MAHOGANY ANDERSON
ANTIOCH,TN
Summary
Healthcare/managed care professional with 15+ years of experience supporting Medicaid/member services, utilization management, regulatory compliance, and member-facing communications. Known for strong stakeholder communication, detailed documentation, and delivering compliant projects in fast-paced environments focused on member health needs.
Overview
25
25
years of professional experience
Work History
Marketing Project Manager, MESP
Anthem, Inc./Wellpoint
Nashville, TN
02.2023 - Current
- Manage all member facing communications for Tennessee Medicaid and CoverKids members
- Oversee all renewal and retention strategies
- Maintain contractual changes and update necessary departments of changes so they are implemented timely
- Provide relevant information to stakeholders during audits to prove compliance
- Manage internal policies and procedures to ensure compliance with internal and external partners
- Support enterprise marketing team in relation to the development of member facing communications for the Tennessee health plan
- Collaborate with vendors to develop member communications that support member benefits
- Oversee new project implementations
Regulatory Affairs Specialist, HCM
Anthem, Inc. / Amerigroup Real Solutions
Nashville, TN
11.2014 - 02.2023
- Develop and maintain working knowledge of those federal and state laws/regulations that govern the business
- Constantly review information about new laws/regulations and changes in interpretation on laws/ regulations obtained from various sources
- Ensure that all affected organizational units are informed of new laws/regulations and how they impact the business
- Produce concise and accurate written summaries of any new laws or regulations
- Discuss new laws/regulations in a thorough, yet understandable manner
- Perform original research on points of laws that may arise as issues of concern
- Draft policy or certificate language that complies with any new or changed law/regulation to assist in the implementation of new or changed product
Case Specialist, HCMS, Outpatient UM
Amerigroup Real Solutions
Nashville, TN
02.2009 - 11.2014
- Managing services via authorization requests
- Working with team of nurses to research utilization of services
- Coordinating hospice authorizations for members
- Efficient filing, charting, and documenting
- Implementing programs for case specialist team
- Cross training of new hires
- Serving as lead for case specialists questions and concerns
- Managing phone queue assignments
- Conducted Population Health Outreach in accordance with State requirements
- Serving as Subject Matter Expert for processes and system changes
- Operating as Durable Medical Equipment Subject Matter Expert
- Assisted with Emergency Room Diversion
- Served on Employee Advisory Committee
- Collaborating with regulatory team on Tenncare Guidelines
- Managing departmental voice mail queue
- Redirecting inappropriate services
- Www.amerigroupcorp.com
Customer Care Representative
Amerigroup Corporation
Nashville, TN
12.2007 - 02.2009
- Answered phones and greeted customers. Directed calls to the appropriate designations
- Assisted members with locating Primary Care Physicians and Specialty Providers
- Researched Claims Issues
- Www.amerigroupcorp.com
Customer Care Representative
Verizon Wireless
Murfreesboro, TN
04.2004 - 03.2007
- Answered phones and greeted customers. Directed calls to the appropriate designations
- Assisted customers with pricing plan options and upgrades on equipment
- Provided basic troubleshooting for faulty equipment
Lead Operator
Metro One Telecommunications
Nashville, TN
10.2001 - 03.2003
- Assisted callers with informational listings
- Conducted new hire trainings
- Handled escalation calls
- Served as front line management for floor representatives
- Conducted ongoing trainings for current staff and management team
- Assisted with process improvement
Education
Bachelor of Science - Psychology
University of Phoenix
Nashville, TN01-2012
Bachelor of Arts - Interdisciplinary Studies with Minor in Psychology
Tennessee State University
Nashville, TN01-2003
High School Diploma - undefined
Greeneville High School
Greeneville, TN01-1999
Skills
- Excellent people skills and thrives on helping to solve problems
- Superb communication skills, verbal and written
- Strong attention to detail and proficient at running and handling office equipment
- Good filing, charting, documenting and organizational skills, along with other office requirements
- Fluent in all Microsoft Office products
- Process improvement
- Campaign management
- Resource management
- Project management
- Marketing campaigns
- Marketing campaign development
Timeline
Marketing Project Manager, MESP
Anthem, Inc./Wellpoint
02.2023 - Current
Regulatory Affairs Specialist, HCM
Anthem, Inc. / Amerigroup Real Solutions
11.2014 - 02.2023
Case Specialist, HCMS, Outpatient UM
Amerigroup Real Solutions
02.2009 - 11.2014
Customer Care Representative
Amerigroup Corporation
12.2007 - 02.2009
Customer Care Representative
Verizon Wireless
04.2004 - 03.2007
Lead Operator
Metro One Telecommunications
10.2001 - 03.2003
High School Diploma - undefined
Greeneville High School
Bachelor of Arts - Interdisciplinary Studies with Minor in Psychology
Tennessee State University
Bachelor of Science - Psychology
University of Phoenix
OTHER TRAINING AND EXPOSURES
- Utilization Clinical Theory
- Medical terminology
- Case Management Theory
- Hospice Criteria