Saane Pongi Email & Phone Number

Portland, Oregon, United States

Lake Oswego, Oregon

Portland, Oregon Area

• Utilize various resources to identify and develop leads for potential new contracts to resolve gaps in the network • Conduct analysis related to provider contract renewals, including payment methodology • Participate in contract negotiations and perform financial impact analysis by using claims data to calculate the bottom line impact• Build relationships with new providers and preserve strong relationships with existing providers • Monitor and evaluate provider performance to determine compliance with contractual obligations • Review and negotiate contract language request from hospitals, physicians, and ancillary providers

Portland, Oregon Area

• Communicated job expectations and provided training/tools to ensure successful performance of individuals and team• Created new training manual and related documents for new Service Coordinators• Provided weekly reviews and recommendation to Service Coordinators’ caseloads• Represented the department in management team meetings and planning work groups • Compiled data and submitted weekly reports to Management team for review • Tracked staff attendance and processed time card

Portland, Oregon Area

• Scheduled and facilitated staff training for new team members• Ensured all roles within the P2ORT worked collaboratively with other departments • Received and resolved escalated calls from providers and members regarding benefits and claims• Participated in internal and off-site interdisciplinary care team (ICT) meetings • Maintained a low to moderate acuity caseload• Assisted walk-in members with educational support and referrals to community resources

Portland, Oregon

• Contacted dual population members to fill out Health Risk Assessment over the phone • Assessed members’ needs and assigned cases in VITAL for Service Coordination follow up • Identified potential health, dental and nutrition related community resources for members with agencies serving low income population • Followed up with members to ensure needs are being met with requested services • Answered provider and member questions regarding referrals, authorizations, claims and pharmacy benefits • Provided administrative support to the Service Coordinators and Care Coordinators

Portland, Oregon

• Processed referrals and authorizations per Medicaid and Medicare guidelines• Assembled information concerning member’s clinical background and referral needs, and per referral guidelines provided appropriate clinical information for medical review• Answered provider questions about Medicaid and Medicare guidelines• Maintained procedures and documentations to support authorization process

Portland, Oregon

• Analyzed provider issues regarding claims payment, turn-around times and contracts to determine the causes of identified problems • Facilitated quarterly provider training workshops regarding new programs, changes in policies and system updates• Maintained Provider data base, loaded and updated new provider fee schedules• Performed internal audits of practitioner and facility credentialing and re-credentialing files to ensure accurate and quality performance standards comply with company policy

Portland, Oregon Area

• Answered incoming provider calls regarding eligibility, claims, pharmacy and benefits• Build sustainable relationships and trust with Providers through open and interactive communication• Provided all aspects of customer service to walk in members• Entered and updated PCP assignments

St. Helens, Oregon

• Maintained the Adult and Protective Services files to ensure they meet agency guidelines • Represented Columbia County at the monthly Home Care Worker meetings in Salem• Entered and processed Home Care Worker time cards • Provided administrative duties to support the Office Manager and Case Managers

Portland, Oregon