Jamie Williams
Columbia,TN
Summary
Seasoned Appeals and Grievance Analyst with a proven track record at Farm Bureau Health Plans, showcasing expertise in analytical thinking and team collaboration. Excelled in reducing liability risks through comprehensive compliance training and improved patient care coordination at Compassus Hospice. Demonstrates exceptional ability in data research, validation, and fostering strong relationships across all levels.
Overview
22
22
years of professional experience
Work History
Appeals and Grievance Analyst
Farm Bureau Health Plans
06.2023 - Current
- When members have concerns about any aspect of their health plan, investigations are done into their grievances/complaints.
- Resolve member’s grievances and provide the member with a resolution letter within timeframe.
- Knowledge of Medicare guidelines as well as Farm Bureau MAPD and PDP policies.
- Data entry into Facets program.
- Conducted workplace compliance training to reduce liability risks and operate effectively.
- Identified and resolved problems through root cause analysis and research.
Palliative Care Team Coordinator Lead
Compassus Hospice And Palliative Care
05.2015 - 05.2023
- Managed team workload to reach targets for specific tasks.
- Built strong relationships with patients and referral sources through positive attitude and attentive response.
- Improved team collaboration with regular meetings, progress updates, and transparent communication.
- Provided comprehensive administrative support to the team, enabling them to focus on high-impact tasks and achieve better results.
- Managed multiple projects simultaneously, prioritizing tasks for optimal resource allocation and workflow efficiency.
- Communicated with nurse practitioners (NP) regarding patient needs and physician needs, with patients and families regarding scheduling their visits, and with referral sources such as hospitals, PCP offices, home health, etc.
- Process new referrals and run their insurance information and keep the EMR up-to-date.
- Facilitate the flow of patient care from initial referral to patient discharge.
- Team trainer of new palliative care coordinators.
- Schedule and conduct monthly team meetings, agenda, meeting minutes and reports to supervisors.
Child Protective Services Investigator
Department Of Children's Services
12.2002 - 05.2015
- Reduced risk of harm to children by identifying immediate safety concerns and implementing appropriate interventions.
- Collaborated with multidisciplinary teams to develop comprehensive case plans for at-risk children and their families.
- Maintained open lines of communication with law enforcement agencies to share pertinent information related to ongoing investigations or emergent safety concerns.
- Performed daily duties, computer records updates, and keep detailed notes.
- Enhanced family functioning by providing education on positive parenting strategies, child development, and available community resources.
- Enhanced communication with families by providing clear explanations of investigation processes and outcomes.
- Improved child safety by conducting thorough investigations of alleged abuse and neglect cases.
Education
Bachelor of Science - Psychology
Middle Tennessee State University
Murfreesboro, TN08.2001
Skills
- Analytical Thinking
- MS Excel
- Team Collaboration and Leadership
- Documentation And Reporting
- Data Research and Validation
- Data Processing
- Motivated individual with healthcare/social services knowledge, and ready to learn more
- Experience in daily scheduling, leading meetings, and patient log data collection
- Experience in investigation of member grievances
- Able to multitask and prioritize tasks to complete efficiently
- Respect for my superiors, co-workers, and patients/clients
Timeline
Appeals and Grievance Analyst
Farm Bureau Health Plans
06.2023 - Current
Palliative Care Team Coordinator Lead
Compassus Hospice And Palliative Care
05.2015 - 05.2023
Child Protective Services Investigator
Department Of Children's Services
12.2002 - 05.2015
Bachelor of Science - Psychology
Middle Tennessee State University
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