UnitedHealth Group:
Senior Provider Data Specialist:
I seized the opportunity to contribute to the creation of a new department focused on Provider Terminations, and I thrived in this role. I began by thoroughly investigating our existing processes and identified innovative ways to save time, streamline operations, and improve turnaround times. As a leader in the department, I played a key role in developing a Standard Operating Procedure (SOP) tailored to our specific needs and led training for new employees. I conducted in-depth research on Medicare and Medicaid primary and specialty provider panels to ensure compliance and created data analytics to track and assess these panels. Additionally, I contributed to reducing the number of “orphaned” members (those without a primary care provider) and led calls with state representatives to discuss the provider and member experience.
Enrollment and Eligibility Representative:
I worked with the Enrollment and Eligibility team for primary Medicaid members, processing updates related to eligibility status, personal information changes, and other important details. My role required gathering and verifying data in compliance with state audit requests, ensuring that all information was accurate and timely. I utilized internal systems to manage and track these updates, helping maintain compliance with Medicaid regulations and ensure smooth processing of member data
CIOX:
Client Service Representative:
During my time at CIOX Health, I began my career in technology, gaining valuable experience in the healthcare industry. As a contracted third-party provider, my primary responsibility was to release medical records to patients, providers, insurance companies, and legal entities. I became proficient in navigating and utilizing their electronic medical records system.