Professional Experience
United Healthcare Community & State, Southfield, Mi
CSHCS Care Navigator, Feb 2015 – December 2017
• Review clinical documents to determine eligibility for SNF disenrollment for members who have exceeded their 45 days in skilled nursing care
• Outreach to members and resolve complaints regarding Special Disenrollment For Cause submissions from The State of Michigan
• Support customer service calls regarding members in the CSHCS population
United Healthcare Community & State, Southfield, MI
Network Audit & Recovery Specialist, Sept 2013 - Feb 2015
• Used medical records requests, maintain members’ CSHCS eligibility according to their renewal dates
• When medical records were insufficient for a CSHCS renewal, contacted parents & notify them of need for a specialist visit
• In conjunction with the clinical team used medical records requests, qualified new member into CSHCS
• Act as the SME for the CSHCS team
Dell’s Prescription Center, Pontiac, Mi
Billing Manager, Feb 2010 - Sept 2013
• Audited claims for retail & long-term care pharmacy
• Obtained and managed of prior authorizations
• Inventory control and cost evaluation of all inventory
• Implemented Cycle-Fill System to streamline pharmacy filling and reduce error rate
• Implemented of aging A/R system to transition into a paperless system
• Pharmacy PDP (including part D) billing, A/R maintenance and cash posting for long-term care residents
Reliance Pharmacy, Canton, Mi
Billing Manager, Sept 2009 - Feb 2010
• Pharmacy PDP (including part D) billing, A/R maintenance and cash posting for long-term care residents
• Obtained and managed prior authorizations to ensure coverage and prevent therapy interruption
• Managed collections and recovery for past due claims and private accounts
Infusion Partners, Auburn Hills, Mi
Reimbursement Specialist, Nov 2006 - Apr 2008
• Performed medical billing, collections and accounting for infusion therapies
• Obtained and managed prior authorizations ensure coverage and prevent therapy interruption
• Managed collections and recovery efforts for past due claims and private cash payment accounts
The Harvard Drug Group, Livonia, Mi
Medicare and Medicaid Research Associate, Sept 2005 - July 2006
• Created sales tools through research of covered prescription and over the counter products within The Harvard Drug Group’s portfolio by Medicare and Medicaid
• Analyzed profit margins for Medicaid covered prescription and over the counter products within The Harvard Drug Group’s portfolio by Medicare and Medicaid
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