TAUCHA T. HODGE LPN
ENTERPRISE,USA
Overview
15
15
years of professional experience
Work History
Coordinator- UM Decision Support
Carecentrix
07.2017 - Current
- Involved in the collection, verification and confirmation non-clinical information. Gathers structured clinical documentation tom provide appropriate non-clinical issue resolution and escalation of issues when needed
- Provide accurate and timely approval and/or denial decision from PAC nurse and/or medical director according to the insurance plan the member has
- Complete initial case set up process
- Contact health plans to gather policy benefits/limitations and completes eligibility and benefits verification to ensure services provided will be covered by the carrier required.
- Document all communication and decisions into computer database
- Serves as a liaison between nurses and providers
- Created reports, presentations, and documents to support project goals.
- Provide support to supervisors/managers with various projects
Provider Data/Research Analyst
AmeriHealth Caritas Family of Companies - Prestige Health Choice
05.2014 - 07.2017
- Participates and supports nursing tasks, including but not limited to: faxes, discharge preparations, request of clinical information, and creation of authorizations if necessary
- Interacts with other departments including Claims, Rapid Response and Member Services to resolve member and provider issues
- Conducts member follow-up and outreach calls for members enrolled in integrated case management programs and/or Disease Management Programs
- Conduct daily review of all inpatient admissions and discharges to coordinate and schedule discharge follow-up appointments, and provide operational reports Produces, formats and edits correspondence and documents to send to members and/or providers
- Serves as a liaison in corresponding and communicating with providers, vendors, contacts and/or member representatives.
ICP Medicaid Processor
Medicaid Done Right
04.2013 - 05.2014
- Responsible for file intake; reviewing required documentation
- Gathering all information needed to apply for ICP Medicaid (Long Term Care) for residents that are currently residing in a nursing facility
- Request necessary documents from various institutions and tracking each file until all applicable documents are received
- Data entry accurately and efficiently, follows up with clients, nursing facilities and regulatory agencies in a timely manner and be organized
- Corresponding with clients and Regulatory Agencies to ensure successful processing of all Medicaid applications from the beginning to end
- Liaison between the clients and Regulatory Agencies with successfully processing of all Medicaid applications along with supportive documentation to DCF (Department for Children and Families) through the approval for ICP Medicaid.
CNA (Certified Nursing Assistant)
Eagle Lake Rehab
02.2013 - 04.2013
- Performing personal care tasks, including assistance with basic personal hygiene, grooming, feeding, ambulation, medical monitoring, and health care related tasks
- Fostering positive relationships between individuals served and their housemates
- Ensuring client safety and maintaining a safe environment
- Assisting with toileting, including bedpans, urinals, and commode chairs
- Reminding/assisting client with self-administration of medications (with proper training)
- Encouraging self-help activities
- Reporting changes in client’s condition or family situation to the office and documenting services provided
CNA (Certified Nursing Assistant)
Lexington Health and Rehab
09.2010 - 02.2013
- Performing personal care tasks, including assistance with basic personal hygiene and grooming, feeding, and ambulation, medical monitoring, and health care related tasks
- Fostering positive relationships between individuals served and their housemates
- Ensuring client safety and maintaining a safe environment
- Assisting with toileting, including bedpans, urinals, and commode chairs
- Reminding/assisting client with self-administration of medications (with proper training)
- Encouraging self-help activities
- Reporting changes in client’s condition or family situation to the office
- Documenting services provided
- Performing home management functions such as light housekeeping, laundry, bed making, and cleaning
- Planning meals, shopping for groceries, preparing and serving food/meals, feeding and clean-up
- Accompanying client to scheduled appointments and transporting clients or running errands for clients.
Care Advocate
Community Health Solutions of America
02.2011 - 01.2013
- Maintains and ensures the confidentiality of all Personal Health Information (PHI) collected
- Serves as a member advocate, providing support, triage and referral access to the clinical staff
- Places outreach calls to members/responsible parties for coordination, scheduling, collecting demographic/non-clinical information, referrals, DME requests, and other ancillary provider requests, as directed by nursing staff
- Uses reason and logic to solve problems during the review process and maintains a positive, professional and respectful attitude with peers and clients
- Reviews and analyzes claims data in accordance with coordination for financial reports
- Verifies Medicaid eligibility and demographic on participants and assists participants to maintain eligibility
- Work with participants and State Agencies (AHCA, DCF) to obtain the state Medicaid plan services
- Assist the Team Leads complete report documents for staff productivity
- Organize agendas for staff meetings; Provide support to supervisors/managers and marketing with various projects; including training new hires.
Education
Practical Nursing - Nursing
Pinellas Technical College
St. Petersburg, FL07.2023
Skills
- Multitasking and organization
- Customer service
- Data entry
- Decision-making
- Workflow planning
- Cross-functional collaboration
- New hire orientation
- Documentation and control
- Phone and email etiquette
- Documentation and recordkeeping
- Microsoft office
- Risk management
- Deadline management
- Task prioritization
- Verbal and written communication
- Clear communication
- Adaptability and flexibility
- Attention to detail
- Time management
- Problem-solving
- Insurance verification
- Medical terminology
- Information collection
- MS office
Timeline
Coordinator- UM Decision Support
Carecentrix
07.2017 - Current
Provider Data/Research Analyst
AmeriHealth Caritas Family of Companies - Prestige Health Choice
05.2014 - 07.2017
ICP Medicaid Processor
Medicaid Done Right
04.2013 - 05.2014
CNA (Certified Nursing Assistant)
Eagle Lake Rehab
02.2013 - 04.2013
Care Advocate
Community Health Solutions of America
02.2011 - 01.2013
CNA (Certified Nursing Assistant)
Lexington Health and Rehab
09.2010 - 02.2013
Practical Nursing - Nursing
Pinellas Technical College
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