Mandi Crew

• Managed a high volume of prior authorizations and appeals requests while maintaining a keen attention to detail and accuracy.
• Comprehensive understanding of CMS regulations and HIPPA Guidelines, ensuring strict adherence to all legal and ethical standards in daily operations.
• Analyzed member inquiries, identified root causes, and collaborated with internal teams to develop and implement effective sortitions.
• Ensured patients received necessary medications by navigating complex coverage guidelines, researching alternative options, and assisting with prior authorization process.

• Comprehensive knowledge of health plan benefits, claims procedures, authorization requirements, and provider networks, ensuring timely and accurate solutions.
• Utilized active listening and empathy to understand member needs and provide effective personalized support.
• Proficiently navigated internal knowledge bases and resources to quickly and accurately address customer inquiries and resolve complex issues.
• Surpassed call center performance goals, including call volume, quality scores, and call duration will maintaining a high level of efficiency and effectiveness.

• Maintained current knowledge of eligibility requirements and applied this expertise to ensure fair and consistent decision making.
• Conducted through investigations and applied knowledge of state and federal regulations to accurately determine eligibility for KanCare medical assistance program, carefully reviewing applications.
• Ensured accurate and efficient processing of applications within the KEES system, including data entry, documentation, and communications.
• Ensured the accuracy and completeness of applicant information by diligently utilizing available computer systems and resources to verify details related to household income, resources, and expenses.

Solved Customer problems and ensured compliance with relevant guidelines by accurately interpreting information and applying critical thinking skills.

Successfully navigated complex insurance requirements and pre-authorization processes to ensure timely access to DME for patients.

Protected the integrity of patient data by meticulously inputting and verifying information within the EHR system, ensuring accuracy, completeness, and strict adherence to confidentiality guidelines.

Delivered exceptional customer service by staying informed about the latest policies and procedures through active participation in training programs and independent learning.

• Successfully supervised and evaluated team members, providing constructive feedback and guidance to optimize their performance in implementing ISP's.
• Maintained a safe and supportive environment for individuals by accurately administering medications, promoting healthy practices, and consistently adhering to established protocols and procedures.
• Contributed to a positive supportive work environment by demonstrating flexibility and proactively covering shifts to ensure consistent and uninterrupted care.
• Managed budget performance and resource allocation through analysis and reporting.

• Maintained clean, safe, and well-organized patient environment.
• Documented progress notes thoroughly to track client achievements, concerns, or changes in behavior patterns that may need attention from the interdisciplinary team.
• Assisted clients with daily living needs to maintain self-esteem and general wellness.
• Assisted with crisis intervention to de-escalate challenging behavior and maintain peaceful encounters.