Robin Thornton Email & Phone Number

Long Island City, Ny, Us

Assure provider orientations, site visits, access, and availability studies are completed within established timeframes. Establish and maintain positive relationships with key providers by coordinating and facilitating meetings and identifying onsite enrollment opportunities. Deliver excellent customer service in a caring, professional, and courteous manner representing the company positively at all times.Retrieve Fidelis members’ healthcare records ensuring achievement of optimum QARR scores. Investigate and resolve member complaints regarding providers to maintain member and provider satisfaction. Assist Contract Management in developing and implementing strategies for the improvements in HEDIS/Star Scores, MRA documentation/coding, and meeting Medical Loss Ratios (MLR) goals. Provide contractual information for capitation, fee for service, and value-based programs. Complete credentialing and re-credentialing audits for delegated providers.

New York, Ny, Us

Developed lesson plans, activities, and assessments for students learning all subjects while under the guidance of the supervising teacher. Designed and implemented multiple learning activities. Used evaluative assessments to create and modify instructional grouping. Communicate with supervising instructional staff and professional support personnel for the purpose of assisting in the evaluation of progress.

New York, Ny, Us

Supports all aspects of departmental programming implementation from ITG development to testing of the finished product.Designs test plans for system modifications and additions.Identify, track, research and resolve system problems.Coordinate installation and testing of multiple systems, mainframe, Network Access, Internet applications, EMC, OCR, and Medicare Crossover. Supervises, coordinates and review all the work of assigned staff.

Conduct group site visits to ensure client satisfaction and provide details on available products.Respond to written and telephone inquiries from brokers regarding medical, dental and hospital coverage and claims.Research and respond to group enrollment issues, premium inquiries and claim payments.Interdepartmental liaison between Membership, Sales, Accounting and Underwriting.

Handled Group Administrators inquiries for small and large groups.Verified patient eligibility, processed claims, payments and refunds when required.Maintained inquiry reports to small business groups.Conducted group visits to ensure group satisfaction of claim processing enrollments and covered benefits.

Provided benefit coverage, contractual limitations and claim settlement information to subscriber and providers in a high volume area.Handled 100 plus subscriber and provider calls daily.Various clerical responsibilities.

Master Of Arts - Ma, Social And Public Policy

Bachelor Of Science, Community Health Education

Education record