Sasha Walker

Primary Responsibilities:

• Provides, arranges services and acts as a liaison between each child and other staff to meet the needs of each child in residential care.
• Provides basic daily care services, establishes and builds supportive, nurturing relationships.
• Provides holistic, trauma-informed care and safety
• Provides services for immediate risk reduction and short-term therapeutic interventions.
• Continually assess ongoing changes in behavior, circumstances or conditions that may affect the childs safety.
• Monitors and reports on resident compliance with house rules.
• Ability to work with frequent interruptions and in stressful situations and responds to crisis situations with patience and good judgement.
• Responsible for responding to on-scene to crisis situations and providing trauma-informed care ,crisis intervention, advocacy, outreach, emotional support, as well as able to and to maintain active case loads of sex trafficking survivors and their non-offending caregivers.
• Builds nurturing relationships with the children using the Trust-Based Relationship with Intervention model (TBRI).
• Assist children with day-to-day needs including implementing schedules, supervising activities, administering medications, and teaching/coaching the children on a variety of life
  skills.
• Completes regular documentation and reports accurately and on-time (e.g., medical monitoring, progress notes, etc.)
  

WFM Primary Responsibilities:

• Assisted in the development and implementation of workforce planning strategies to ensure staffing levels align with business goals and operational needs.
• Built and maintained forecasts and staffing plans with Research and Data Analysis.
• Evaluated trends in utilization and developed initiatives to make improvements to internal processes.
• Conducted detailed research that targeted areas of opportunity.
• Communicated staffing plans and risks, conveyed the findings and/or recommendations to the appropriate leaders.
• Operationalized solutions to identified barriers and collaboratively approach solutions with appropriate stakeholders
• Analyzed inventory and performance against targets, while utilizing WFM tools.
• Monitored related outcomes and made recommendations for changes.
• Made recommendations to overcome system barriers and promoted consistency in practices
• Improved processes to optimize performance and value over time. routinely presented to and collaborated with Operations/Business partners.
• Developed effective/strategic business solutions through research and analysis of data.
• Analyzed, reviewed, forecasted trends complex data – creating “what if” models.
• Worked independently with a strong business ownership drive.
• Communicated the daily work direction plans.
• Conducted intraday data and metric monitoring
• Lead on developing requirements for any new or enhance inventory reporting.
• Monitored intake site to review new report requests
• Served as a data analyst in various project management, implantation, initiatives and/or pilot programs.
• Acted as a Subject matter expertise and completes project assignments in a timely and effective manner.
• Gathered and interpreted upcoming changes in work type, volume, requirements, KPIs, etc. and provided updated workload and volume forecasts.
• Utilized tools to observe actual state of agents in coalition to their actual schedule state.
• Continuous Improvement: Identified opportunities for process improvement and automation. Implemented best practices to enhance workforce efficiency and productivity.

Clinical Team Lead-Primary Responsibilities:

• Provided members with information needed to make better decisions about their health, helping them get access to the right care the first time.
• Health Coordinator that acted as a navigator and coordinator to proactively engage, assist, and promote initiatives relevant to heath care gaps.
• Help guided and educated members about the fundamentals and benefits of consumer - driven health care topics.
• Supervised, motivated and set priorities for the Engagement Specialist team while maintaining high standards, ensuring task completion, performance productivity, quality standards and goals were meet such as: Quality, Adherence, Service Level and AHT.
• Coached team on ways to improve operational performance; including call management, call back rate, transfer rate and quality.
• Coordinated and communicated effectively with all internal stakeholders and was accountable for the daily ,weekly, monthly activities of the team for all business support and production needs.
• Gave team directions, resolved all team scheduling issues, problems, conflicts, and provided guidance, coaching and feedback to the team.
• Maintained accurate and complete internal documentation of required information that meet risk management and regulatory requirements.
• Provided training on culture and values that are aligned with Culture; including cross training employees to improve and/or enhance employee growth acknowledge.
• Made outbound calls when appropriate to identify and assist with securing member resources and/or services.
• Determined purpose of calls by actively listening and interacting with callers, triaged call in a in a professional and timely manner.

• Performed daily inventory
• Loaded inventory
• Determined Shipping methods for materials
• Staged product on floor
• Proficient in all Pack Departments
• Performed Quality Control Inspections
• Ensured environment were safe
• Trained all new employees
• Trained in all Problem Solve Processes
• Knockout Operator, Jackpot Operator and ensuring that all priority orders are out on time
• Seasonal Problem Solve Process Assistant during peak
• Responsible for the motivation, productivity and success of all problem solvers.
• problem solver in new functions and supervised to ensure that all processes were done correctly.
• Sent quarterly emails to update Area Manager

• Performed various follow-up activities to ensure the accuracy and appropriateness of reimbursements made to healthcare providers. Responsibilities include identifying payment variances and working internally and externally to resolve such issue.
• Reviewed medical claims for accuracy and completeness, verifying patient eligibility and coding.
• Ensured compliance with insurance company policies and procedures related to the processing of claims.
• Analyzed claims data to identify contractual over payments and billing errors.
• Assisted department and leadership in obtaining complex information from various financial, clinical and operational systems and data sources.
• Established and maintained detailed knowledge and documentation of all analysis/data sources within the department.
• Investigated discrepancies in medical billing information such as incorrect codes or amounts due.
• Processed a high volume of claims on a daily basis using established time frames.
• Researched claim denials and appeals to determine appropriate resolution.

• Created simplicity by effectively using knowledge of plans, products, procedures and systems to provide information and resolve issues, resulting in enhanced customer satisfaction and retention
• Worked in an inbound and outbound call center environment and completed outbound phone calls and research
• Received and answered questions from CVS Retail Pharmacy Customers regarding billing statements, payment information and reimbursement issues.
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• Communicated effectively with physicians, nurses, patients and other healthcare professionals regarding medication needs or issues related to prescriptions.
• Entered and processed prescriptions into internal system with accuracy to avoid filling delays.
• Verified patient insurance coverage and eligibility for prescription medications.
• Processed prescription orders using pharmacy software system.
• Assisted pharmacists with filling prescriptions accurately and efficiently.
• Maintained accurate records of all transactions, including refills and new prescriptions.
• Adhered to all HIPAA regulations regarding patient privacy and confidentiality.
• Answered incoming calls promptly, courteously and professionally.
• Reviewed orders prior to dispensing to ensure accuracy of information entered into the computer system.

• Performed medical or behavioral review/authorization process.
• Ensured coverage was appropriate services within benefit and medical necessity guidelines.
• Utilized allocated resources to back up review determinations.
• Identified and made referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.).
• Participated in data collection/input into system for clinical information flow and proper claims adjudication.
• Maintained most current knowledge of contracts and network status of all service providers and applied them appropriately.
• Provided appropriate communications (written, telephone) regarding requested services to both health care providers and members.
• Submitted prior authorization requests electronically or by phone to payers.
• Reviewed prior authorization requests for completeness and accuracy.
• Educated customers about the prior authorization process including applicable deadlines.
• Maintained files for referral and insurance information, entering referrals into system.