Milton L. Howard
Charlotte,N.C.
Summary
Healthcare professional with proven track record in provider relations, bringing valuable experience in facilitating smooth interactions between providers and healthcare entities. Known for collaborative approach and results-driven mindset, consistently meeting dynamic needs of team and organization. Skilled in conflict resolution and process improvement, with focus on delivering high-quality service.
Overview
27
27
years of professional experience
1
1
Certification
Work History
Provider Relations Representative
WellCare of North Carolina
01.2022 - Current
- Hired as a Provider Relations Representative for six Counties in Region 1 for North Carolina’s Medicaid Managed Care program.
- Worked directly with Providers to resolve Claim issues, Provider Roster reconciliation and conducted training for new staff in how to utilize WellCare’s online services.
- Conducted in-person and online Zoom meetings with staff as follow up after a Provider visit to insure all issues were resolved and to address any follow up questions.
- Trained Providers in completing the Appointment Agendas assigned to their Members. I contacted each Provider individually, explained the program benefits and their potential to earn Bonus Payments for participating in the program. I was one of the highest producers in Providing participation in the program.
- Promoted to the role of Provider Engagement Account Manager in 2023. I was the sole point of contact for all 100 North Carolina Local Health Departments, all Federally Qualified Health Centers and all Rural Health Centers.
- Successfully trained all of my practice groups in streamlining their previous processing in issue resolution for Claims, Monthly Reports and Credentialing request.
Quality Comprehensive Health Services, Inc.
01.2020 - 01.2022
- Certified to conduct Rapid HIV and Hepatitis C testing and trained in collecting urine specimens prior to being submitted to the lab for testing.
- Counseled individuals at high risk for HIV/STI infection on the preventative options available to reduce their chance of becoming HIV positive.
- Educated and advised high risk clients of the benefits of Pre-exposure prophylaxis (PreP).
- Expanded HIV/STI Testing sites in Mecklenburg County. Currently awaiting final approval for our “Memorandum of Understanding” (MOU) to partner and conduct testing at Wal-Mart locations in North, South, East and West Mecklenburg County.
- Improved client’s access to “After Hours” testing and implemented the “Text to Test” protocol for clients unable to be test during normal business hours at the agency and the offsite clinic.
- Conducted HIV/Hep C testing in unconventional settings at the clients request to insure privacy and HIPPA (Health Insurance Privacy and Portability) compliance.
- Provided condom distribution in high-risk communities in the City of Charlotte, the local LGBT bars and nightclubs, and students attending Johnson C. Smith University.
- Compiled data for the monthly Mecklenburg County Health Department’s HIV/STI (Sexually Transmitted Infections) Report. The report includes statistics for clients tested for HIV, Hepatitis C, Syphilis, Chlamydia and Gonorrhea.
- Worked with other HIV Testing Prevention teams within the agency that receive grant funding from the Centers for Disease Control (CDC) and The North Carolina Department of Health and Human Services (NCDHHS).
Medicaid Managed Care County Liaison Specialist
Data-Staff, Inc.
01.2019 - 01.2022
- Employed as the Mecklenburg County Liaison for The North Carolina Medicaid Managed Care program. The objective of the Managed Care program is to link Medicaid beneficiaries to a primary care provider contracted with a prepaid health which assumes all risk associated with patient care services.
- Primary responsibilities were to train and educate County Caseworkers and the senior management team in implementing the Managed Care initiatives according to State policy, procedures and guidelines.
- Conducted online presentations, program updates and protocol to County staff as required by The North Carolina Department of Health and Human Services.
- Trained new staff to use software application to enroll beneficiaries into a health plan of their choice.
- Auto assigned non-responsive beneficiaries to a health plan after 90 days and update health plan assignments upon request.
- Provided Choice Counseling to educate beneficiaries in making an informed decision when making a health plan selection.
Owner/Manager
The Nickel Bar, Inc.
01.2009 - 01.2019
- Owner and General Manager of a licensed North Carolina ABC (Alcoholic Beverage Commission) retail establishment.
