Elliott Sparks Email and Phone Number

Promises Behavioral Health, formerly Elements Behavioral Health

1/2016-Present: Elements Behavioral Health10/16 to Present: National Appeals Manager and UR Business Analyst Modified UR and AR documentation processes to create daily authorization status reports for 25 treatment facilities showing census by level of care, current authorization, expired authorization, denial, and self- pay statuses at company-wide, facility, and individual patient levels  Collaborated with National UR Director, corporate Executive Leadership, and facility Executive Directors to establish standard communication and action plans based on patient authorization status Created trending reports based on authorized days, denied days, level of care, and facility with primary focus on authorized day trending and proportion of days authorized at higher levels of care Created and routinely produce financial reports with focus on individual payer reimbursement and denial (i.e. denials for all reasons) patterns Comprehensive oversight of clinical appeals team responsible for appeals and medical records requests associated with average daily patient census of 750. Appeals team has won over $1.5M in appeal and medical record submissions to payers1/2016 to 9/16: Clinical Appeal Specialist and UR Business Analyst Wrote clinical appeal letters establishing medical necessity according to ASAM and payer level of care guidelines Created systematic approach for submission and prioritization of clinical appeals and routine medical record submissions based on dates of service, amount billed, and payer appeal criteria Established internal documentation and communication processes among UR, AR/collections, and appeals staffs to rate, prioritize, and maximize appeal-ability of accounts Created and standardized clinical appeal letter templates based on ASAM and payer level of care guidelines

8/13-5/15: Director of Community Care Startup and comprehensive oversight of inner city outreach/care coordination program for high risk, chronically ill, and high cost members with serious physical and/or behavioral health conditions (including substance use and co-occurring disorders) Spearheaded all start-up activities including procurement and development of real estate, hiring staffs, writing SOPs, and training Success of the program resulted in expansion from 12 employees in Memphis, Nashville, and Knoxville to 70 throughout the state, adopted nationally by UHC as the core of its public sector clinical outreach programs.  Integrated existing nurse case management programs with community health workers Worked closely with UHC Accountable Care medical providers to initiate and coordinate care for chronically ill, high cost members to ensure closure of care gaps and decrease subsequent utilization.  Partnered with health care providers, transportation vendors, and community partners to modify services or create services to meet member care and basic needs Received award for outstanding contributions as a principal RFP writer for UHC’s successful $10.5 billion rebid for TennCare Medicaid contract TennCare Medicaid Population Health subject matter expert

3/11 – 8/13: Director of Behavioral Health Field Care Management  Managed a team of 26 Field Care Managers, discharge specialists, and managers (2) responsible for coordinating care for high risk members with serious psychiatric illnesses, co-morbid physical health and/or substance use disorder conditions  Created tools & processes for continuous improvement of all department activities  Aligned resources and efforts to meet utilization targets Collaborated with physical health and behavioral health Utilization Management and Case Management, CHOICES, Quality, Contracting, Compliance, and Provider Relations Established effective, productive relationships with multiple external and internal partners, to include an excellent working relationship with the TennCare Population Health oversight team Compiled data and created all behavioral health case management TennCare reports per TennCare specifications to include both annual and quarterly reports with written analyses.  Responsible for compliance with internal/external regulatory and stakeholder requirements and deliverables including TennCare, Quality, Compliance NCQA, and consent decrees

2/08-3/11: Manager of Behavioral Health Field Care Management Managed statewide team of 10 Field Care Managers (FCM) coordinating care for high risk members with serious psychiatric illnesses as well as co-morbid physical health and/or substance use disorder conditions.  Wrote and implemented all FCM SOPs and job aids for startup FCM program Responsible for all TennCare behavioral health case management deliverables to include compilation of all quarterly and annual case management reports for TennCare