Sofia Hussein Mohammed Email & Phone Number

Pleasanton, California, United States

Pleasanton, California, United States

Responsible for handling member concerns through research and communication with involved departments/member. Partner with internal and external departments and staff to achieve resolution for member concerns. Manage database for cases. Responsible for timely case resolution and maintaining compliance, Participate in managing the organization's complaint and grievance process. Accountable for investigation of all issues including collection and documentation of appropriate data. Identify and address specialty/flagged cases and follow appropriate process for all types of cases. Communicate with a diverse set of internal and external clientele to achieve excellent results in the areas of complaint and grievance handling, compliance, documentation and enhancement of the member experience. Partner with and outreach internal staff, other MS departments, managers and physicians to resolve issues as quickly as possible. Research, resolve and communicate complaints and grievances filed by members and communicate Health Plan's decisions appropriately back to member or their authorized representatives. Ensure that complaints and grievances are processed in accordance with regulations, compliance standards and policies and procedures. Meet time frames for performance while balancing the need to produce high quality work related to complex and sensitive member issues. Ensure integrity of department database by thorough, timely, and accurate entry, consistent with regulatory protocols and effectively manage case resolution inbox everyday.

Pleasanton, California

Responsible for handling member concerns through research and communication with involved departments/member. Partner with internal and external departments and staff to achieve resolution for member concerns. Manage database for cases. Responsible for timely case resolution and maintaining compliance, Participate in managing the organization's complaint and grievance process. Accountable for investigation of all issues including collection and documentation of appropriate data. Identify and address specialty/flagged cases and follow appropriate process for all types of cases. Communicate with a diverse set of internal and external clientele to achieve excellent results in the areas of complaint and grievance handling, compliance, documentation and enhancement of the member experience. Partner with and outreach internal staff, other MS departments, managers and physicians to resolve issues as quickly as possible. Research, resolve and communicate complaints and grievances filed by members and communicate Health Plan's decisions appropriately back to member or their authorized representatives. Ensure that complaints and grievances are processed in accordance with regulations, compliance standards and policies and procedures. Meet time frames for performance while balancing the need to produce high quality work related to complex and sensitive member issues. Ensure integrity of department database by thorough, timely, and accurate entry, consistent with regulatory protocols and effectively manage case resolution inbox everyday.

Redwood City, California

The Clinical Assistant III is expected to handle assigned duties as well as coordinating day to day operations of their assigned area. Applies principles and expert knowledge to manage assigned processes. Identifies complex problems that often require expert knowledge and skill to resolve. The Clinic Assistant III is expected to handle most situations independently using general guidelines. Good performance is highly dependent on gaining the cooperation of others. The Authorization Specialist position is intended as an intermediate-level position for individuals with a strong background in verification of insurance eligibility, submitting and obtaining authorization for all outpatient clinic services (E&M and procedures) and ancillary (radiology, lab) procedures and a working knowledge of insurance reimbursement requirements of healthcare payers. Authorization Specialist will perform prior authorization activities in accordance with Payor regulatory guidelines, HIPPA and Compliance policies and Clinic department protocol. This responsibility is further defined as those specific duties that are assigned by the individual's supervisor which supports and advances the organization's and team's goals, as it relates to financially securing patient scheduled encounter requiring precertification/authorizations, prior to all services rendered.