MEMBER ADVOCATE Education Training 2009 University Incarnate Word City State Bachelor Business Administration 2011 University Incarnate Word City State Master Business Administration Professional Experience 01/2012 Current Company Name － City State Member Advocate Represent DentaQuest community events meetings provide information low-income populations dental benefits available Medicaid CHIP eligible members. Establish, develop, maintain partnerships community organizations identify coordinate outreach opportunities facilitate growth enrollment. Conduct presentations promote preventative dental care good oral hygiene practices compliance Texas Health Steps checkups. Provide case management members need care coordination assist members claims issues appeals. 01/2012 Company Name － City State Provider Relations Specialist Served liaison Medicaid CHIP Managed Care contractor health care providers. Responsible establishing maintaining working relationships existing provider network. Researched resolved provider inquiries include credentialing, claims issues, complaints grievances. Educated providers new protocols, policies, procedures facilitate process improvements. Ensured provider database documentation date, accurate, complete. Assisted development implementation provider training programs. 01/2011 Company Name － City State Business Development/Admissions Coordinator Responsible development admission statistics long-term acute care hospital setting developing referral sources converting referrals admissions. Responded inquiries hospital discharge planners, families, referral sources. Conducted facility tours informed families potential patients admission criteria, insurance coverage, costs associated patient care. Verified insurance benefits, obtained prior authorizations, ensured potential barriers claims payment addressed resolved prior admission. Coordinated admissions process start end alerted department heads projected admissions, bed changes, discharges, protocols compliance patient's managed care insurance requirements. 01/2004 01/2009 Company Name － City State Beneficiary Services Representative Acted liaison TRICARE beneficiaries health care providers. Provided customer service support beneficiaries visited local TRICARE Service Center responding benefit inquiries, resolving claims issues, assisting appeals, complaints, grievances. Advised beneficiaries health dental plan options processed enrollments, disenrollments, primary care provider assignments, plan changes. Provided customer support local military treatment facility administrative clinical staff assisted case management team referrals prior authorizations. Traveled within state Texas conduct benefit enrollment presentations different military groups, active duty service members transitioning retirement, new active duty service members base transfers, National Guard Reserve members called full-time active duty services. Provided health care providers assistance claims issues, appeals, complaints grievances. 01/2002 01/2004 Company Name － City State Office Coordinator Served administrative clinical support various office settings throughout hospital organization include outpatient physical, occupational, speech therapy, inpatient skilled nursing, outpatient wound care services. Acquired insurance authorizations patient services. Prepared required claims documentation including referrals, treatment plans, required correspondence reduce incidence denials. Assisted areas hospital investigating resolving claims discrepancies order collect unpaid patient accounts. Played key role opening hospital's new wound care center assisting director areas development, including creating policies procedures, creating forms clinical billing staff, obtaining insurance credentialing providers. 01/1999 01/2001 Company Name － City State Business Office Manager Managed business office skilled nursing, rehabilitation, long-term care facility. Billed Medicaid, Medicare, private insurance companies services rendered patients. Managed facility's accounts receivables accounts payables. Prepared administrative reports directors, Chief Financial Officer, Chief Executive Officer. Responsible interviewing, hiring, training, termination office personnel. Skills accounts payables, accounts receivables, administrative, benefits, billing, oral, customer service, customer support, database, documentation, Financial, forms, hiring, insurance, director, meetings, office, network, nursing, personnel, policies, presentations, protocols, speech, statistics, training programs