Marieca Murphy Email & Phone Number

Baton Rouge, Louisiana, United States

Work with credentialing and contracting to ensure provider network adequacy for Medicaid/Medicare member's in a Managed Care setting.Ensures the provider network meets compliance and Louisiana Department of Health contractual obligations.

Work with credentialing and contracting to ensure provider network adequacy for Medicaid/Medicare member's in a Managed Care setting.Ensures the provider network meets compliance and Louisiana Department of Health contractual obligations.

Baton Rouge, Louisiana, United States

Baton Rouge, Louisiana Area

 Review and find solutions for member’s complaints submitted to the health plan Gather facts, analyze the root cause of complaints, and draft report on findings Assist with gathering and editing language for reports submitted to the state Make outbound calls to members and resolve issues over the phone when applicable Interact with various departments within the health plan to resolve member issues Maintain accurate records of all member grievances

 Work with internal and external providers to clear up issues with member’s eligibility.  Research and resolve claims issues  Maintain and track data regarding issues reported for eligibility issues via spreadsheets to identify and resolve trends.  Work with Medicaid and Medicare to investigate issues pertaining to member’s coverage.  Train providers on using billing systems and eligiblity information effectively Complete authorizations, when necessary, for mental health and substance abuse services in all levels of care. Stay up to date on current GPD coverage plans and corresponding services. Contact providers written and verbally to resolve issues.

 Assist callers with various Medicaid and Medicare issues. Complete intake for inpatient and outpatient mental health services. Responsibilities include answering incoming calls on eligibility, benefits, claims, and authorization of services from providers and members.  Responsibilities also include the administration of intake documentation in the appropriate systems.  Provide outstanding service to our internal and external customers and strive to resolve member and provider needs on the first call.  Meets or exceeds call center production standards. Actively listens and probes callers in a professionally and timely manner to determine purpose of the calls.  Resolves customer administrative concerns as the first line of contact - this may include claims resolutions and other expressions of dissatisfaction.  Refers patients/providers to the Magellan’s Care Management team.

High School

Education record