- Developed all daily business operational procedures, negotiated vendor contracts and compliance standards per North Carolina ABC regulatory guidelines.
- Handled all Cash and Credit Card transactions, bank deposits, business cycle tracking and product promotions.
- Responsible for all Accounts Receivables/Payables, employee payroll and business revenue reporting for Mecklenburg County and The North Carolina Department of Revenue’s State tax reporting purposes.
- Managed and trained a staff of 7 employees in providing superior Customer Service, Sales, Product Promotions and effective Customer communications.
- Designed, developed, reviewed and approved all Marketing initiatives in print and online.
- Partnered with Quality Comprehensive Health Services and The Mecklenburg County Health Department to provide condom distribution to bar patrons upon request.
Health Benefits Advisor/Outreach Coordinator
Public Consulting Group, Inc.
01.1998 - 01.2009
- Served as a Health Benefits Advisor and Carolina ACCESS and Medicaid Outreach Coordinator for The North Carolina Medicaid Managed Care program.
- Reviewed recipient’s application for assistance to determine Aid Category: Temporary Assistance to Needy Families (TANF), Food and Nutrition Services (FNS), Medicaid for Infants and Children (MIC), Medicaid for Pregnant Women (MPW) and Medicaid for the Disabled (MAD)
- Enrolled Medicaid recipients into a Managed Care health plan onsite at for The Department of Social Services in Mecklenburg and Rowan Counties.
- Trained Medicaid Caseworkers in program implementation guidelines and mandated protocols.
- Served as the Medicaid Managed Care Outreach Coordinator in Mecklenburg and Rowan Counties working directly with Medicaid applicants to assist in primary care physician selections.
- Assisted providers with all billing and payment issues. Determined when payment overrides were applicable for medical services provided to patients.
- Compiled monthly program statistical data reports for The North Carolina Department of Health and Human Services. Presented data via face to face meetings and/or teleconference calls with the State’s Medicaid Management team.
- Designed and developed Medicaid Recipient Educational handbooks. Developed Medicaid training manuals for Medicaid Caseworkers as well as follow up one on one meetings upon request.
- Worked with the South Carolina DHEC (Department of Health and Environmental Control) in conducting a Federal Survey within the State under the Ryan White Act to determine the needs of HIV positive clients and services available at area HIV clinics.
- Assisted recipients with obtaining Durable Medical Equipment according to physician’s orders.
- Conducted research and recovery for Third Party Private Insurance coverage for Medicaid/Medicare Paid Claims files.
- Reviewed/audited North Carolina Mental Health medical claims from healthcare providers for accuracy prior to submitting for final payment for Medicaid/Medicare services.
Education
Marketing
Central Piedmont Community College
Charlotte, North CarolinaSkills
- Claims reviewing
- Health plan operations
- Project management
- Provider support
- Strategic business relationships
- Healthcare industry
- Relationship management
Accomplishments
Promoted from Provider Relations Representative to Provider Engagement Account Manager within 1.5 years
Certification
- North Carolina Enrollment Broker and Outreach Specialist 2019 ~ The NCDHHS – N.C. Medicaid Division of Public Health
- Rapid HIV Testing October 2020 ~ The NCDHHS HIV-STD Prevention and Care Branch & Whetstone Consultations
- OraQuick – Hepatitis C (HCV) September 2021 ~ OraSure Technologies, Inc.
Qualification
HIV Testing/Prevention ~ Medicaid Managed Care Program Implementation ~ Staff and Management Outreach Coordinator ~ NC FAST ~ Customer Service ~ Human Resources ~ Contract Procurement
Timeline
Provider Relations Representative
WellCare of North Carolina
01.2022 - Current
Quality Comprehensive Health Services, Inc.
01.2020 - 01.2022
Medicaid Managed Care County Liaison Specialist
Data-Staff, Inc.
01.2019 - 01.2022
Owner/Manager
The Nickel Bar, Inc.
01.2009 - 01.2019
Health Benefits Advisor/Outreach Coordinator
Public Consulting Group, Inc.
01.1998 - 01.2009
Marketing
Central Piedmont Community College
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