Khadija Hamza Email and Phone Number

Working with DSPA Health Compliance and other internal teams to prepare comprehensive action plans and timelines for project deliverables. Drive initiatives from start to finish and perform various project related tasks, collaborate cross-functionally, along with administrative duties, like maintaining project documentation and communications.

Oversee and coordinate the operational aspects of consultant engagement program for North America and serve as a liaison between project managers and Legal & Compliance departments. Collaborate with key internal stakeholders to execute and improve processes and support global Ethics & Compliance training and monitoring efforts.

Responsible for planning, developing, communicating, implementation, or and evaluating programs that involve working with external entities and their corresponding resourcesas well as with the company's internal resources. Manage project and/or program managers withinassigned program and/or project. Works within the constraints of budget, schedule and scope whilemanaging risk and ensuring adherence to established processes and methodologies.

Responsible for planning, developing, communicating, implementation, or and evaluating programs that involve working with external entities and their corresponding resourcesas well as with the company's internal resources. Manage project and/or program managers withinassigned program and/or project. Works within the constraints of budget, schedule and scope whilemanaging risk and ensuring adherence to established processes and methodologies.

Uploading of provider notes and instructions to eOntrak, our proprietary database.Contacting providers for missing information and scheduling of member appointments.Making sure information in eOnTrak is accurate, notes and codes match.Making providers aware when members are nearing their session maximum.Scheduling initial and f/u appointments with providers, calling members to remind them of appointments.Sending required mailings, contacting members who have gone 30/60 days with no contact.Processing enrollment paperwork from members into the system.Checking member eligibility with health plan when alerted about loss of coverage.Researching invalid phone numbers and addresses.Scheduling provider training and distributing training materials.Matching provider note claims.Assisting with claims and reimbursement process

Developed and maintained business relationships with providers offices.Provided superior customer service for incoming and outgoing telephone calls to or from members,providers, employer groups and other persons deemed necessary by management.Provided expertise claims support by reviewing, researching, and investigating all types of preventiveand clinical claims to ensure members received appropriate critical measures.Created claim letters to send out to external customers utilizing the UHG data software.Provided routing administrative support for clinical projects.Served as a day to day contact to address client’s requests, contractual obligations, work procedures,appointment request for MD’s, scheduling and other elements of supporting assigned clients.Worked as a liaison between members, physicians’ offices, and functional team including nurses, socialworkers, and medical directors.Documented all outcomes by maintaining records, reports, and statistics as required.Managed administrative intake of members or the physician office for request of prior authorization.Managed the referrals process, processing incoming and outgoing referrals, and prior authorizations.Review request for adverse determination, approval notification, and processing notificationrequirements.Reviewed gap requests and determined gap exceptions according to health policies.Reviewed and processed prior authorization denials.Establish and maintain effective working relationships with co-workers, supervisors, manager.Confirmed scheduled surgeries of patients by calling physician offices. Medical coding and coveragedetermination necessary for claim processing.Make outbound calls to contact Providers, requesting clinical from provider as necessary.

• Contact patients to introduce and explain the benefits of the MTM program• Manage confidential database containing patient information.• Schedule appointments for the MTM Pharmacist to complete the Comprehensive Medication Review or the Targeted Intervention.• Maintain clear and consistent communication to foster healthy stakeholder management.• Encourage team members to think out of their silos and share ideas to enhance operational efficiency and maintaining healthy work environment.• Send out weekly pharmacist schedules to team members• Create weekly/monthly reports for tracking purposes with Word & Excel• Establish new patients and create electronic files for them• Communicate with pharmacists, long term facilities, and other organizations as needed• Follow and properly execute company MTM policies and MTM procedures• Handle excel reports, special projects and additional job tasks.• Contribute by handling inbound team call overflow.• Work closely within a team structure.• Maintain professionalism