• Utilized Zscaler for secure logins to the CVS Health portal, leveraging multi-factor authentication with Symantec VIP one-time passcodes. Ensured compliance with stringent security protocols for case management and data access. • Managed both inbound and outbound calls to ensure customer satisfaction while maintaining adherence to risk management protocols. Applied standardized scripts and guidelines to minimize errors and mitigate potential compliance risks during customer interactions. Assessed call handling techniques to maintain quality assurance, enhancing overall service delivery and client satisfaction • Managed the creation and processing of over 60 cases daily, including prior authorization (PA) , appeal and grievances requests via the MHK system. Conducted detailed analyses of medication requests from providers using RXclaims, focusing on identifying claim rejection codes and corresponding reasons such as Prior Authorization (PA), Quality Limits (QL), Step Therapy, Non-Formulary, and Opioid Quality Limits. • Utilized internal note tools to extract critical information from providers, applying CVS Health’s DLT exception guidelines to determine appropriate responses. Facilitated clinical decision-making processes by evaluating criteria such as non-formulary medication justifications and quantity limit requests, ensuring cases were either approved, escalated for further clinical review, or routed to the Medical Director’s Office (MDO) for final determination. • Emphasized precision in timestamp management when creating cases within MHK, recognizing its impact on authorization decision thresholds. Ensured expedited requests were handled promptly to avoid auto-escalations, which could result in financial penalties for CVS Health. • Analyzed non-formulary requests by reviewing clinical information to determine the appropriateness of alternative medications, considering factors like potential adverse effects or ineffectiveness.

• Processing and submission of insurance claims, appeal and grievances. • Updating the client’s information in the EMR system. Prepare response letters for member and provider complaints, grievances and appeals• Verifies correct Medicaid coding to ensure prompt payment. • Checks to ensure that clinic records for clients include all information required for Medicaid and other insurance reimbursements. • Check authorization for providers clients and facilitates the OMS process as needed. • Creating and implementing healthcare service delivery improvement plans • Performing other administrative tasks as required.

• Ensure all clinical record for clients include all information required for Medicaid and other insurance reimbursements• Verify all Medicaid coding using Incedo and calling the Maryland public behavioral health system to ensure prompt payment • Consult with Optum and other payor agencies about any disputed claims and follows up on all bills • Process prior authorization for client’s medication management, doctor’s client and facilitates the OMS process as needed• Acting as a liaison with outside agencies such as government bodies and insurance companies• Documenting all process and maintaining records using celerity• Performing other administrative tasks as required

• Testing persons suspected of having COVID-19 for the virus SARS-COV-2 • Registration of participants data into testing database • Trained more than 40 staffs on how to use covid-19 testing kits • Prepare lab requisition and specimen tube • Assist with replenishing supplies

• Tender general assistance /information to patients and families. • Work with doctors and nurses with distribution of unit stock deliveries (medical supplies) as appropriate • Aid unit staff with the patient lunch program (7th floor infusion clinic) • Tender support/ conservation to patients receiving chemotherapy and disturbance complimentary items