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 appointments and route information.• 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 • 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 appointments and route information.• 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 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.• Participates in cross training of responsibilities as appropriate. Show less

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 • 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 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• Maintain customer/patient confidentiality Show less

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 • 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.• 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 • 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 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 • 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 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• Performance standards of 15 claims/hour with 97% or above financial and procedural quality & accuracy rates Show less

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 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 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 • 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 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 • 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 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 • 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 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 • 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 processing and completion of all mandated applications and accompanying documentation. • 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 case • 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 • 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 case • 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 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 • 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 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 • 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 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 • 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. • 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