Mari Leon Email & Phone Number

Rancho Cucamonga, California, United States

Contact out-of-network providers and conduct rate negotiations on Member Letter of Agreements. Worked closely with management on Covered California Product Expansion and Implementation agreements, such as Specialty Care, Behavioral Health and Hospital Based Provider Agreements.Knowledge in researching Medi-Cal (DHCS) and Medicare (CMS) reimbursement rates..

Rancho Cucamonga, California, United States

Ensure all Contracts are current with IEHP’s contractual requirements which includes, NCQA, CMS and DHCS requirements for licensure, insurance, accreditation and audits.Subject matter expert (SME) for Provider Contracting Specialist, assist with any operational questions and provide guidance and clarity for processes. Ensure all incoming signed Letter of.

Rancho Cucamonga, California, United States

Work directly with the Chief Medical Director/Senior Medical Director on Peer Review Subcommittee/Credentialing Subcommittee cases and summaries.Preparation of Peer Review Subcommittee agenda to be approved by the IEHP Chief Medical Director.Preparation of Credentialing Subcommittee agenda to be approved by the IEHP Senior Medical Director.Extensive.

San Bernardino, California, United States

Knowledgeable in IEHP direct, delegated and vision credentialing process.Responsible for gathering and coordinating all credentialing information.Review new applications for IEHP direct, Vision Providers and Delegated packets.Process initial and reappointment applications.Prepare credentialing files to be approved by the IEHP Medical Director and Associate.

San Bernardino, California, United States

Communication with members (bilingual) providing information and assistance.Member health plan orientation, advocacy, and health education advisory.Maintain standard for member rights and responsibilities, such as confidentiality.Member primary care/facility assignments, selections, and changes.Supply eligibility status of members to providers.Assisted.

Perris, California, United States

Dental Assistant.Worked directly with dentist on treatment plans for patients.Verified patients’ eligibility, benefits, and scheduled referral appointments.Assisted with x-rays, sterilization of equipment.