Jeanine Teti

To obtain a position with a company that can not only utilize my current knowledge and skills, but will provide a challenging environment leading to the ultimate growth of both my employer and myself.

Hostess - Tates Italian Restaurant & Pizzeria - Tampa, FL

(2021-08 - 2024-09)

Greet customers at the door. Take orders over the phone and in-person. Prepare salads for in-house and for to-go orders. Side work included stocking the salad station, preparing pizza boxes and assisting where needed. Tuesday and Wednesday evenings closed out the registers and completed end of shift reports.

Network Management Representative II - Anthem/Elevance - Tampa, FL

(2016-08)

Primarily performs various duties in support of the provider credentialing and re-credentialing process. Obtains necessary information to credential provider files using automated on-line and hard copy sources. Assist senior credentialing team members in daily business operations including, but not limited to, resolutions of non-responsive providers, coordination of site visits with Health Plan Provider Relations staff or independent contractor and working with various group administrators and hospital medical staff offices to ensure the successful completion of the credentialing process for Amerigroup providers.

Within this new role I will be responsible for assisting with the training of new team members in the credentialing and re-credentialing policies as they are set using the Anthem guidelines.

Network Management Representative - Anthem - Tampa, FL

(2015-09 - 2016-08)

Provides quality, accessible and comprehensive services to the Anthem provider community. Provides assistance regarding education, contract questions and non-routine claim issues.

Primary duties may include, but are not limited to: Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns. Develops, maintains, and enhances relations with providers to foster cooperative business relationships. Coordinates prompt claims resolution through direct contact with providers and claims department. Provides assistance with policy interpretation. Researches, analyzes and recommends resolution for provider disputes as well as issues with billing and other practices. Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery. Tracks customer service patterns/trends and identifies training when appropriate. Drafts training documents and conduct provider refresher training at onsite provider locations or by telephone. Researches issues that may impact future provider negotiations or jeopardize network retention.

Provider Contract Specialist 1 - Amerigroup - Tampa, FL

(2013-12 - 2015-09)

Performs various duties in support of the provider credentialing and re-credentialing process. Obtains necessary information to credential provider files using automated on-line and hard copy sources. Assist senior credentialing team members in daily business operations including, but not limited to, resolutions of non-responsive providers, coordination of site visits with Health Plan Provider Relations staff or independent contractor and working with various group administrators and hospital medical staff offices to ensure the successful completion of the credentialing process for Amerigroup providers.

Credentialing Coordinator - Coast Dental - Tampa, FL

(2011-05 - 2013-12)

Assist the credentialing department with special projects as assigned by the manager. Work with the credentialing representatives with looking-up and entering in provider effective dates from the individual carrier web-sites, e-mail and letters. Update and enter hygienists and dentist into the Eaglesoft database daily.

Confirm active providers have a Medicaid number. Assist with entering new providers in to system and printing applications for the providers to review and complete. Send off completed credentialing applications with all credentials to the carriers.

Respond to multiple request from our dental offices and insurance carriers. Prepare and submit re-credentialing applications as needed. Prepare and send off monthly reports to the insurances carriers. Process all paperwork necessary to open up a new dental office/.

Other duties as assigned.

Credentialing Associate - Manpower - Tampa, FL

(2010-09 - 2011-05)

Assist the credentialing department with special projects as assigned by the manager. Look-up and enter in provider effective dates from the carriers web-sites, e-mail and letters. Update and enter hygienists and dentist into the Eaglesoft database daily. Confirm active providers have a Medicaid number. Assist with entering providers in to system and printing applications for the providers to review and complete.

Account Advisor - Humana - Tampa, FL

(2006 - 2010)

Responsible for all aspects of servicing the Primary Plus clients in managed care accounts, including implementation of new accounts and implementation of changes in managed care plans. Serve as the primary contact for managed care plans. Provide required reports to all Primary Plus HMO partners monthly.

Move encounter data files from an internal FTP Site to the required HMO plans that it is being created for. Communicate internal notifications of new plans that need to be set-up in the system on a weekly basis as needed by the requesting HMO. Other duties as assigned by leadership.

Managed Care Plan Coordinator - CompBenefits/Humana - Tampa, FL

(2006 - 2009)

Responsible for all aspects of servicing client managed care accounts, including implementation of new accounts and implementation of changes in managed care plans. Serve as the primary contact for managed care plans. Provide sales and marketing support to the CEO and COO. Monitor revenues and profitability of the plans.

Administrative Assistant III/Sr. Credentialing Coordinator - CompBenefits - Tampa, FL

(2003 - 2006)

To provide administrative support to the Manager and Director in all areas applicable to the daily operation of the Professional Relations and Credentialing Department. To provide ancillary assistance to the Chief Operating Officer for Compbenefits.

• Handles incoming calls and keeps log for the PR Director, Manager and Supervisors
• Correspondence for the PR Director, Manager, and Supervisors
• Coordinates the Physician Advisory Committee (PAC) Meetings; prepares the agenda, creates meeting packets, collects relevant documents and assists with minutes as appropriate for the PAC
• Coordinates the PR monthly meetings; prepares the agenda, coordinates educational materials; attends the meeting and takes minutes for distribution to department staff
• Assists the Director in conducting Provider Satisfaction Surveys – sending audit tools, making calls and generating reports
• Compiles weekly departmental productions reports for Campaign 100 and other management reports, prepares weekly packets and distributes to senior management
• Assists in collecting articles for the quarterly provider newsletter, FOCUS; sends reminders company-wide for interdepartmental participation in educating the providers
• Research and organization of data for report generation for the Director, Manager, CEO and COO and distribution of those reports

Sr. Credentialing Coordinator - Vision Care, Inc. - Tampa, FL

(1998 - 2003)

To provide administrative support to the Manager and Director in all areas applicable to the daily operation of the Professional Relations and Credentialing Department. To credential provider files in accordance with the Credentialing Policy and Procedures for CompBenefits.

• Credential files as assigned by Credentialing Manager
• Handle incoming calls and written correspondence for the PR Director, Manager, and Supervisors
• Prepares the PAC Credentialing Committee agenda, creates meeting packets, collects relevant documents and assists with minutes as appropriate for the Credentialing Committee
• Coordinates the PR monthly meetings; prepares the agenda, coordinates educational materials; attends the meeting and takes minutes for distribution to department staff
• Assists the Director in conducting Provider Satisfaction Surveys – sending audit tools, making calls and generating reports
• Assists in collecting articles for the provider newsletter, FOCUS; sends reminders company-wide for interdepartmental participation in educating the providers
• Research and organization of data for report generation and distribution for the Director, Manager, VP, CEO and COO

Customer Service Representative - Vision Care, Inc. - Tampa, FL

(1997 - 1998)

Answer incoming calls from providers to verify member’s eligibility for eyewear, answer incoming calls from members to advise them of providers in their area and explain the benefits they have. Research claims issues for providers and members and explain proper procedures when necessary.

Associates - Business - Florida Metropolitan University (1997-10 - 1999-01)