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

• 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

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

• 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

• 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