Carrie Spitz, Lah Email and Phone Number

Responsible for reviewing, controlling provider issue requests to ensure the proper departments w/in the organization handle issues to resolution. Serves as a key triage/liaison and facilitator of provider issue resolution between the PR/Network Management Staff, internal support areas, and participating physicians, hospitals and large billing groups, to support the goal of improved provider satisfaction. Primary contact for internal departments on identified issues: complaints, grievances and non compliance with administrative processes. Support the goal of improved Member health, works in cooperation with Medical Services to review Provider data on compliance with administrative processes and care management programs, creates reports, and related tools that the PR Representatives can use to educate Providers.

• Supports sales representative with the management and retention of health care plans for a large book of businesses in the Rochester area • Collaborates with brokers that represent businesses and its employees regarding inquiries or issues associated with health care plan renewals, claims, membership, or billing matters • Maintains continuous communication with brokers and business human resource contacts regarding inquiries and resolutions to issues associated with employees’ health care matters • Demonstrates strong prioritization, organizational skills and professional communications • Utilizes various systems and software applications in order to process renewals of health care plans and assist employees with various health care inquries.

Responsible for our Employer group's Membership and Billing. I work with all employer groups and brokers on a daily basis. I also work closely with our Customer Service Department and Sales Department. I escalate and execute the enrollments in Urgent situations. I'm also responsible for reconciling the employer groups invoices based on their enrollment changes on a member and group level. My job is challenging, and exciting everyday.

Responsible for assisting provider’s, members with benefits and claims. Also work closely with our Membership and Billing, Grievance, Claims and Sales Department. Escalate and execute urgent calls. Responsible for reconciling provider remits, member’s deductible and coinsurance.

Supervisor over Front End Cashier employees. Assisted in morning and nightly audits of deposits and Cash Office. In charge of maintain the Guest Service return and Exchange program through Corporate Standards. Interviewed potential team members and gave feedback to HR. Required to give yearly reviews and help coach team members