Michelle Mathis Email & Phone Number

Canton, Ct, Us

United States

Cromwell

DSS T19- Manage Care. Behavioral-Home Health/Authorization & Insurance Eligibility.Responsible for ensuring the authorization of all patient care visits. Obtain and review clinical documentation via workload and clinical ques regarding care and patient status from field Intake department, RNs and Nursing Supervisors. Coordinates and tracks authorizations and patient status. Communicates authorization information, available resources to promote quality, cost effective outcomes for the agency and its payer sources.Medicaid or commercial insurance eligibility authorization.Home health care experience working managed care organization dual payorsvoral Health

Cromwell, Connecticut

Clear all patients via eligibility protocols prior to service in order to ensure proper payment in compliance within all legal and regulatory parameters, in cooperation with all other branch departments. Evaluates referrals against branch service model payors parameters. Equipment selection and utilization, and participates in the submission of clean claims through compliance to proper pharmacy, DME billing procedures.Communicates with various payors, referral sources, patients and Doctors/HospitalsVerifies eligibility and benefits.Obtain initial authorizations via fax or email.Resmed authorizations extension overides.

Farmington, Connecticut

Utilization review Medicare ER inpatient hospital authorization. Outpatient SNF, DME, Home Healtj..

Bloomfield. Connecticut

United States

Hartford, Connecticut Area

(SME) State of Connecticut Health Insurance Market Exchange. ACA-Affordable Care Act-HealthCare Reform.

Hartford, Connecticut

Escalated eligibility issues. EDI reports via Anthem CT care, Husky Medicare Medicaid verifying income guidelines Affordable Care Act (ACA) administration overrides, complaints and appeals. Educating customers via consumer portals. Enrollment, plan summary, members benefits, wellness programs. De-escalating issues before they reach the Governor Malloy, other third parties. Certification:STATE OF CONNECTICUTOFFICE OF STATE ETHICSPUBLIC OFFICIAL AND STATE EMPLOYEE TRAININGCERTIFICATION OF COMPLETION - March 03/7/2016

Hartford, Connecticut Area

Finance Corporate Tax Dept. /Workman’s Compensation/FSA.Identify associate needs beyond the initial inquiry by answering the unasked questions. Traditional-HMO-HNO cross trained. Product knowledge in Medicare (COB). Handled rework claims, respond to claim representative.Turnaround time for claims processed are handled correctly, efficiently, no interest. Claim adjudication ID 9, ICD 10, CPT, HCPC, medical billing and coding, provider billing Prepared final committee credentialing applications for providers. Strong analytical skills, ability to learn new technology quickly. Medical, Pharmacy, Behavioral Health care background. Eligibility enrollment, expert in Aetna systems. Answers questions and resolves issues as a single-point-of-contact based on phone calls, plan sponsors. Educate and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience. Utilizes all relevant information to effectively influence member engagement. Proactively assesses customer issues and anticipates their needs. Adhere to strict confidentiality guidelines and Code of Conduct standards, HIPAA regulations. (PHI), and HCR. Strong analytical skills, ability to learn new technology quickly. Medical, Pharmacy, and Behavioral Health care background. Eligibility enrollment, expert in Aetna systems. Answers questions and resolves issues as a single-point-of-contact. Educate and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience. Utilizes all relevant information to effectively influence member engagement. I'm very proud to have worked within the departments here at Aetna. Received several written letters of Customer service appreciation for going above and beyond from customers, my supervisors Victor Fontana(2), Lou Shimkowitz (1), and (3) letters with Annmarie Bennett.

Teleworking

Serves as the advisor to the Medical Director on clinical policies for approvals on authorization, and precertification for over 40 of our National Plan Sponsor/ Employers. Support Operation Courses for peace international. Peace keeping and international conflict resolution, working with the United Nations employees and provide methods and techniques for any humanitarian impact.Resolves cases involving various programs administered by the Employers Human Services; as well as cases involving benefit programs administered by other agencies; licensing of health-related occupations; enforcement of health-related regulations; and licensing of certain types of facilities, from our Insurance Market Places for alternative health programs for low income families, Health Care Reform Medicaid. Department of Mental Health/Disabilities.Adhere to strict confidentiality guidelines and Code of Conduct standards, HIPAA regulations. (PHI), and HCR. Strong analytical skills, ability to learn new technology quickly. Medical, Pharmacy, and Behavioral Health care background. Eligibility enrollment, Awarded Subject Matter Expert each quarter.I have prepared final committee credentialing applications for provider filesDeveloped and maintained strong relationships with community and employees referral sources, such as, schools churches, government resources centers and local businesses.Trained new employees on educational and medical records diagnostics evaluations and eligibility.Coaches, trains and assists in the development of call center staff, as required. Participates in and/or leads special projects/initiatives addressing service issues.Provides technical or subject matter expertise concerning policies, procedures, and function-related applications/systems tools as needed.