Dawn Speegle Email and Phone Number

lead, Member Services Resolving escalated issues with members and providers Mentoring and coaching a team of 15- 20 employees Handle incoming telephone inquiries from internal representatives regarding benefits and claim processes. Trained on multiple states handled by Molina Healthcare (WA, WI, OH and FL) representatives calls Work the Member Services Webmail email box which is responsible for responding to e-mail inquiries regarding issues on their account within a contractual turnaround time of 1 business day. Monitor service levels Taking on any extra projects from supervisors as needed Engage and collaborate with other departments Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) Reviewing configuration, credentialing and claim processing per Molina guidelines for Medicaid, Medicare, and Marketplace claims. I: Explain Medicaid benefits to clients when they call in for clarification. Assist clients with navigating online provider directories for their primary care physician or specialists, working not only with the Molina online provider directory but also with the Health Care Authority's ProviderOne provider directory when benefits are a carve out covered by the state. Assign members to their chosen primary care physician when that change is necessary due to an automatic assignment or a problem with their current physician. Take client complaints regarding a provider, Molina representative, or process. Assist clients in seeking a reimbursement for a medication or procedure paid for out of pocket. Verify client eligibility and benefits for providers when they call, checking CPT (procedure) codes for precise information about how a procedure is covered through Molina Medicaid or Marketplace plans. Assist clients with billing issues when they are billed in error or balance billed. This process often requires calling a provide