Megan Garrity Dressman
Phoenix,AZ
Summary
Seasoned Contract Specialist and Business Analyst with a proven track record at Phoenix Health Plan, adept in operations and staff training. Spearheaded the implementation of the MC-400 system and streamlined prior authorization processes, enhancing provider satisfaction. Excels in MS Office and navigating contracting policies, demonstrating a robust blend of technical and interpersonal skills. Currently enrolled in a Medical Billing and coding program with Devry University. Anticipating a graduation date in the Summer of 2025. Very eager to use my medical coding knowledge and relevant skills to to assign and sequence codes correctly.
Overview
21
21
years of professional experience
Work History
Contract Specialist
PHS
Phoenix, USA
04.2020 - 10.2020
- Proof reading Physician and Facility contracts
- Negotiating contract rates with the providers
- Detailing specifics of the contracts including the different Medicare and Medicaid rates
Business Analyst II
Conifer Value Based Care
Phoenix, USA
01.2014 - 01.2018
- Assisted with implementing the MC-400 web authorization system by creating and testing the workflow, creating queues to determine the status of the authorization and activity codes
- Worked with the Senior Director of Operations on Special Projects
- Implemented TriZetto Encounter Data Manager for Arizona and Detroit, including gathering information and meeting with stakeholders to develop the business requirement document
- Trained and implemented utilization review, customer service, and prior authorization on the Nice In-Contact cloud-based phone system
- Assisted with the management of all customer service agents in workforce management
- Managed all the electronic authorization files from the California IPAs
Prior Authorization Trainer
Phoenix Health Plan
Phoenix, USA
01.2011 - 01.2014
- Worked with Medical Directors and Senior Management to maximize the prior authorization coordinator approval list reducing the number of cases needing nurse and medical director review and increasing provider satisfaction
- Assisted Network Management with onsite training in provider offices on prior authorization procedures as needed
- Served as resource to team members for questions and assistance
- Identified training needs for the Prior Authorization Department
- Developed training materials and outlines, ensured training materials were up to date, and adapted to accommodate all learning styles and keep trainees engaged
- Provided one-on-one training and small group training as needed for new and current prior authorization team members
- Audited trainees’ work during training periods and re-educated to ensure quality standards
- Helped trainees apply new concepts and coached in areas that need improvement
- Trained other departments throughout the plan on prior authorization procedures
- Facilitated data entry and telephones to ensure that AHCCCS quality standards were met
Prior Authorization Coordinator
Phoenix Health Plan
Phoenix, USA
01.2009 - 01.2011
- Responded to telephone and fax requests for prior authorization from providers, meeting productivity and quality measures that ensure exceptional customer service
- Resolved inbound call requests by approving authorizations, educating provider office on use of guidelines, and/or informing provider of medical review process of their request
- Input prior authorization data and related information into the medical management system in accordance with established guidelines, including diagnosis of service and procedure codes
- Gathered, sorted and tracked information as requested to meet business needs
- Triaged inbound prior authorization requests and referred requests to prior authorization nurse
- Referred potential high-risk members through prior authorization process to maternal, asthma, diabetes, and other case management programs
- Participated in the denial process through data entry and faxing providers
- Served as top data entry performer, continually exceeding the data entry production standards, and as resource to co-workers for questions and assistance
- Trained and mentoring new staff
Lead Prior Certification and Authorization Representative
Arizona Foundation for Medical Care
Phoenix, USA
01.2000 - 01.2007
- Reported to the office manager and worked closely with four registered nurses, evaluating incoming clinical information
- Participated in new hire interviews and decisions
- Received and reviewed incoming patient clinical information and coded in accordance with ICD-9, CPT and HCPC codes and regulations
- Facilitated data entry necessary to support client claims payments
- Served as a coding resource to clients’ claims processing department
- Suggested and implemented processes to streamline the prior authorization process
- This resulted in a 24-hour authorization turn around time
Education
Medical Coding and Billing
DeVry University
Phoenix, AZ01.2024
Nurse Assistant Certification -
Gateway Community College
Skills
- Operations
- Staff training
- Prior authorization
- MS Office
- American Health Holdings System
- Contracting policies and regulations
Recognition
Nominated four times and awarded Employee of the Year
Timeline
Contract Specialist
PHS
04.2020 - 10.2020
Business Analyst II
Conifer Value Based Care
01.2014 - 01.2018
Prior Authorization Trainer
Phoenix Health Plan
01.2011 - 01.2014
Prior Authorization Coordinator
Phoenix Health Plan
01.2009 - 01.2011
Lead Prior Certification and Authorization Representative
Arizona Foundation for Medical Care
01.2000 - 01.2007
Medical Coding and Billing
DeVry University
Nurse Assistant Certification -
Gateway Community College
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