Jaclyn Napolitano

-Assists clinical team with complex cases

-Creates and routes medical director review templates, authorizations, and mailings via ACMP, AUMI, HIP, and Facets

-Completes daily/monthly data reports for the department as needed

-Serves as liaison between clinical team and operations

-Monitors communication from the state and ensures RFI's/approvals/critical incidents are routed appropriately and timely

-Completes member/provider outreaches as needed

-Created authorizations for members services as allocated by the care manager

-Provided assistance to providers/vendors to resolve claims issues and authorization discrepancies

-Solely managed transportation for all MLTC members including: resolving escalation issues, reoccurring trips, and creating monthly analytical report

-Engaged with new members to relay benefits and establish initial home care services

-Reviewed and processed provider credentialing applications and provider updates

-Trained and assisted all department new hires

-Answered incoming telephone inquiries from providers and assisted with claims/credentialing issues

-Managed multiple large provider groups and hospital systems

-Created data reports to assist providers/department keep track of application status

-Managed staff, prepared weekly schedules, and assigned work details

-Determined staffing requirements, interviewed, hired, and trained new employees

-Managed large wholesale accounts

-Resolved customer complaints