Johnathan Turner Email and Phone Number

Serve as primary contact for providers and act as a liaison between the providers and the health plan • Conduct monthly face-to-face meetings with the provider account representatives documenting discussions, issues, attendees, action items, and research claims issues on-site, where possible, and route to the appropriate party for resolution • Receive and effectively respond to external provider related issues • Provide education on health plan’s innovative contracting strategies • Initiate data entry of provider-related demographic information changes and oversee testing and completion of change requests for the network • Investigate, resolve and communicate provider claim issues and changes • Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics • Perform provider orientations and ongoing provider education, including writing and updating orientation materials • Ability to travel

• Provide health education and coaching to members tailored to issues identified within treatment and service plans.• Coordinate with various healthcare providers for diagnostics, ambulatory care, and hospital services.• Assist members with social determinants of health including access to exercise and healthy food.• Promote activities focused on health of patient and their community, including without limitation outreach, quality improvement, and patient panel management.• Coordinate community-based management of medication therapy.• Fielded provider, client, and employee phone calls regarding PPO network.• Completed assessments with elderly people with long-term health issues, to identify support services needed in home or facility setting.• Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information• Maintain confidential health information according to state and federal regulations including HIPAA.• Serve as liaison between Integrated Health Care Management and Utilization Management departments.

• Coordinates activities of committee to create win-win outcomes and leads with vision to further agenda of labor movement• Presides and conducts meetings following Robert's Rules of Order in accordance with UAW Constitution• Review employer practices and employee data to ensure compliance with contracts on matters such as wages, hours, or conditions of employment• Administers and handles labor relations issues, collective agreements, and mediation disputes within organization• Assures adherence and implementation of collective bargaining agreements and memorandum of agreements• Reviews and documents union grievances and other contractual matters through grievance process.• Managed over 250 employees.• Follows Seven Steps of Just Cause Discipline, conducts thorough investigations, interprets contract language, and develops solid workable solutions• Leads bargaining committee in labor contract negotiations and monitors management adherence to agreements• Investigates and evaluates union complaints or arguments related to following employee services; payroll, benefits, leave of absence, unemployment, harassment, and workforce administration.• Negotiated collective bargaining agreements.• Provided expertise on labor and employment laws to help employers make more effective decisions.• Improved operations through consistent hard work and dedication.• Demonstrated respect, friendliness and willingness to help wherever needed.• Reduced grievances and arbitration need by educating frontline managers on techniques for enhancing interactions between labor and leadership.• Completed in-depth investigations into issues pertaining to discipline and grievance management and recommended strategies.• Mediated discussions between employer and employee representatives in attempt to reconcile differences.• Interpreted and advised on labor relations policies and previously negotiated agreements.

• Managed day to day operations and serves as primary liaison between client and multiple internal groups to ensure clarity of goals and adherence to deadlines• Research inquiries by accessing claims processing system and maintains related departmental records• Reviews and prepares orthodontic and complex service claims for processing• Consults with HR personnel and client account managers regarding eligibility, enrollment, and bene t portal matters• Coordinates and assists with annual open enrollment implementation initiatives• Responds to manager escalations and identifies problems while investigating business concerns and recommends practical solutions• Researches and provides information regarding member eligibility, bene ts, referrals, authorizations, and claims• Translates policy language and concepts into clear, simple and understandable information for clients and maximizes potential for them to take equitable action• Conducts internal and external research and reviews subscriber's coverage to determine type and level of benefits• Provided knowledgeable service and support for all customer needs.• Helped large volume of customers every day with positive attitude and focus on customer satisfaction.• Coordinated with operations staff to resolve service problems and boost client satisfaction.• Introduced clients to available online resources and services to increase convenience.• Responded to customer calls and emails to answer questions about products and services.• Cultivated long-lasting client relationships based on trust and solid understanding of business needs.• Resolved concerns with products or services to help with retention and drive sales.• Communicated with clients regarding account services, statements, and balances.• Accepted and processed payments, updated accounts and issued receipts.