Nathanael McCooey
Lockport,NY
Summary
Robust background in managed care serving in many roles. Adept in processing and coordinating healthcare services with precision. Excel in leveraging Microsoft Office and managed care systems to enhance operational efficiency. Renowned for having a detail-oriented approach, being a team player and adapting easily to changes, ensuring high-quality provider and member support.
Overview
26
26
years of professional experience
Work History
Provider Data Coordinator I
Centene Corporation - WellCare
08.2022 - Current
- Processing enrollment of newly contracted providers and groups; addition of new providers to existing contracts with health plan.
- Reviewing credentialing applications in the CAQH system for complete work history, current licensure, etc. to verify if a provider can begin the credentialing process.
- Making updates to provider profiles as requested, i.e. adding locations, changing specialties, etc, as well as terminating providers from the health plan upon request.
- Assisting with and completing large medical group reconciliation projects as needed.
Program Coordinator I/Clinical Services Associate
Centene Corporation - Fidelis Care
07.2018 - 08.2022
- Transition of Care: Outreach to inpatient facilities to monitor status of admitted members. Ensuring members receive proper post-discharge care.
- Care Coordination: Outreach to enrollees in the Medicare Dual Advantage plan for review of care plan goals and assisting with scheduling appointments, refilling of medications, etc. as needed.
- High Risk OB/NICU: Processing referrals to the health plan's OB case management program and outreaching members to offer services. Daily entry of delivery reports from New York State.
HARP Service Coordinator
Centene Corporation - Fidelis Care
06.2017 - 07.2018
- Outreach to enrollees in the Health and Recovery Plan option. Explain what the program offers and introduce assigned case manager.
- Routine follow-up with members based on acuity.
- Monitoring the health plan's crisis line to assist members identified as potentially being in behavioral health crisis; connecting with a case manager and partnering with community agencies if necessary.
Authorizations Coordinator
Centene Corporation - Fidelis Care
02.2016 - 06.2017
- Processing requests for prior authorization of services received from provider offices and facilities. Approving requests as permitted; sending requests for clinical review as required.
- Checking status of existing authorization requests and providing updates.
- Educating providers on health plan appeals options for services denied.
Electronics Sales Associate/Department Manager
Walmart
03.2007 - 01.2016
Electronics Team Member, Assets Protection
Target
07.2000 - 11.2006
Education
Bachelor of Science - Criminal Justice
Buffalo State College
Buffalo, NY05-2005
Skills
- Proficient with Microsoft Office
- Experience with managed care systems including but not limited to PCA, Portico/Cenprov and XCelys
- Very thorough and detail-attentive
- Well known for being a strong team player
- Ten years of experience in various member and provider-focused roles within Centene Corporation
Timeline
Provider Data Coordinator I
Centene Corporation - WellCare
08.2022 - Current
Program Coordinator I/Clinical Services Associate
Centene Corporation - Fidelis Care
07.2018 - 08.2022
HARP Service Coordinator
Centene Corporation - Fidelis Care
06.2017 - 07.2018
Authorizations Coordinator
Centene Corporation - Fidelis Care
02.2016 - 06.2017
Electronics Sales Associate/Department Manager
Walmart
03.2007 - 01.2016
Electronics Team Member, Assets Protection
Target
07.2000 - 11.2006
Bachelor of Science - Criminal Justice
Buffalo State College