Stephanie Williams
Wichita,KS
Summary
Outcomes-oriented Clinical Director with expertise in benefits administration, assessing clients' insurance needs and detecting potential risk. In-depth knowledge of third party administrators, healthcare savings programs, and claims processing. Outstanding analytical, interpersonal and organizational skills. Dedicated to expediently resolving insurance issues and finding creative solutions to improve outcomes.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Director of Clinical Operations
Carepath Benefits
10.2021 - Current
- Assisted with design and implementation of employee benefits programs.
- Evaluated applications to determine risk analysis and appropriate insurance coverage.
- Monitored changes in health insurance laws and regulations to verify continuous compliance.
- Contacted third party administrator to discuss and resolve unpaid claims and incorrectly paid claims.
- Managed employee benefits program, working with vendors, providers and staff.
- Managed continuous enrollment processes, as well as yearly enrollment periods.
- Reviewed benefits paperwork for accuracy and completeness.
- Analyzed and reported on employee benefits data to identify trends and develop strategies for improvement.
- Created employee education programs to improve understanding of benefits packages and increase utilization.
- Researched and evaluated new benefits programs to select cost-effective providers and coverage levels.
Clinical Director
Medova Healthcare
03.2021 - 10.2021
- Established and oversaw performance targets for 10 health insurance call center associates.
- Established UR and CM performance goals for nurses and provided feedback on methods for reaching those milestones.
- Developed, implemented, revised, and evaluated policies and procedures.
- Conducted full claim investigations and reported updates for appeals.
- Provided advice to customers regarding claims, rights and insurance processes to resolve disputes.
- Initiated cost containment by conducting thorough audits and data mining.
Care Coordination Manager
Medova Healthcare
09.2018 - 03.2021
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and prior authorization.
- Monitored and analyzed business performance to identify areas of improvement and make necessary adjustments.
- Streamlined and monitored quality programs to alleviate overdue compliance activities.
- Took ownership of customer issues and followed problems through to resolution.
- Trained and regularly mentored associates on performance-oriented strategies and customer service techniques.
Utilization Review/Telephonic Nurse Case Manager
Medova Healthcare
03.2017 - 03.2021
- Created and launched medication assistance program
- Performed medical and prescription reviews for medical necessity based upon Interqual, NCCN, or step-therapy specification.
- Evaluated and negotiated contracts to procure favorable financial terms for clients, employers, and health plan.
- Evaluated patients referred for case management to determine physical, mental, financial and psychosocial status by utilizing comprehensive, standardized criteria.
- Interfaced with third-party payer and stop loss carriers for utilization review and case management activities and submitted monthly reports.
- Provided education and support services to members with chronic and acute conditions
- Implemented cost reductions and developed reporting procedures and systems resulting in significant cost savings to clients, employers, and health plan.
- Researched issues related to claims processing to identify origins and implement corrective solutions.
Field Care Manager
Acuity Healthcare (Humana Contract)
07.2016 - 11.2020
- Managed caseload of up to 30 members per month
- Created care plans and evaluated barriers and ability to attain goals
- Communicated with healthcare providers to facilitate continuity of care.
- Responded to emergency situations and provided support to promote client safety and wellbeing.
- Educated clients and families on community resources, treatment options and health care services to better manage conditions.
Care Coordinator
Medova Healthcare
08.2015 - 07.2017
- Created and maintained spreadsheets detailing medical procedures and insurance denials and approvals.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Developed, implemented, revised, and evaluated policies and procedures.
- Coached and trained newly hired employees so that each understood job responsibilities and requirements of positions.
- Prepared and distributed denial letters, detailing reasons for denial and appeal measures.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization utilizing CMS and Interqual guidelines.
Care Manager/Director of Nursing Services
Glen Carr House
02.2014 - 08.2015
- Coached and trained newly hired employees to promote knowledge of responsibilities and position requirements.
- Established team priorities, maintained schedules and monitored performance of 50 employees.
- Performed payroll functions, such as maintaining timekeeping information and processing and submitting payroll
- Developed and modified patient care plans and assisted interdisciplinary team in identifying resident needs and goals to determine priorities of care.
- Implemented aspects of patient care under physician orders and sought clarification when needed to promote safety, quality and cost-efficient care.
- Analyzed patient responses to medications, therapies and variances in plans of care.
- Managed support services and fostered communication among social workers, therapists, hospital staff, and patients.
Licensed Practical Nurse
Glen Carr House
08.2013 - 02.2014
- Documented accurate and complete patient information to address patient problems and expected outcomes.
- Collaborated with interdisciplinary team of healthcare and social service providers to address residents' needs through effective intervention and care planning.
- Offered immediate assistance in emergency and routine paging situations to evaluate needs and deliver care.
- Administered medications and injections to patients.
- Performed rounds of 54 residents with community healthcare provider to observe care and interview staff, residents, and families.
- Communicated effectively with family members on regular basis regarding care, issues and overall health of loved ones.
Licensed Practical Nurse
Ascension Via Christi Clinic
04.2013 - 08.2013
- Built meaningful relationships with patients and families for optimal care.
- Educated patients, families and caregivers about conditions and treatments.
- Administered medications and treatments to manage patient's condition.
- Measured and recorded weight, height, body temperature and blood pressure for average of 25 patients per day.
- Maintained accurate and comprehensive patient records in line with regulatory standards.
- Monitored and maintained clinical supplies, materials and inventory.
Medical Assistant
Ascension Via Christi Clinic
08.2007 - 04.2013
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Sanitized, restocked, and organized exam rooms and medical equipment.
- Called and faxed pharmacies to submit prescriptions and refills.
- Assisted physicians with minor surgeries, including preparing operating room and sterilizing instruments.
- Answered telephone calls to answer patient questions and provide physician recommendations.
- Completed EKGs and other tests based on patient presentation in office.
- Prepared lab specimens for diagnostic evaluation.
- Updated inventory, expiration and vaccine logs to maintain current tracking documentation.
Education
ASSOCIATE OF SCIENCE - NURSING
COWLEY COUNTY COMMUNITY COLLEGE
Arkansas City, KS05.2013
CERTIFICATE LICENSED PRACTICAL NURSE, WICHITA -
AREA TECHINCAL COLLEGE
Wichita, KS12.2012
Skills
- Profitability Strategies
- Compliance with Regulatory Guidelines
- Utilization Management
- Clinical Development and Operations
- MS Office Suite
- Claims Analysis
- Claims Investigation and Research
- Claims Auditing
Affiliations
Wichita Women for Good
Certification
- Licensed Practical Nurse - 2013-current
Timeline
Director of Clinical Operations
Carepath Benefits
10.2021 - Current
Clinical Director
Medova Healthcare
03.2021 - 10.2021
Care Coordination Manager
Medova Healthcare
09.2018 - 03.2021
Utilization Review/Telephonic Nurse Case Manager
Medova Healthcare
03.2017 - 03.2021
Field Care Manager
Acuity Healthcare (Humana Contract)
07.2016 - 11.2020
Care Coordinator
Medova Healthcare
08.2015 - 07.2017
Care Manager/Director of Nursing Services
Glen Carr House
02.2014 - 08.2015
Licensed Practical Nurse
Glen Carr House
08.2013 - 02.2014
Licensed Practical Nurse
Ascension Via Christi Clinic
04.2013 - 08.2013
Medical Assistant
Ascension Via Christi Clinic
08.2007 - 04.2013
ASSOCIATE OF SCIENCE - NURSING
COWLEY COUNTY COMMUNITY COLLEGE
CERTIFICATE LICENSED PRACTICAL NURSE, WICHITA -
AREA TECHINCAL COLLEGE
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