Jasimine Robinson
Poughkeepsie ,NY
Summary
Proficient provider relations representative with over 10+ years of managed care experience. A decisive decision-maker who understands the importance of relationship building and establishing strategies to maximize business potential.
Overview
17
17
years of professional experience
Work History
Provider Relations Specialist
Maximus
New York, NY
08.2022 - Current
- Establish and manage collaborative relationships with more than 300 providers.
- Serve as a primary contact for NYIA providers to provide technical support.
- Point of contact for providers, resolving provider grievances.
- Ensure provider adhere to Service Level Agreements
- Recruitment of providers based on geographic needs.
- Develop and implement efficient recruitment strategies in collaboration with the vendor(s), ensuring a strong pipeline of applicants across platforms as needed.
- Physician training and education.
- Attends internal and external meetings for the department, such as vendor reporting, departmental and cross-functional meetings, community and provider meetings, etc.
- Collaborate with the credentialing department, review clinician certifications (BLS), health certifications, board certification, licensing, and malpractice verifications.
Case Investigator
NYC Health and Hospitals
Manhattan, New York
05.2020 - 08.2022
- Conduct disease surveillance, epidemiological outbreak investigation, and intervention activities during Covid- 19 pandemic.
- Collabarate with NYC (SIT) room to avoid NYC school closure due to
cluster outbreaks and evaluate risk factors or high-risk transmission
settings. - Conducted over 100 persons reportable disease case investigations.
- Participate in the DOHMH's Surveillance and Epidemiology Emergency
Response Section's preparedness and response activities for the
Surveillance & Investigations. - Electronic health record review and abstractions and conduct contact
tracing. - Conducted training for teams on investigating and reporting covid cluster transmissions to DOE/DOH/NYC Situation Room.
- Providing health education and guidance in order to interrupt ongoing disease transmission.
- Collect and data analysis on demographics, current symptoms, current health status, and possible high-risk settings into Contact Tracing/Contact information Management system.
- Utilize established database(s) to identify newly diagnosed patients and contacts for tracing efforts. Inputs data collected (i.e. symptoms, contacts (etc.) into database and assures database is kept up to date.
Referral Coordinator
Health Quest Medical Practice
Langrangeville , NY
07.2019 - 05.2022
- Determined medical necessity, obtained authorizations for diagnostic imaging, outpatient and inpatient hospital services and procedures.
- Claims resolution, appeals and denials.
- CPT coding, diagnostic coding and diagnosis coding.
- Resolved billing and claims issues.
- Utilize online portals such as AIM, Evicore, NIA Magellan, and RAD MD to submit authorizations.
- Researched and resolved billing inconsistencies and errors through individual and collaborative analysis.
- Contact insurance to verify insurance eligibility and benefits.
- Extract relevant clinical data and EHR from Cerner and Eclinicals (ECW) and various clinicals information to support the need of radiology imaging.
- Scheduled patients according to availability, urgency and insurance authorization guidelines.
- Verified documents and associated records to catch and resolve discrepancies.
- Investigated and resolved issues to maintain billing accuracy.
Referral Coordinator
Option Care
Shelton, CT
06.2018 - 06.2019
- Delegated home IV infusion therapy, home parenteral nutrition and enteral nutrition support for patients with acute and chronic conditions.
- Collaborated with hospital staff, providers and social workers to arrange home antibiotic infusion services to members upon discharge from hospitals and various healthcare facilities
- Extracted patient's clinical information and hospital discharge summary from EPIC and Allscripts, Navinet and various hospital software.
- Facilitated IV infusion services by obtaining MD's orders from hospital discharge paperwork.
- Educated patient's on insurance benefits, out of pocket cost.
Paralegal
Rinaldi Law
Poughkeepsie , NY
02.2016 - 06.2018
- Identified and analyzed legal documents, discovery documents and contracts.
- Execution of various legal, documents pertaining to law, modifications, and proposals.
- Prepared clients for appointments and interviews, including depositions and testimony.
- Used online databases such as WestLaw and LexisNexis to examine secondary sources, statutory law, case law and federal and state regulations.
- Worked with attorneys and case reviewers to resolve legal complaints.
- Prepared affidavits facts and law of cases to determine causes of action and to prepare cases.
- Preparations of bill of particulars and response to demands.
- Drafted judicial correspondence and handled court mailings.
- Assisted litigation teams on legal automation requirements and systems capabilities to facilitate investigatory or litigation decisions, trial preparation and trial presentation.
