Pamela McKenzie
Bridgeport,CT
Summary
Dynamic and results-driven administrator with a proven ability to cultivate strong relationships with clients, colleagues, and local agencies. Adept at navigating independent and collaborative work environments, ensuring seamless operations and effective communication. Committed to fostering a positive team culture while delivering exceptional service and support. Recognized for a proactive approach to problem-solving and dedication to achieving organizational goals.
Overview
21
21
years of professional experience
Work History
Provider Contract Specialist-Provider Network Management Dept - Remote
Emblem Health
New York, New York
08.2024 - 01.2026
- Assist providers in all matters related to contract disputes and ensure accurate contracts and rate load implementations are done in a timely manner
- Communicate with providers and response to provider inquiries in a timely, accurate and professional manner
- Ensure the accuracy of provider demographic data in the plan's database; review provider data for assigned providers; handle provider requests for demographic changes, research provider discrepancies identified by provider returned mail and potential provider demographic errors.
- Coordinate delegated credentialing functions and activities
- Recruit available providers to fulfill Network deficiencies
- Provide timely, useful and accurate responses to provider requests for plan materials; provider questions regarding fees, the plan's website and IVR, information in the plan's provider manual, and escalated claim inquiries.
- Oversaw contracts for over 30 different ancilliary/ professionals/hospitals using both manual and automated strategies.
Member Navigator-Loyalty & Retention Dept. – Remote-Customer Service Rep
Emblem Health
New York, New York
03.2022 - 01.2024
- Proactively research Emblem Health member issues utilizing multiple enterprise systems and data to explain and resolve complicated customer service issues, close gaps in care, completion of HRA's enabling higher retention of members within each Line of Business
- Conduct outbound outreach to members (60+ calls per day) based on identified gaps and needs; respond to customer needs and help solve issues related to coverage and transactions, provide information on care management programming and help enroll members in applicable programs, understand and assist with additional customer operational needs related to the health plan, coverage and benefits possible, and document any further follow-up needed specifically from clinical/care management.
- Document interactions in support of quantitative metrics for the site and department.
- Perform research and analysis to identify trends and root causes.
- Work closely with enterprise teams to identify member needs on care gaps closures, HRA completions, care management program enrollment and risk for disenrollment; review assigned member's profiles and experience, including all interactions with EmblemHealth, and prioritize for outreach.
- Prepare for outreach by customizing available scripting based on individual member needs and gaps.
- Participate in weekly meetings with manager and team members to discuss customer concerns, improvement opportunities (people, processes and technology), and other company priorities.
- Perform ad hoc customer facing calls based on additional identified needs.
HARP Care Coordinator
EmblemHealth
New York, NY
06.2020 - 01.2022
- Perform outreach calls( approximately 30+ calls per day), in addition to field visits to members to convey the programs offered, assess members, and create a care plan.
- Develop person-centered care plans and goals with the member and other care team members as required.
- Offer proficient knowledge of community resources to eliminate barriers to care and provide follow ups on progress toward meeting goals.
- Coach Medicaid members in effective management of their chronic health conditions and self-care, i.e. Asthma, PDI/ PQI, diabetes, HIV, etc.
- Collaborate and track LTSS members home visits, assessments, and discharges.
- Assist members in accessing services, considering social determinants of health.
- Help members understand their care plans and instructions.
- Actively collaborate with other care team members and support care management interventions including discharge plan review.
- Engage new enrollees: educate them regarding Medicaid benefits and review health risk assessments.
- Remove barriers to assist members in meeting care plan goals, including making doctors' appointments, referrals to internal and external resources, and setting up transportation.
- Collaborate with quality management team(s) as needed to ensure gaps in care are addressed.
Care Coordinator
WellLife Network
Brooklyn, NY
09.2019 - 06.2020
- Managed patient caseloads effectively, ensuring timely follow-up and appropriate interventions.
- Assessed patient needs and connected them with appropriate resources to ensure optimal health outcomes.
- Conducted regular evaluations of care plan effectiveness, making necessary adjustments based on feedback from patients and providers.
- Improved communication among healthcare providers, streamlining the coordination of services for patients.
- Conducted thorough assessments of patient needs to devise personalized care plans, addressing both health and social determinants.
- Developed patient education materials on chronic disease management, empowering patients to take active role in their health.
- Created customized care plans, working with hospital staff and families to assess and meet individual needs.
- Developed and maintained strong relationships with patients and their families, providing emotional support and health education.
Promoted to Entitlements Specialist
Services for the Underserved (SUS)
New York, New York
04.2017 - 02.2018
- Ensured that consumers were receiving entitlements and maintaining eligibility by assisting them through the eligibility process for the appropriate benefits. Submitted all applications, i.e., redeterminations, SNAP, Medicaid, recertification, CDR's, HEAP, face to face and representative payee in a timely manner. Escort consumers to various government and city agencies (Social Security Administration, HRA-Public Assistance, Medicaid and SNAP offices. Maintained active, updated records of consumer's entitlements.
Promoted to Intake Coordinator – Veteran Services
Services for the Underserved (SUS)
New York, NY
10.2016 - 04.2017
- Maintained accurate and up-to-date client records.
- Completed intake assessment forms and filed clients' charts.
- Answered phone calls and provided new clients with required paperwork to initiate service.
