Empower seniors and families to make informed decisions about senior living options. Act as a Professional guide to support families through the “senior care maze.” Assist families with determining senior care options that best meet the needs of loved ones. Obtain full assessment of patients care needs, desired location, and services that are most important to the client. Establish trusted family relationships, serve as a fierce client advocate, and ensure homes or communities meet physical, mental, and medical needs for quality living. Lead with compassion, utilize expertise, and maintain integrityEngage with home health services, rehabilitation facilities, and hospices and obtain client referrals. Formulate marketing strategies for the intended referral segment and distribute advertising collateral. Research assisted living options, update related databases, and monitor activity within the territory.Assess state surveys and other pertinent information to ensure quality standards are met and match client needs.Oversee the full scope of the referral and placement process to include help with state aide applications.Interpret the latest data on senior care options and formulate opinions on which options are best suited for clients. Guide the family to the most appropriate facilities based on a variety of mutually discussed factors.Execute intake via software, generate client reports, review community data, and execute contracts, as required. Generate placement invoice, collect and record payments received, and complete contract and billing process with the group home/organization/entity once client is successfully placed.

Offer stellar support comprised of medical contracting and credentialing for dentist who specializes in Oral Facial Pain and Dental Sleep Medicine. Make contract recommendations based on payor client enrollment, reimbursement, and coverage. Additionally, negotiate medical rates on received insurance contracts to maximize provider reimbursement and revenue. Communicate with clients, insurance companies, and dental staff regarding contract recommendations and rates for the provided services. Utilize medical and dental terminology when negotiating contracts. Maintain client files and multiple contract databases. Utilize multiple Contracting Systems (PECOS, Availity, State Medicaid Portals, and Individual Insurance Carrier Portals).Deliver exceptional client service with every interaction.

Delivered exemplary leadership by defining organizational objectives, charting courses of action, and executing strategies that fueled growth while providing exceptional client service. Forged new payer relationships in breakout markets, executed contracts, upheld requirements, processed documentation, and cultivated referral business. Embraced the mission of offering an orthotic device to correct an abnormal head shape in infants. Credited as a key driver of organizational growth who helped expand the company from 5 employees to 500+ during tenure. Served as a Subject Matter Expert (SME) who educated Corporate Managers regarding managed care contracting, protocols, policies, and industry standard procedures. Promoted to manage the Authorization team during tenure; oversaw 15+ Authorization Coordinators remotely across multiple states. Additionally, hired quality candidates and drafted policies/procedures for the role. Offered insight and expertise regarding standard service models as well as select services; facilitated improved relationships and served as an advocate for augmented coverage. Leveraged acumen for negotiation to secure advantageous agreements with physician groups, hospital systems, IPAs, and managed healthcare firms.Served as a Member of the Quality Control Team and point of contact for all customer complaints for all clinics. Maintained complaint files per FDA regulations. Entrusted as a team member for all FDA Audits. Attended monthly quality meetings and offered reports on customer complaints and outcomes. Elevated internal processes, improved controls, and utilized creative problem solving while engaging cross-functional teams.Regarded as a knowledgeable resource and trainer for the Insurance Specialist Team for all function areas. Analyzed business and payer changes while formulating action plans for impacted departments and organizations; credited for integrating positive solutions that retained long-term business.