Behavioral Health Specialist - Well Sense - Boston, MA
(2026-01 - 2026-09)
- Investigated benefit discrepancies, coding issues (ICD‑10, CPT, HCPCS), and care gaps; documented findings
- Conduct comprehensive behavioral health assessments to identify member needs, barriers to care, appropriate disposition, and level-of-care recommendations across Mental Health and SUD services.
- Coordinate admissions, transfers, referrals, and transitions of care with physicians, nurses, inpatient psychiatric units, community providers, and insurance partners.
- Support payer workflows including eligibility, benefits, prior authorization, utilization management, care coordination, and clinical documentation.
- Review clinical records and documentation for medical necessity, level-of-care recommendations, authorization decisions, and compliance with payer and regulatory requirements.
- Maintain accurate, timely, and audit-ready documentation in Jiva while adhering to HIPAA, regulatory, contractual, and accreditation standards.
- Collaborate with clinical, provider, operations, QA, and technology teams to identify workflow gaps, improve processes, and support Substance Abuse/behavioral health quality initiatives.
- Utilize Facets, Guiding Care, Jiva, Excel, and SQL to manage healthcare data, analyze referral and utilization trends, support workflow optimization, and develop operational reports.
- Support UAT, workflow validation, gap analysis, and process improvement activities while translating clinical and operational needs into effective healthcare workflows.
Behavioral Health Care Coordinator - Blue Cross Blue Shield - Chicago, IL
(2022-11 - 2025-05)
- Translate complex weekly behavioral health data such as patient risk scores, treatment effectiveness, care gaps, and patient engagement metrics to improve decision-making for care management.
- Clinical data management
- Conduct comprehensive reviews of behavioral medical records and ensure compliance with clinical guidelines to support quality improvement initiatives and patient care outcome.
- Support utilization review processes by gathering clinical documentation, verifying benefit coverage, and preparing cases for clinical escalation.
- Collaborate with Behavioral Health and Physical Health teams daily to enhance treatment workflows, identifying and resolving bottlenecks to optimize processes.
- Generate weekly clinical, population health, and quarterly performance reports and analysis to support operational efficiency and performance improvements.
- Conduct daily data analysis on caseload metrics to enhance operational efficiency.
Case Manager - The Bowen Center - Elkhart, IN
(2021-04 - 2022-02)
- Developed personalized care plans for approx. 12 Medicaid clients by synthesizing clinical and claims data.
- Analyzed patient data trends to inform workflow quality of care improvements and service delivery enhancements.
- Ensured accurate and compliant documentation aligned with legal, ethical, and clinical standards, optimizing record-keeping process.
- Partnered with stakeholders such as healthcare providers, behavioral health organizations, and government agencies to deliver integrated, patient-centered care solutions.
Student Researcher - Indiana University - South Bend, IN
(2021-03 - 2021-12)
- Conducted advanced data analysis using IBM SPSS and presented insights in statistical reports.
- Designed and programmed research surveys in Qualtrics, ensuring high-quality data collection and integrity.
- Documented workflows and maintained strict quality control standards throughout research projects.
Research Assistant - Department of Sociology, South Suburban College - South Holland, IL
(2016-08 - 2018-05)
- Spearheaded survey design and analysis initiatives, leveraging SPSS to extract actionable insights.
- Presented findings to diverse stakeholders, emphasizing clinical and operational implications.
- Maintained detailed records and ensured alignment with project objectives and regulatory compliance.
