Lanie Prye
Hillsboro
Summary
Experienced healthcare professional with a strong background in case management, Medicaid eligibility, and healthcare coordination. Skilled in navigating complex insurance systems, managing referrals, and securing service authorizations for diverse patient needs. Proficient in utilizing state databases and Electronic Medical Record (EMR) systems to ensure compliance and optimize service delivery. Known for exceptional patient advocacy, regulatory compliance expertise, and a commitment to improving patient outcomes. Adept at collaborating with interdisciplinary teams and leading processes to drive efficiency and quality care.
Overview
4
4
years of professional experience
Work History
Mental Health/Behavioral Health Case Manager
ViaQuest Psychiatric & Behavioral Solutions
08.2024 - Current
- Managed referrals, insurance authorizations, and care coordination for individuals with mental health needs.
- Developed and implemented individualized treatment plans to improve coping skills and adjustment.
- Navigated complex insurance portals to secure approvals for specialist visits, procedures, and medications.
- Maintained accurate case documentation in EMR systems while ensuring compliance with policies.
- Provided crisis intervention and collaborated with interdisciplinary teams to optimize patient care.
Medicaid Eligibility Referral Specialist
Highland County Government
03.2024 - 08.2024
- Managed referrals, insurance authorizations, and Medicaid eligibility determinations, ensuring patients received necessary care and services.
- Navigated state databases to verify eligibility, process applications, and resolve coverage issues.
- Coordinated with healthcare providers and insurers to secure approvals for specialist visits, procedures, and high-cost medications.
- Maintained compliance with regulations through accurate documentation in EMR systems and insurance portals.
- Provided patient support by explaining eligibility requirements and assisting with enrollment processes.
Manager
Assurance Health
05.2022 - 03.2024
- Oversaw daily operations of home health services, ensuring compliance with Medicaid and insurance requirements.
- Managed staff scheduling, patient referrals, and care coordination to optimize service delivery.
- Reviewed Medicaid eligibility cases, verifying coverage and securing authorizations for home health services.
- Collaborated with multidisciplinary teams to develop personalized care plans and improve patient outcomes.
- Implemented process improvements to enhance efficiency in patient intake, documentation, and billing.
Independent Healthcare Provider
Ohio Department Of Developmental Disabilities
12.2020 - 03.2022
- Provided direct care and case management services for individuals with developmental disabilities, ensuring compliance with state regulations.
- Managed Medicaid eligibility verification, service authorizations, and referrals using state databases.
- Navigated Ohio DODD systems to document services, process claims, and coordinate care with providers.
- Maintained accurate records and ensured adherence to state policies and compliance standards.
Education
Associate of Arts - Social Work
Sinclair Community College
Dayton, OH12-2026
High School Diploma -
Lynchburg-Clay High School
Lynchburg05-2020
Skills
- Medicaid Eligibility & Case Management
- Insurance & Authorization Navigation
- State Database Management
- Healthcare Coordination
- Electronic Medical Record (EMR) Systems
- Regulatory Compliance
- Patient Advocacy & Education
- Team Leadership & Collaboration
- Process Improvement
- Crisis Intervention & Support
Timeline
Mental Health/Behavioral Health Case Manager
ViaQuest Psychiatric & Behavioral Solutions
08.2024 - Current
Medicaid Eligibility Referral Specialist
Highland County Government
03.2024 - 08.2024
Manager
Assurance Health
05.2022 - 03.2024
Independent Healthcare Provider
Ohio Department Of Developmental Disabilities
12.2020 - 03.2022
Associate of Arts - Social Work
Sinclair Community College
High School Diploma -
Lynchburg-Clay High School
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