Tessa E. Email & Phone Number

Minneapolis, Mn, Us

Bloomington, Minnesota, United States

Collaborate with Contracting team in the management of ancillary, national, and complex clinic agreements• Lead, manage, and participate in projects that will impact the team/department• Identify and recommend efficiencies that will contribute to the department’s success• Develop and maintain collaborative relationships and communications with matrix partnersand providers• Partner with IT as needed on system enhancements• Assisting with internal and external auditsMaintain protocols, job aides, and formsProcess behavioral provider contract amendment requests for individuals, clinics, and facilities• Create and maintain CPT fee schedules• Ensure all new facility and clinic contracts are loaded per the terms of the contract• Process provider termination requests• Respond to internal and external provider requests as needed• Upload contract documents into FileNet• Manage national amendment mailings as assigned• Work with matrix partners within Contracting, Provider Relations, and downstream systemsto ensure data accuracy

Process behavioral provider contract amendment requests for individuals, clinics, and facilities• Create and maintain CPT fee schedules• Ensure all new facility and clinic contracts are loaded per the terms of the contract• Process provider termination requests• Respond to internal and external provider requests as needed• Upload contract documents into FileNet• Manage national amendment mailings as assigned• Work with matrix partners within Contracting, Provider Relations, and downstream systemsto ensure data accuracy

Eden Prairie, Minnesota

Responsible for validating HIPAA, verifying eligibility, quoting benefits, providing referrals, and completing authorization and handoff processes• Utilize workflows to efficiently and accurately complete authorization and/or handoff processes• Hand cases off to licensed clinicians when they do not meet Fast Cert Authorization criteria• Having knowledge on multiple systems and utilizing them to obtain clinical information and create authorizations• Answer Care Allies Customer and Provider calls and processing Care Allies Fast Cert Authorizations• Utilize state mandate and account specific rules to make medical necessity decisions• Research complicated cases, i.e. eligibility, escalated cases, etc.• Consult with providers on bed search requests and follow up care for patients• Process electronic authorization requests• Participate in implementing tasks related to increasing holistic approach to management of customer cases including meaningful engagement, aftercare follow-up planning and integration of services with matrix partners.

Responsible for handling paperwork regarding medications, medical devices, and medical programs for patients and doctors• Knowledge of the function and use of diabetic devices such as insulin pumps, continuous glucose monitors, and blood glucose meters• Knowledge of insurance coverage guidelines of medications and plan exclusions• Initiate prior authorizations for medications and medical devices. Follow up on the authorizations with appeals or alternative prescriptions• Assure that each patient is getting the correct medications prescribed to them, or an acceptable alternative• Manage paperwork with the necessary clinical information for pharmacies and medical device companies• Speak with pharmacies and insurance companies to get processes started and to• Relay correct clinical information to insurance companies for prior authorizations• Work alongside the International Diabetes Center to get patients the supplies and care they need

Responsible for Call Center and Front Desk duties• Keep track of and support doctor’s schedules and patient care through computer and organization skills• Schedule appointments for patients and answer questions regarding appointments• Knowledge of endocrine and infectious disease diagnoses and treatment plans for patients• Utilize the Epic system to create and manage patient demographics and chart information• Verify and enter insurance information so that patients are billed correctly• Provide excellent customer service and support to patients in clinic by answering questions, checking them in for the appointments, and scheduling follow up visits