Admission Specialist
Visiting Nurse Services of Westchester
White Plains , NY
07.2015 - 01.2016
- Delegated homecare services for patients discharged from hospitals, hospice, and skilled nursing facilities to prevent hospital readmission.
- Arranged home visiting nursing services, such as IV infusion therapy, palliative care, wound care, speech therapy, physical therapy and home health aides.
- Ensured homecare admissions follow corporate policies. Monitored daily admissions and streamlined new intake referral process.
- Coordinated admissions into homecare services efficiently by communicating with providers and discharge planners to obtain medical records records and transfer documentation.
- Provided administrative support to the Director of Nursing and recommended referral process improvements.
- Extracted clinical data from EMR Systems and hospital software (EPIC, Allscripts, Cerner) to obtain supporting clinical documentation for homecare services.
Referral Coordinator
Dominican Sisters Family Health Services
Ossining , NY
05.2014 - 06.2015
- Collaborated with hospital staff, providers and social workers to arrange homecare services to members upon discharge from hospitals and various healthcare facilities. Verified patient’s eligibility and benefits.
- Scheduled patients according to availability, urgency and insurance authorization guidelines.
- Coordinated home visiting nurse services, physical therapy, occupational therapy, wound care visits.
Appeals and Grievances Coordinator
Visiting Nurse Services of New York (MLTC)
New York , NY
10.2012 - 05.2014
- Managed long term care enrollment.
- Resolved appeals and grievances while adhering to contractual commitments for Medicaid, home health care, managed long-term care, and Medicare managed care organizations.
- Triaged all cases, analyzed, investigated and resolved internal and external complaints, contracted and non- contracted provider appeals and fair hearings.
- Organized external case reviews that enrollees have requested, including organizing their preparation and submission in accordance with legal specifications under The Centers for Medicare and Medicaid Services (CMS), New York State's Fair Hearings, Independent Review Entities, and Quality Improvement Organizations.
- Assured timely and accurate resolution of all cases.
- Prepares appeal summaries, correspondence, and document findings
- Prepared written correspondence to members and providers regarding the outcome of grievance and appeals.
- Negotiated collective bargaining agreements on behalf of companies.
- Interpreted contractual agreements for employers and employees to support collective bargaining.
- Apply contract language, benefits, and review of covered services.
Field Enrollment Counselor
Maximus (Managed Care)
New York , NY
03.2007 - 10.2012
- Worked closely with the Department of Social Services to enroll Medicaid recipients into Managed Care Health plans.
- Traveled throughout the NYS area giving presentations, updating the local Department of Social Services of the changes in the NYS Medicaid Program.
- Distributed flyers, brochures or other informational or educational documents to inform members of targeted community.
- Delivered healthy living and disease management information to specific population groups.
- Helped people enroll in programs, arrange transportation and coordinate paperwork.
- Assisted with Medicaid recertification process.
Education
Bachelor of Science - Legal Studies
Mercy College
Dobbs Ferry, NY01.2020
Associate of Science - Paralegal Studies
Dutchess Community College
Poughkeepsie, NY01-2016
Skills
- Provider relationship management
- Provider training and education
- Recruitment
- Provider onboarding
- Provider network contracting
- Negotiating contractual terms
- Rate negotiation
- Billing and Claims resolution, rate reimbursement
- Grievance and appeals
- Managed Care
- Managed long-term care (MLTC)
- Conflict Resolution
- Computer Skills, data analyzing, Power BI
- Microsoft Office, data management
- Smartsheets, Adobe, DocuSign
- Managing Operations and Efficiency
Timeline
Provider Relations Specialist
Maximus
08.2022 - Current
Case Investigator
NYC Health and Hospitals
05.2020 - 08.2022
Referral Coordinator
Health Quest Medical Practice
07.2019 - 05.2022
Referral Coordinator
Option Care
06.2018 - 06.2019
Paralegal
Rinaldi Law
02.2016 - 06.2018
Admission Specialist
Visiting Nurse Services of Westchester
07.2015 - 01.2016
Referral Coordinator
Dominican Sisters Family Health Services
05.2014 - 06.2015
Appeals and Grievances Coordinator
Visiting Nurse Services of New York (MLTC)
10.2012 - 05.2014
Field Enrollment Counselor
Maximus (Managed Care)
03.2007 - 10.2012
Bachelor of Science - Legal Studies
Mercy College
Associate of Science - Paralegal Studies
Dutchess Community College