Roberta Thorpe Email & Phone Number

• Acts as the first point of contact with all customers, taking non-emergency transportation reservations through various sources. Securing transportation with providers, verifying trip details, and confirming medical.
• Manages high volume of inbound and outbound calls within specified performance metrics, including average handle time.
• Maintains an acceptable level of quality assurance, within specified performance metrics, company policies and… Show more
• Maintains an acceptable level of quality assurance, within specified performance metrics, company policies and procedures and compliance to contractual plan call handling processes.
• Remains available and engaged to assist with call volume as scheduled, achieving departmental schedule adherence goals.
• Manages requests using telephone, voicemail, and computerized scheduling systems and records incidents and complaints and refers to Manager for resolution.

Stratford, Connecticut, United States

• Supervise the store’s crew through assigning, directing and following up of all activities.Effectively communicate information both to and from store management and crews.
• Check in various vendors and ensure store inventory is accurate through POS system.
• Set and recommended mark-up rates, markdown rates and selling prices for merchandise, monitored and analyzed sales records and consumer purchasing trends.
• Assist customers with their questions, problems and complaints by… Show more
• Assist customers with their questions, problems and complaints by promoting CVS customer service culture.
• Handle all customer relations issues in accordance with company policy and promote a positive shopping experience for all CVS customers

Shelton, Connecticut, United States

• Interacts with external service providers and the Option Care Commercial Team to transition newpatients onto service with Option Care.
• Coordinates the onboarding of referrals between different functional areas within Option Care includingPharmacy, Nursing, Warehouse and Revenue Cycle.
• Proactively maintains and grows relationships with referral sources and serves as a key point of contactand representative of Option Care. Attend meetings with key accounts as needed.
• … Show more
• Communicates frequently with the Commercial team to provide updates on patient referral status andresolve any related issues.
• Responsible for collecting, reviewing and completing applicable care transition documents. Participateswith any data collection required. Show less

Shelton, Connecticut, United States

• Organizes patient documentation in advance of claim preparation, notifies reimbursement of missing documentation, monitors unbilled for missing documentation.
• Responsible for coordinating patient benefit reauthorization process by tracking documentation for completion by patient/physician, verifies for accuracy and completeness once returned.
• Facilitates Referral received notification back to referral source. Performs routine clerical duties such as data entry, filing, compiling… Show more
• Facilitates Referral received notification back to referral source. Performs routine clerical duties such as data entry, filing, compiling and/or posting records, and photocopying as needed in the department.
• Scanning, indexing, processing incoming faxes and assisting with referral tracking.
• Accepts other responsibilities and duties that may be assigned. Show less

New York City Metropolitan Area

• Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
• Analyzes and approves routine claims that cannot be auto adjudicated, responsible for reviewing denied claims and managing the claim appeals process.
• Facilitate training when considered topic subject matter expert and participate in projects as required.
• Work with the… Show more
• Work with the management team to stay updated on claims processing criteria, regulatory updates, new benefits and/or products and be informed of any changes in company policies.
• Demonstrate a thorough knowledge of the Plan's claims processing procedures as provided in training materials and proficiency with the core and ancillary system applications

Greater Nashville Area, TN

• Receive request for authorization from hospitals, providers, members and vendors; Meet service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to Answer, abandonment rate).
• Determine authorization requirements based on company policy, member benefit grid and provider status.
• Review authorization requests and make determinations on correct authorization process (i.e. auto approve, refer to Precert Nurse or Medical Director).
• Maintain benchmark standards for… Show more Receive request for authorization from hospitals, providers, members and vendors; Meet service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to.
• Maintain benchmark standards for TAT (Turn Around Time) as established by the organization.
• Provide determinations on authorizations request to members and/or providers based on benchmark standards for authorization decisions. Process extensions of authorizations as appropriate. Show less

Nashville, Tennessee

• Processes coverage determination requests received by mail, fax, electronic portal or telephone. Works in various queues to ensure proper handling of all processes related to coverage determination requests.
• Works with time sensitive material and must adhere to mandates turnaround times on all work.
• Responds to inquiries from customers for information and assistance related to coverage determinations.
• Performs research to respond to inquiries and interprets policy provisions to… Show more
• Performs research to respond to inquiries and interprets policy provisions to determine most effective response. Developed and published useful job aids for ongoing projects and tasks.
• Makes outbound notification calls to members and/or their appointed representatives regarding status of requests. Seeks assistance with complex customer services issues. Show less

