Morgan Mcdaniel Email & Phone Number

Fairview, NC, US

Asheville, North Carolina, United States

Asheville, North Carolina, United States

Asheville, North Carolina, United States

Asheville, North Carolina, United States

Greater San Diego Area

• Provide excellent service and support to San Diego network of providers, including PCPs, ancillary, and specialty networks while assisting with credentialing, contracting, claims issues, and providing education
• Receives, researches, and resolves provider inquiries such as claims, eligibility, and other inquiries. Act as a liaison between the providers, medical groups and health plan.
• Provide assistance and back up to team of Provider Service Representatives that are primarily in the field by handling documentation of New Provider Orientations, putting together of New Provider Orientations, and.
• Represent Molina Healthcare at meetings in the community and at the office with providers and provider staff
• Project manage provider database in terms of addition and/or editing of provider information as it pertains to onboarding, credentialing, and terminating network providers
• Ensure that provider network is educated on a quarterly basis at the least on managed Medi-Cal, Medicare, and Covered California policies and procedures i.e. HEDIS, utilization management, claims, case management.

Greater San Diego Area

• Provide excellent quality of care and customer service to members seeking and/or involved in mental/behavioral health treatment that include a broad continuum of care, which includes working with Behavioral Health Care.
• HEDIS functions for acute inpatient admissions to include assisting with referrals and appointments for step down to lower level of care to reduce recidivism and support member needs
• Ensure clear, concise documentation and HIPAA compliance for all cases worked on using WMDS
• Provide administrative support to Behavioral Health department to include benefits clarification using Mainframe and Call Care Browser, research information in EOCs as it pertains to benefit authorization or denial.
• Transcribe clinical reviews for Care Managers accurately and quickly, using proper terms and abbreviations for clinical terms, including medications and instructions for use
• Oversee projects using SMART goals to ensure that they are completed in a timely manner. Projects included creating files for analyst based on specific needs and ensuring that any and all identifying information is.

Greater San Diego Area

• Assist principal investigator and project manager with data collection, analysis, statistical calculations, and organization of materials related to Boca Sana, Cuerpo Sano community-based participatory research project
• Create multiple linked Excel worksheets, organize data, perform literature searches and present reviews to principal investigator
• Assist with grant writing for multiple health-related initiatives
• Attend meetings with key stakeholders and community agencies to promote awareness of Boca Sana, Cuerpo Sano and assist in developing curriculum for the program
• Contact potential key stakeholders and/or supporters of work by writing personalized Letters of Support for their review and potential signature, or calling and inciting stakeholders to provide a Letter of Support
• Audit dental providers all over San Diego County to evaluate the availibility of providers, particularly bilingual, for Medi-Cal or uninsured patients as well as to provide evidence and support for the need of more.

Greater San Diego Area

• Responsible for coding and billing of outpatient mental health claims for multi-facility clinic both electronically as well as those that must be billed on paper, including dropping secondary insurance claims to paper.
• Singularly responsible for billing charges for hospitalists within practice
• Extensive knowledge of managed care, military healthcare (TriCare & UHC), Medicare, Medi-Cal (Medicaid), PPOs, HMOs, IPAs, Capitated, and other types of insurance as well as their billing requirements including Parity.
• Post remittances from insurers and private pay to patient accounts, pursue collections from patients, provide multiple reports to Controller regarding billing income, collections accounts, number of processed claims
• Handle denials by insurers, obtain pre-authorizations, supervise billing for Eastlake offices and for multiple insurance companies
• Write and submit primary or secondary appeals to insurers when needed, and in most cases, payment was remitted

Greater San Diego Area

• Handled high risk cases over the phone by conducting triage and scheduling; assisting the clinicians and administration with referring patients to higher levels of care, including facilitating the hospitalization.
• Assist Quality Management Team by providing concise, detailed summaries of cases, issues, etc. and following direction for patient accounts that had legal or other considerations (ex. Child custody arrangements, POA.
• Responsible for completing intake process for new and existing patients, including scheduling and verifying insurance benefits as well as getting authorizations when needed
• Provided excellent customer service in a high call volume, fast-paced environment that was responsible for the scheduling and insurance verification for patients being seen at six office locations around San Diego.
• Assisting patients with scheduling with a provider that meets their needs or criteria as well as offering and scheduling dual referrals, where they may be seen by both a psychiatrist as well as a therapist for a.
• Responsible for scheduling and insurance authorizations for CD IOP program at main office

Master Of Public Administration

Activities and Societies: Member of UNC Chapel Hill ICMA Student Chapter Student member of NCCCMA Student member of ASPA

Bachelor Of Science (B.S.), Public Health

Activities and Societies: Students for Public Health and Scholars Without Borders

H.S. Diploma

Education record