Expanse Associate Trainer - HCA Healthcare
(2024-04 - 2025-06)
- Led cross-functional training initiatives for Meditech Expanse platform rollouts, ensuring consistent adoption across multiple facilities.
- Collaborated with corporate, division, and facility leadership to align implementation plans with strategic business objectives.
- Developed, refined, and delivered training materials, improving knowledge retention and user performance.
- Identified functional gaps, recommended system enhancements, and partnered with stakeholders to optimize workflows.
Referral Specialist I - myNEXUS
(2022-01 - 2023-08)
- Managed high-volume referral workflows, ensuring accuracy, compliance, and timely service delivery.
- Acted as the primary liaison among hospitals, physicians, vendors, and patients to resolve complex service issues.
- Implemented process improvements that reduced turnaround times and improved stakeholder satisfaction.
- Monitored referral queues and proactively escalated urgent requests to ensure timely patient care coordination.
- Verified insurance coverage and prior authorization requirements, reducing service delays and preventing claim denials.
Medical Receptionist - Vanderbilt University Medical Center
(2021-08 - 2021-12)
- Coordinated daily patient scheduling and order processing for a high-volume medical unit, improving service efficiency.
- Acted as a key communication link between patients, families, and clinical teams to ensure smooth care transitions.
- Maintained and updated operational logs and documentation to support quality and compliance standards.
- Proactively identified scheduling conflicts and implemented adjustments to minimize delays in patient care.
- Assisted leadership with workflow planning to optimize clinic resources and staffing coverage.
Claims Examiner I - Disability Determination Services
(2021-02 - 2021-07)
- Managed a caseload of disability claims, ensuring timely and accurate eligibility determinations.
- Coordinated with physicians, specialists, and claimants to collect and analyze critical medical and employment documentation.
- Led end-to-end case review processes, from initial intake through final written decision, ensuring compliance with federal and state regulations.
- Identified process bottlenecks and worked with peers to improve efficiency in document review and case handling.
- Provided subject matter expertise to peers on case documentation best practices, contributing to team training efforts.
Member/Provider Enrollment Representative - Cigna-HealthSpring - Nashville, TN
(2017-01 - 2020-12)
- Served as the primary contact for prospective and current members, answered questions via phone or email regarding program options, benefits, eligibility, and procedures.
- Guided members through the application process, ensuring all required documentation and forms are completed accurately and correctly.
- Accurately entered and updated member information into databases or CRM systems and maintained meticulous digital records.
- Investigated and resolved any enrollment issues, discrepancies, or setbacks (e.g., incomplete applications, eligibility denials), escalating complex cases when necessary.
- Ensured all enrollment activities, documentation, and data handling comply with relevant policies and regulations (e.g., HIPAA in healthcare, FERPA in education).
- Conducted proactive follow-up with applicants to track enrollment progress, gather missing information, and ensure a timely and smooth process.
- Clearly explained program guidelines, coverage options, and procedures to members, ensuring they understood their benefits and responsibilities.
- Created eligibility lists and reports to track enrollment statistics and progress for management and other departments.
- Prepared, reviewed, and submitted initial enrollment and re-enrollment applications to various government and commercial payers.
- Coordinated and collected necessary documentation from providers, such as medical degrees, state licenses, DEA numbers, board certifications, CVs, and liability insurance information.
- Ensured all application information is accurate and complete and that providers meet all compliance and regulatory standards, including primary source verification of credentials.
- Monitored the status of applications with insurance carriers and conducting consistent follow-up to expedite the process and obtain provider numbers (payer IDs).
- Accurately entered and updated provider information in internal databases, credentialing software (like CAQH or PECOS), and payer-specific systems.
- Acted as a liaison between providers, billing departments, and insurance payers to investigate and resolve enrollment issues, claim denials, or discrepancies.
- Staying current on the ever-changing federal, state, and payer-specific regulations and policies (e.g., CMS regulations, HIPAA) to ensure all enrollment activities adhere to compliance standards.
- Managed the revalidation process for previously enrolled providers and groups to prevent any lapses in coverage or billing ability.
Case Analyst II - Cognosante - Nashville, TN
(2017-12 - 2018-03)
- Resolved inquiries regarding healthcare program policies and eligibility for a variety of internal and external clients (e.g., beneficiaries, providers, and representatives of public and private organizations).
- Performed special investigations as requested.
- Created testing requirements.
- Tested data maintenance.
- Settled client case complaints by exchanging data and information across internal Cognosante departments and federal Marketplace staff.
- Administered and exchanged written, electronic, and/or verbal information/data to clients for services, premiums, and plan administration.
- Researched, Identified, and implemented consumer data issues related to health insurance exchange coverage.
- Provided detailed information regarding medication availability according to the client's Medicare Part D insurance tier.
