Ciara W. Email & Phone Number

Pittsburgh, Pa, Us

Pittsburgh, Pa, Us

Lake Forest, Illinois, United States

Pittsburgh, Pennsylvania, United States

- Support the implementation and optimization of various operational processes and systems. - Complete UAT and SIT testing as required. - Assist the monitoring of operational processes and procedures. -Communicate efficiently and effectively with stakeholders. - Work with cross-functional teams to identify and resolve issues. - Create guides to assist team members and host training sessions as necessary.- Ensure testing documentation is organized in an easy to follow, professional manner.-Participate in all DCO and requirement gathering meetings- Assist management by gathering information from a wide variety of sources , organizing it in a complete and concise manner that can be universally understood.- Supports Management in department-related research and projects as requested.- Ability to perform complex research and analysis to support business operations.- Develops recommendations to address problems/issues and makes presentations to the supervisor, project leader or manager.

Pittsburgh, Pennsylvania, United States

Pittsburgh, Pa, United States

- Monitor the inventory of complaints, grievances and appeals. - Ensure that the cases are assigned and processed according to regulatory and accrediting requirements. - Monitor cases for completeness, accuracy and timeliness. - Evaluate the department processes and make recommendations to improve operational performance. - Continually examine team performance against department standards. - Assess needs for staff training and development. - Assist in the development of training materials and training for staff. - Maintain a positive work environment through employee recognition and interaction.- Prepare staff performance reviews. - Participate in interviewing, hiring and training of team members.- Collaborate with other departments or external customers in the identification of opportunities and the development of action plans.- Monitor and prepare routine reports.- Manage special projects.

Pittsburgh, Pennsylvania

In addition to the Provider Appeals Coordinator, the Provider Appeals Coordinator II has additional responsibilities of:- Mentor new hire staff throughout onboarding. - - Distribute case workload to Provider Appeal Coordinators.- Monitor management reports including but not limited to timeliness, case volumes, overturns and identify opportunities for improvement. - Support implementation of special projects.

Greater Pittsburgh Area

Investigate member complaints and grievances, and provider appeals, and respond in writing according to department standardsEffectively utilize key internal and external Health Plan contacts, including: Health Plan staff, providers, and external review organizations, to help in this process. Organize all tasks within regulatory requirements/deadlines. Understand and interpret medical information, recognize trends, and identify opportunities for improvement within the Health Plan.

Shea Medical Center

Interview and register patients at the time of or prior to the visit dateConfirm/verifies insurance benefits with the appropriate carrier via online verification systems or telephone inquiriesSchedules appointments based on business unit requirementsCollects and records patient payment including coinsurance, copayment & deductibles

Pittsburgh, Pa

Investigate member complaints and grievances, and provider appeals, and respond in writing according to department standardsEffectively utilize key internal and external Health Plan contacts, including: Health Plan staff, providers, and external review organizations, to help in this process. Organize all tasks within regulatory requirements/deadlines. Understand and interpret medical information, recognize trends, and identify opportunities for improvement within the Health Plan.

Pittsburgh, Pa

Conduct case intake process, via cases received through verbal and written requests, and set up new cases in the C&G information systemAccurately and promptly assess, enter and maintain documents in files and/or databases to assure that information is organized and readily available.Identify and escalate priority and expedited issues to management within a timely manner.Complete data entry into various information systems to support C&G processes

Pittsburgh, Pa

Maintains comprehensive understanding of member benefits, covered benefits, limitations, exclusions, policies and procedures, computer screens and code definitions, and maintains current awareness of plan changes and developments.Aids members, providers, prospective members and others, both internal and external, with information concerning benefits, coverage, procedures, etc.Works with the care management staff, and other staff as appropriate, to develop necessary materials; special projects; member/provider alerts; and ability to discuss new procedures with members and providersContacts assigned members for various outreach and follow up initiativesAssists members in the identification of providers and/or other community resources.Determines if the member needs intervention by the Care Manager for emergent or urgent situations as directed by protocol.Receives member and provider complaints, attempts resolution, and logs data.Coordinates members' use of the complaint process and assists Members, as needed, at all levels of the complaint process according to policy.

Pittsburgh, Pa

Provide ongoing guidance, mentoring, feedback & motivation to staff to ensure competent performance while adhering to department & PHEAA policies & procedures.Interview & recommend prospective candidates for open departmental positions Recommend and/or make decisions in personnel related matters (performance review, disciplinary actions, and terminations). This includes monitoring attendance, leave requests, ensure accuracy of hours worked & adherence to Agency policies & procedures

Mechanicsburg, Pennsylvania

Reviewed borrower accounts & adjustments made to the accounts to ensure all representatives are following regulations & procedures Monitored recorded phone callsAssisted on special projects, compiled information & provided feedback after reviewing borrower accounts & representative workAnalyzed trends while reviewing incoming phone calls and processing tasks

Mechanicsburg, Pennsylvania

Provided outstanding customer service to borrowers, school representatives & third party service providersProcessed tasks on borrower accounts as accurately & efficiently as possible in numerous queuesAssisted other representatives with any questions they may have while they're processing

Bachelor Of Science - Bs, Exercise Science

Health And Physical Education/Fitness

N, General Studies

High School Diploma