Judy Echols, Ba Email & Phone Number

Nashville Metropolitan Area

Greater Nashville Area, Tn

Responsible for greeting and directing convention guestsProvide event information as well as answer questions pertaining to local restaurants, hotels, transportation, parking, attractions, and internal convention events

Greater Nashville Area, Tn

Greater Milwaukee Area

• Managed a team of guest service employees during sporting and entertainment events • Handled all unanticipated issues during assigned shift • Resolved customer complaints, address behavior issues with staff members • Assigned work tasks for team members• Facilitated team meetings and shift briefings

Greater Milwaukee Area

• Acted as a non-clinical liaison between medical management, behavioral health, and provider relations departments, responsible for creating denial letters per medical determinations• Gathered clinical information for complex UM cases, determine appropriate internal referrals• Conducted initial review of incoming prior authorization faxes, documents all actions for new case referrals, prepared departmental reports, census reports, monthly data reporting• Resolved provider and member complaints telephonically • Worked closely with the medical director and clinicians to coordinate managed care for Medicaid subscribers

Greater Milwaukee Area

Responsible for managing suite staffVerified all guests had an admission ticket to attend concerts and sporting eventsHandled guests requests and inquires Addressed any issues or concerns by team members and guests

Greater Milwaukee Area

• Interviewed clinic patients for Federal and State Benefit Programs • Assisted patients with Medicaid applications for Badger Care and The Market Place Exchange• Referral source for internal clinic staff for enrollment in dental and state insurance plans • Participated in offsite community outreach events and health fairs to promote and market clinic services in women’s health, dental, pediatrics, internal medicine, and family medicine• Data Reporting; weekly, monthly and quarterly• Operated in a patient advocacy role, completed face to face assessments • Telephonic financial evaluations to determine eligibility for state and government-funded health insurance, pharmacy assistance, and Food Share state-funded programs

Milwaukee, Wi

• Supported the planning, coordination, and execution of training for Medicaid products• Preparation of classroom materials, scheduled training classes for new hires • Medicaid resource for team members and claim examiners audited Medicaid claims• Acted in a leadership role, SME (Subject Matter Expert) for Medicaid/Medicare lines of business• Responsible for team metrics to establish client productivity goals and turnaround times (TAT)• Assisted with performance management goals to reach Service Level Agreements (SLA)• Acted as a liaison between internal and external customers • Provided mentoring and work directives to lower-level associates

Nashville Tn And Milwaukee, Wi

• Responsible for communicating appropriate clinical data to internal and external providers • Worked with EMR (Electronic Medical Systems), coordinated new referrals and RN assignments• Conducted telephonic healthcare screenings, scheduled P2P conference calls for Physicians • Triaged prior authorizations, controlled end to end processes in the pre-authorization department • Entered, updated, and maintained the clinical database, tracked & reported data for clinical staff• Administratively managed & tracked medical data for follow up preventative care • Responsible enrolling members in outreach advocacy and community programs• Provided community and health care resources for Medicaid subscribers• HEDIS/NCQA audit preparation; file management to ensure compliance with state policies• Acted as a non-clinical administrator for Disease Management, Healthy First Steps, Private Duty, Home Health, Hospice, Utilization Management, Care Management, and NICU departments

Milwaukee, Wi

- Negotiated Per Diem, Inpatient and Physician reimbursement rates on medical insurance claims. - Extensive phone contact with attorneys, physicians and external vendors to determine negotiation rates for medical insurance claims (e.g. home health, long term care, hospice and nursing homes). Worked closely with nurses and case managers to determine rates for individual treatment plans.- Responsible for electronically creating case files, tracking payments and logging final claim reports.

Milwaukee, Wi

- Reviewed Medical History Records, Operative Reports and Police Reports.- Determined coverage eligibility after reviewing ICD9 and HCPCS codes submitted on UB82, UB92 and HCFA forms during the first 90 days of coverage. Investigated pre-existing medical conditions.- Worked closely with Underwriting and Clinical Review Departments to determine coverage limits and applicable policy exclusions based on clinical findings.

Milwaukee, Wi

- Responsible for Interpreting Individual Medical and Group Insurance policy language.- Reviewed Explanation of Benefits (EOB), reconciled claim errors on UB92’s and HCFA forms.- Administered benefit payments to private, commercial and government insurance carriers. - Extensive phone contact with pricing vendors (i.e. Multiplan, Concentra).

Prepared employee payroll biweekly for collections staff, as well as assigned administrative duties within the HR Department.

Bachelor Of Arts - Ba, Health/Health Care Administration/Management, 3.8

Activities and Societies: Student Council Member, Magna Cum Laude Honor SocietyGraduated with Honors

Associate Of Science (A.S.), Health Care Administration, 3.8

Communications