Alisa Sharp Email & Phone Number

Parkville, MD, US

Rosedale, Maryland

• Ensure compliance of the Customer Service Department with NCQA, state (COMAR) and contractual requirements; Monthly and quarterly monitoring of member services stats, telephone stats and member satisfaction surveys
• Develop annual strategies to improve member compliance and HEDIS rates; Monitor strategy implementation, reports on progress and change initiatives when goals are not met
• Maintain a working knowledge of NCQA, state and contractual regulations/requirements; Ensure compliance with NCQA, state and contractual regulations
• Assist with the preparation of annual audits, including Delmarva, HEDIS, Medical Record audits
• Assist with medical abstraction, when needed
• Ensure Member Services telephone goals and service levels are met; Develop, implement and maintain policies and procedures according to NCQA standards; Analyze and evaluate Member Services reports, identify trends or.

Rosedale, Maryland

• Ensure Outreach Program member compliance with HEDIS, Maryland Value Based Purchasing Care Measures for the state and district requirements
• Ensure members receive outstanding customer service and highest quality healthcare services
• Monitor critical data on member wellness initiatives and other reports as required by the State of Maryland
• Responsible for development of annual Outreach Plan and Appraisal
• Facilitated collaboration with Quality Assurance, Case Management and Provider Relations to ensure quality improvement, disease management and health promotion
• Implemented Standard Operating Procedures used to educate and assist non-compliant members with obtaining care for compliance with HEDIS wellness programs including: mammogram & Pap smear, immunizations, EPSDT and.

White Marsh, Maryland

• Monitor State/DHMH referrals to assist members with complaints and inquires regarding MCO Benefits and Services, such as pharmacy issues, provider complaints and access to care
• Input all member complaints and inquires in Customer Service Assessment in CCMS, make sure all complaints/inquires are addressed and send letters to appropriate parties concerning any provider issues
• Assure all complaints/inquires are addressed and resolved in mandated timeline depending on issues
• Research eligibility of a newborn whose MCO assignment is in question and confirm for the provider the MCO to which the newborn is assigned
• Coordinate and authorize out of network care in the cases where the MCO cannot offer the newborn an appropriate in network provider
• Facilitate the resolution of claims for service provided to newborns and or direct a provider to the appropriate e claims contact for assistance

White Marsh, Maryland

• Complete Welcome Call Assessment with all new Helix Family Choice (HFC) members in a courteous manner and within the required time frames.
• Accurately document all member outreach efforts, successful and unsuccessful
• Obtain pertinent member information from the Health Risk Assessment (HRA) and refer member to Case Management as indicated on the Case Management diagnosis trigger list.
• Facilitate member understanding and utilization of the HFC Benefit Plan, resolves member inquiries and assists the patient in coordinating care or services when requested or required.
• Investigate to locate members to facilitate coordination of care. Work closely with the member, case management staff, clinical staff, health care providers and local health departments documenting all care.
• Coordinates and arrange transportation for HFC members when criteria are met.