- Collected, verified, recorded and processed client demographics, insurance payments, and referral information.
- Communicated with referral sources, physicians, and associated staff to check documentation for proper signatures.
- Ensured regulatory compliance by maintaining up-to-date records and documentation.
- Improved client satisfaction scores with personalized attention during intake procedure.
- Contributed to a positive work environment through effective teamwork and open communication among colleagues.
- Increased efficiency in patient intake flow, optimizing scheduling procedures and minimizing delays.
- Advocated for patients by liaising with insurance companies, ensuring coverage and reducing financial stress for patients.
- Developed strong relationships with referral sources, resulting in increased referrals for services provided by the organization.
- Streamlined patient intake process, reducing wait times by implementing efficient data collection methods.
- Maintained confidentiality and compliance with healthcare regulations, safeguarding patient information.
Housing Generalist/Case Manager
Services for the Underserved (SUS)
Brooklyn, NY
10.2014 - 10.2016
- Worked diligently to serve the needs of substance abusers, homeless, HIV and individuals with chronic illnesses. Provided case management, crisis intervention and advocacy. Assessed needs and made appropriate referrals. Collaborated with individuals in the development of goal and corresponding plan.
- Provided accurate, complete and timely documentation of social service records including service plans, reports and progress notes. Provided recreation, money management and other hands-on assistance with activities of daily living i.e., medication reminders as needed. Identified and coordinated community-based resources and organizations for supportive services. Processed 2010E housing applications.
Site Coordinator
BRC Jack Ryan Residence
New York, New York
06.2011 - 10.2011
- Supervised 24-hour operations staff that provided hands-on services to clients.
- Attended all clinical and management team meetings.
- Organized and inventoried all supplies required for the day-to-day functioning of the program
- Ensured compliance with regulators' requirements.
- Ensured all documentation and reports were completed according to policy. Provided emergency first aid/CPR assistance when needed.
Office Manager
BRC/Cecil Ivory House
New York, New York
04.2005 - 06.2011
- Assisted with the day-to-day operations of the program. Successfully managed and reconciled office expense budgets and modifications. Processed monthly, quarterly and annual reports. Supervised all per-diem, administrative, clerical and maintenance staff. Compiled and analyzed all hiring data. Oversaw scheduling for up to (18) staff including tracking and documenting vacation, sick and compensation time. Implemented and facilitated groups Managed and controlled the distribution of petty cash and metro cards to staff and residents. Case management. Managed office equipment and maintained supply inventory.
- Managed all contractual agreements with vendors and contractors. Processed intakes and discharges of residents via AWARDS, HRA and CAIRS databases as well as the processing of turn around documents (TAD)
- Conducted regular inventory assessments of office supplies, ordering necessary items proactively to prevent stock shortages.
- Assisted in the recruitment process, conducting interviews and onboarding new employees to promote a seamless integration into the team dynamic.
- Maintained accurate financial records by reconciling accounts payable/receivable transactions regularly to ensure balanced budgets.
- Oversaw office inventory activities by ordering and requisitions and stocking and shipment receiving.
- Streamlined office operations by implementing efficient filing systems and organizational strategies.
- Oversaw facility maintenance requests, coordinating with building management to address repairs or improvements efficiently.
- Reduced costs with meticulous budget monitoring and expense tracking for essential supplies and equipment.
- Developed comprehensive policy manuals outlining procedures and guidelines, contributing to a well-organized workplace culture.
- Provided backup to front desk to step in to assist with various tasks whenever employee was absent or at lunch.
- Contributed to workplace safety by ensuring compliance with established emergency protocols and conducting regular equipment inspections.
- Managed vendor relationships, negotiating contracts for cost savings while maintaining high-quality services.
Education
Human Services HS-BCP - Human Services
Center For Credentialing And Education (CCE)
New York, NY06-2010
Master's in Public Administration -
Metropolitan College of New York
New York, NY01-2010
Bachelor of Professional Studies - Human Services
Metropolitan College of New York
New York01-2007
Skills
Exceptional Customer Service
Experienced with Microsoft tools
Proficient in written and oral expression
Effective Communication Skills
Effective Time Management
Regulatory Compliance
Timeline
Provider Contract Specialist-Provider Network Management Dept - Remote
Emblem Health
08.2024 - 01.2026
Member Navigator-Loyalty & Retention Dept. – Remote-Customer Service Rep
Emblem Health
03.2022 - 01.2024
HARP Care Coordinator
EmblemHealth
06.2020 - 01.2022
Care Coordinator
WellLife Network
09.2019 - 06.2020
Promoted to Entitlements Specialist
Services for the Underserved (SUS)
04.2017 - 02.2018
Promoted to Intake Coordinator – Veteran Services
Services for the Underserved (SUS)
10.2016 - 04.2017
Housing Generalist/Case Manager
Services for the Underserved (SUS)
10.2014 - 10.2016
Site Coordinator
BRC Jack Ryan Residence
06.2011 - 10.2011
Office Manager
BRC/Cecil Ivory House
04.2005 - 06.2011
Human Services HS-BCP - Human Services
Center For Credentialing And Education (CCE)
Master's in Public Administration -
Metropolitan College of New York
Bachelor of Professional Studies - Human Services
Metropolitan College of New York