Lorea L. Washington-Cage

Results-driven healthcare professional with 19+ years of progressive experience supporting healthcare programs, provider relations, Medicare/Medicaid operations, regulatory compliance, grievances and appeals, and customer service initiatives. Proven ability to coordinate complex program activities, investigate and resolve escalated issues, analyze operational trends, maintain regulatory compliance, and collaborate with cross-functional teams. Experienced in serving as a liaison among providers, members, internal departments, leadership, and regulatory stakeholders.

Skilled in program administration, provider education, performance monitoring, process improvement, documentation, reporting, and managing multiple priorities within deadline-driven environments. Recognized for strong communication, organization, problem-solving, and relationship-building skills.

Senior Provider Engagement Specialist - MOLINA HEALTHCARE OF MISSISSIPPI - Ridgeland, MS

(2025-05)

Serve as a primary liaison between Molina Healthcare of Mississippi and participating network providers, supporting effective communication, program implementation, organizational objectives, and regulatory requirements.

• Coordinate provider engagement activities designed to strengthen provider relationships, satisfaction, retention, and participation in healthcare programs and initiatives.
• Collaborate with clinical, quality, operations, claims, and other internal departments to investigate and resolve complex or escalated provider concerns.
• Support the implementation and communication of organizational programs, policies, procedures, and quality improvement initiatives.
• Develop and deliver provider education regarding healthcare programs, operational processes, policies, tools, resources, and performance expectations.
• Monitor provider performance through dashboards, reports, and key performance indicators to identify trends, opportunities, and areas requiring additional support.
• Analyze operational information and provider feedback to assist leadership with strategic planning and program improvement.
• Track provider concerns and facilitate timely follow-up and resolution across appropriate departments.
• Maintain accurate documentation of provider interactions, issues, interventions, and outcomes.
• Promote compliance with organizational policies and applicable state and federal healthcare requirements.

Grievance & Appeals Coordinator - MAGNOLIA HEALTH PLAN - Ridgeland, MS

(2015-01 - 2025-05)

Coordinated the investigation, documentation, processing, and resolution of member and provider grievances and appeals involving claims, quality of care, and quality of service.

• Managed cases according to established state, federal, contractual, and organizational turnaround-time requirements.
• Researched complex cases and collaborated with internal departments to obtain documentation and information necessary for resolution.
• Identified denial, grievance, and service trends and communicated findings to appropriate departments and leadership.
• Maintained knowledge of healthcare regulations, member benefits, member rights and responsibilities, and organizational policies and procedures.
• Reviewed medical records, clinical documentation, detailed bills, claims information, and supporting documentation to determine appropriate next steps and resolution.
• Supported compliance with Medicaid, CHIP, Marketplace, and organizational grievance and appeal requirements.
• Educated members regarding health plan benefits and services for MississippiCAN, Mississippi CHIP, and Ambetter products.
• Served as a resource to members and providers by explaining program requirements, benefits, processes, and available resolution options.
• Maintained comprehensive and accurate case documentation to support regulatory and internal audit requirements.
• Collaborated with clinical, claims, customer service, provider relations, and other operational teams to resolve complex cases.
• Delivered service-focused solutions while maintaining professionalism and sensitivity during challenging member and provider interactions.

Medicare Secondary Payer Recovery Supervisor - CAHABA GOVERNMENT BENEFIT ADMINISTRATORS (GBA) - Ridgeland, MS

(2011-10 - 2014-12)

Supervised and supported a team of approximately 20–30 employees responsible for Medicare Secondary Payer Recovery operations and customer service activities.

• Coordinated daily program operations to ensure workload, quality, productivity, and service-level expectations were achieved.
• Investigated and resolved escalated customer service concerns involving beneficiaries, staff, and other stakeholders.
• Monitored staff performance and provided ongoing coaching, training, counseling, and technical assistance.
• Ensured operational activities were completed within required timelines and in accordance with Centers for Medicare & Medicaid Services (CMS) requirements.
• Managed the submission, review, intervention, and resolution of Medicare appeals, grievances, and complaints.
• Served as a subject matter expert and provided technical guidance regarding program policies, procedures, and complex cases.
• Monitored and audited high-volume customer interactions to identify escalation needs, compliance concerns, and opportunities for improvement.
• Assisted with workload distribution and resource coordination to maintain production and quality standards.
• Ensured adherence to HIPAA privacy requirements and applicable CMS policies and procedures.
• Supported leadership with operational issue identification, staff performance management, and service improvement initiatives.

Medicare Secondary Payer Recovery Supervisor - CNI / MEDICARE SECONDARY PAYER RECOVERY CONTRACTOR (MSPRC) - Ridgeland, MS

(2006-12 - 2011-09)

Supervised daily Medicare Secondary Payer Recovery program activities and supported staff responsible for beneficiary and stakeholder inquiries.

• Coordinated workloads and monitored performance to ensure production, quality, timeliness, and compliance expectations were achieved.
• Assisted staff with complex cases, escalations, appeals, grievances, and customer service concerns.
• Interpreted and applied Medicare program guidelines, CMS requirements, operational policies, and procedures.
• Provided coaching, training, technical guidance, and performance support to staff.
• Investigated escalated issues and collaborated with appropriate stakeholders to facilitate timely resolution.
• Maintained confidentiality and compliance with HIPAA, CMS, and organizational requirements.
• Assisted management with identifying operational trends and opportunities to improve workflow, quality, and service delivery.

High School Diploma - Lanier High School (1991) Jackson, MS

Hinds Community College-Jackson (1994) Jackson, MS