La Vergne, TN

• Examined merchandise to verify that it was correctly priced, displayed, and organized racks and shelves to maintain the visual appeal of the store.
• Greeted customers and ascertained customers' needs. Stocked shelves and supplies and organized displays.
• Attended weekly store meetings, participated on the safety team and reported to the assistant manager regarding all store and staff issues.
• Managed and assigned employees to specific duties to best meet the needs of the store and… Show more
• Managed and assigned employees to specific duties to best meet the needs of the store and instructed staff on appropriately handling difficult and complicated sales.
• Set and recommended mark-up rates, mark-down rates and selling prices for merchandise, monitored and analyzed sales records and consumer purchasing trends. Show less

Franklin, TN

• Develop and implement HCH provider recruitment strategies in targeted groups, working with providers to achieve agreement to participate in network and follow up to ensure return of contracting documents.
• Gathered and validated targeted provider’s demographics, retrieval of contracting materials, and engage key decision makers to meet network and strategic goals.
• Identify barriers to achieving contracting goals and enrollment growth and recommend solutions through various strategic… Show more
• Identify barriers to achieving contracting goals and enrollment growth and recommend solutions through various strategic training sessions.
• Ensured maintenance of data quality standards for data entry of provider transactions and maintain accuracy in documentation daily in database.
• Manage front office operations, create and maintain files, folders and databases. Show less

Skyline Medical Center 3441 Dickerson PIKE Nashville, TN

• Re-verifies benefits and obtains authorization and/or referral after treatment plan has been discussed, prior to initiation of treatment. Ensures appropriate signatures are obtained on all necessary forms.
• Obtain legally relevant medical evidence, physician statements and all other documentation required for eligibility determination.
• Complete and file applications. Initiate and maintain proper follow-up with the patient and government agency caseworkers to ensure timely… Show more
• Complete and file applications. Initiate and maintain proper follow-up with the patient and government agency caseworkers to ensure timely processing and completion of all mandated applications and accompanying.
• Ensure all insurance, demographic and eligibility information is obtained and entered into the system accurately. Document progress notes to the patient's file and the hospital computer system.
• Participates in ongoing, comprehensive training programs as required. Show less

Nashville, TN

• Provides case management services for assigned children and families: gathers information (e.g., child’s school records, psychological evaluation report, or medical exam results) relevant to an assigned child welfare.
• Refers family to service providers (e.g., counseling service, parenting training program, alcohol & drug treatment program) needed to meet the objectives of permanency plan
• Met with child on a regular basis to provide counseling and assess progress toward meeting… Show more
• Met with child on a regular basis to provide counseling and assess progress toward meeting objectives of permanency plan
• Participated in regular treatment team meetings and communicated with DCS case manager to report progress and obtain feedback on child’s status Show less

Nashville, TN

• Collects and processes renewal applications for general contractors and limited licensed electricians and plumbers.
• Organize and provide documents, reports and information to department and external clients in an useful and well-organized manner
• Handle and screen telephone calls, emails, routine mail and reallocate as required.
• Manage front office operations, create and maintain files, folders and databases.

Nashville TN

• Ensure that each customer receives outstanding service by providing a friendly environment, which includes greeting and acknowledging every customer, solid product knowledge and all other aspects of customer service.
• As floor sales leader helped managed stores day to day operations ensuring store productivity reaches highest standards.
• Accurately and efficiently handling sales transactions and informing customers of daily promotions and exceeds quota for company sales credit… Show more
• Accurately and efficiently handling sales transactions and informing customers of daily promotions and exceeds quota for company sales credit applications.
• Maintained working knowledge of store’s policies and procedures. Show less

Nashville, TN

• Interviewed and determined eligibility for social services programs such as Medicaid, Food Assistance Programs, and Families First for Davidson county residents.
• Using various computer systems and databases such as Microsoft Access and Outlook to process and track documents and FileNet and ACCENT.
• Re-scheduled appointments as needed, paperwork deadlines, filing, client contacts, and other work activities in a systematic and effective manner.
• Seek and distributes information of… Show more
• Seek and distributes information of community resources outside scope of required work in order to better help applicants for government assistance and ensure customer satisfaction. Show less

Nashville TN

• Collects and processes applications for Medicaid, Food Stamps, and Families First and various amounts of verification's to be submitted to caseworker for determined eligibility.
• Filed emergency applications for First Response May 2010 Flood and worked closely with FEMA. Using various computer systems such as Microsoft Access to process and track documents.
• Schedules appointments, paperwork deadlines, client contacts, and other work activities in a systematic and effective manner.… Show more
• Schedules appointments, paperwork deadlines, client contacts, and other work activities in a systematic and effective manner.
• Seek and distributes information of community resources outside scope of required work in order to better help applicants for government assistance and ensure customer satisfaction. Show less