or post appointment requests as related to medical recommendations or reports are sent to the MDVIP physicians in a timely matter and adhere to department protocols.
Case Manager
Holy Cross Hospital
03.2019 - 01.2021
- Responsible for admitting patients, Completed Biopsychosocial, clinical assessment to present to the attending physician for admitting patients for withdrawal management.
- Manage patient onboarding process from phone inquiry, initiating eligibility verification, scheduling intake, through performing patient assessment. Communicate with physicians and nursing staff as it pertains to patient assessment and continued stay. In-facility followup on patient’s daily care in accordance to policy and procedure. Complete discharge plans with patient’s involvement. Maintain patient privacy best practices, such as HIPAA
- Report on daily census to corporate office and DCF. Managed telephone inquires concerning the New Vision service.
- Perform community outreach with telephone calls, on-site tour of facility, visited community centers to promote Holy Cross and New Vision Withdrawal Management services to generate relationships.
Benefits Manager
TreatmentX
11.2017 - 01.2020
- Serve as the primary point of contact for employees, physicians, and third-party administrators regarding Short Term Disability, Long Term Disability and FMLA paperwork requested by patients to secure their jobs and length of stay in treatment Managed vendor relationships with third-party providers of benefits services.
- Educated Case management team on STD policies, eligibility, and procedures.
- Generated reports on utilization rates, costs associated with different plans. Developed procedures for tracking enrollment in various benefit plans. Conducted audits and reconciliations to ensure data accuracy and compliance.
- Ensured that all documents pertaining to employee benefits were properly maintained according to legal guidelines. Review, validate, and process short-term disability claims in accordance with company policies and applicable laws. Maintain confidential records and ensure compliance with HIPAA and ADA regulations
- Delegated work to the Case Management staff in setting priorities and goals for each client. Act as the primary point of contact for all billing issues pre and post stay in treatment.
Case Manager / Utilization Review
Recovery Unplugged
12.2014 - 09.2018
- Collected and audited clinical notes to be submitted to insurance companies to ensure patients received the most appropriate time at the center for their care.
- Helping clients with aftercare needs, finding housing, finding employment and arranging for continuing outpatient services such as IOP/OP after being discharged.
- Utilization Review and Verification of Benefits. Adhere to HIPPA guidelines. Other documentation completed in accordance with federal, state, regulations.
- Completed daily verification of benefits using Availity or calling insurance companies directly upon client admittance. Daily clinical meetings to discuss a patient’s treatment plan with other professionals working at the residence. Administrative duties related to a client’s care, such as filling out forms for social services benefits and arranging other services as needed throughout the duration of the client’s stay at the facility.
Education
Bachelor of Science - Psychology
University of Florida
Gainesville, FL01.1995
Skills
- Problem-solving
- Team leadership
- Operations management
- Customer service
- Operational efficiency
Certification
- CCM (Certified Case Management) 2015 - present
- CAP (certified Addiction professional 2022 – present)
Timeline
Operations manager
My Bodyworx wellness
10.2023 - 10.2025
Clinical Coordinator
MDVIP
02.2021 - 08.2023
Case Manager
Holy Cross Hospital
03.2019 - 01.2021
Benefits Manager
TreatmentX
11.2017 - 01.2020
Case Manager / Utilization Review
Recovery Unplugged
12.2014 - 09.2018
Bachelor of Science - Psychology
University of Florida