Medicaid representative with experience in managed care, compliance, grievance and case management. Looking to expand my knowledge and join a forward moving team.
Overview
9
9
years of professional experience
Work History
Territory Manager
Medicaid Done Right
09.2024 - Current
Managed 8 homes and their Medicaid population
Cultivated client relationships to enhance satisfaction with Medicaid services.
Assisted families completing long term care applications
Collected necessary documents that were often unavailable to the facility
Traveled throughout community to gather necessary documents for residents.
Connected with families in community to address needs of those unable to meet at facility.
Senior Appeal Analyst
Aetna Better Health of Illinois
01.2020 - Current
Resolved member issues reported to health plan from Bureau of Managed Care
Process Executive and Escalated Complaints
Process Department of Insurance complaints
Process Social Media Complaints
Process Provider Retro Authorization Request
Investigated interdepartmental records to address and resolve issues
Coordinated with management to address state escalated requests
Facilitated state fair hearings to address member grievances.
Tracked and reported trends quarterly and annually to inform strategic decisions
Maintain compliance expectations
Lead for G&A special projects
Compliance Coordinator
Illinicare /Ambetter Health
01.2017 - 01.2020
Processed complaints from the OIG (Office of the Inspector General)
Processed Attorney General Complaints
Processed Department of Insurance Complaints
Developed and maintained tracking system for trending records to enhance compliance oversight
Conducted quarterly HIPAA workstation audits to ensure regulatory adherence
Assisted SIU research efforts by gathering and analyzing information on requests and incidents to inform decision-making