SAUNDRA NAIDENE MCCRAY
Philadelphia,PA
Summary
Profile Overview Exceptional Leadership Abilities - Excellent Communication Skills - Effective Team Player Subject Matter Expert (Dissatisfactions/Grievances/Appeals, DHS Policies) Thorough knowledge of the Managed Care/Medicaid Insurance Industry Trainer (Customer Service, Telephone Etiquette, Patient Registration, Insurance, Patient Diffuse), Knowledge of Medical Terminology Intermediate Skill Level (Dentrix, Excel, Word, Outlook, various EMR systems) Operational reporting and supervision with HRSA, VFC, NCQA, AACO Compliance, Promotes business development and community profile by developing a positive rapport with patients and handling marketing activities. Successful forging partnerships with hospitals and specialty practices to extend patient care reach.
Overview
25
25
years of professional experience
Work History
PRACTICE SUPERVISOR
Spectrum Community Health Center
01.2016 - Current
- Supervise the Provider Service Representatives for all clinical locations (3)
- Function as a rotational Site Manager for Saturday and evening shifts
- Oversee Keystone First Initiative Project
- Engage in meetings and projects that promote Community Outreach and Integrated Care
- Oversee daily patient flow/provider production for all clinical locations (3)
- Capture, investigate, and resolve patient complaints/escalated incidents
- Facilitate system building of providers’ schedules for all clinical locations (3)
- Review company policies and recommend changes to the Executive Team
- Conduct weekly meetings and daily huddles with the Operational Team
- Provide continual training on updated Medicare/Medicaid Policies and Processes
- Effectively manage performance of all direct reports
- Continually work with the Executive Team to create and maintain policies/processes which aides in employee development and patient satisfaction
GRIEVANCE COORDINATOR
AmeriHealth Caritas
01.2011 - 01.2016
- Investigated and resolved Member Dissatisfactions within the mandated 30 day timeline
- Served as an educator and advocate for members
- Acted as a liaison for the Department of Public Welfare for the purpose of resolving constituent complaints
- Worked with and engaged various internal departments to obtain resolution and continuity of care for the member
- Prepared Member Dissatisfaction auditing materials for Independence Blue Cross
- Conducted new hire training with a focus on the Member Dissatisfaction Process.
MEMBER SERVICES REPRESENTATIVE/DISSATISFACTION LIAISON
Keystone Mercy Health Plan
01.2008 - 01.2011
- Functioned as a Dissatisfaction Liaison where I provided resolution to members’ complaints in timely manner required by the Department of Public Welfare
- Contacted and established good rapport with physician offices and hospitals in efforts to resolve member complaints
- Conducted Member Dissatisfaction Process training in new hire classes as well as Member Service Representatives
- Created Member Dissatisfaction Process training materials and exercises
- Provided Member Dissatisfaction weekly reports to Supervisor/Manager as required
- Handled high volume of incoming member calls while maintaining acceptable production levels
- Handled difficult/sensitive calls, performed Supervisor call back calls to members, and assisted with inter-departmental training as needed
REFERRAL COUNSELOR/CALL BACK PROJECT COORDINATOR
University of Pennsylvania Health System
01.1999 - 01.2008
- Provided referrals for physicians and services under the University of Pennsylvania Health System
- Facilitated and provided documentation for appointment scheduling
- Registered patients for various workshops/classes
- Referred clients to outside organizations as necessary
- Served as the coordinator for a project which tracks unscheduled appointments and reports statistics to the Department Manager and various medical department heads as required
- Served as an information counselor for the UPHS television show “Penn Vital Signs”
Education
DIPLOMA - SECRETARIAL SCIENCE
CITE Business Institute
Philadelphia, Pennsylvania1995
DIPLOMA - undefined
William Penn High School
Philadelphia, Pennsylvania1983
Skills
- Vaccination Administration
- Medical Personnel Recruitment
- Resource Monitoring
- Budget Oversight
Timeline
PRACTICE SUPERVISOR
Spectrum Community Health Center
01.2016 - Current
GRIEVANCE COORDINATOR
AmeriHealth Caritas
01.2011 - 01.2016
MEMBER SERVICES REPRESENTATIVE/DISSATISFACTION LIAISON
Keystone Mercy Health Plan
01.2008 - 01.2011
REFERRAL COUNSELOR/CALL BACK PROJECT COORDINATOR
University of Pennsylvania Health System
01.1999 - 01.2008
DIPLOMA - SECRETARIAL SCIENCE
CITE Business Institute
DIPLOMA - undefined
William Penn High School
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