Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas

Monitored & analyzed claims activities, investigated unusual or suspicious incidents, & implemented corrective action plans to assist in preventing & detecting potential fraud, waste, and/or abuse.

Fraud Investigator

Supported members by addressing social determinants of health to promote overall well-being and fill gaps in care via interdepartmental and external community resources.

Member Care Coordinator/ Community Health Worker

Assigned concurrent & prior-authorization cases to medical reviewers, approximately 200-300 inpatient and outpatient cases daily.

Health Coordinator

UNM Medical Group, Inc.

Facilitated communication between internal and/or external physicians for consult or transfer of patients, approximately 50-100 calls daily.

PTTC Coordinator Access UNM/PALS

Mountain View Regional Hospital & Clinic

Provided diagnostic and procedure codes to insurance companies to determine prior authorization requirements for outpatient pain management patients; approximately 30-50 cases weekly.

Preauthorization Coordinator

Community Health Centers of Central Wyoming

Provided patients with documentation requirements & calculated eligibility for Sliding Scale based on household size & income. Provided translation in a variety of areas within the clinic for patients, staff, & medical providers. Patient scheduling, registration, & payment collection.

Intake Specialist

Dedicated professional in possession of a dynamic and varied skillset amenable to new experiences. Committed to excellence in all areas within the professional environment to include written, spoken and interpersonal communication with an emphasis on exceeding personal and collective expectations.

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