Carrie Gann
Post Falls
Summary
Dynamic Care Management Representative at Premera Blue Cross, skilled in policy writing and quality assurance. Proven ability to enhance customer relationships and streamline prior authorization processes. Adept at clinical evaluation and problem-solving, fostering effective communication with healthcare professionals and families to ensure optimal service delivery. Passionate about supporting children's needs.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Care Management Representative
Premera Blue Cross Of Washington
Spokane
07.2022 - Current
- Conducted periodic audits of documentation submitted with prior authorization requests.
- Evaluated clinical information provided by providers against specific criteria set forth by health plans.
- Performed quality assurance reviews on completed work products before submission to payers.
- Researched medical policies to ensure appropriate coverage of services.
- Provided timely feedback to physicians regarding authorization status.
- Facilitated communication between health plan representatives, providers, and members when needed.
- Educated customers about the prior authorization process including applicable deadlines.
- Reviewed prior authorization requests for completeness and accuracy.
- Processed appeals for denials in accordance with established procedures.
- Responded promptly to inquiries from providers, members, and other departments within the organization.
- Assessed insurance benefits and determined eligibility criteria.
- Advised healthcare professionals on proper coding practices that meet requirements of payers.
- Submitted prior authorization requests electronically or by phone to payers.
- Followed all Medicare, Medicaid, HIPAA and private insurance regulations and requirements.
- Verified patient's insurance eligibility prior to appointment date for payment purposes.
Environmental Services Director
Gritman
Moscow
12.2021 - 08.2022
- Managed budgeting, forecasting, and financial analysis of departmental operations.
- Ensured proper record keeping for all documents pertaining to environmental services activities.
- Developed and implemented environmental policies and procedures to ensure compliance with applicable regulations.
- Conducted regular audits of departmental activities to ensure all processes were compliant with relevant standards.
- Maintained up-to-date records of employee attendance, payroll information, vacation requests.
- Conducted regular meetings with staff to discuss progress and identify areas of improvement.
- Assessed team member's skillsets and assigned tasks accordingly for optimal efficiency.
Environmental Services Manager
Kootenai Medical Center
Post Falls
07.2019 - 12.2021
- Developed policies and procedures related to the safe storage, transport, and disposal of hazardous materials.
- Provided training to staff on proper handling of hazardous materials as well as safety procedures.
- Maintained up-to-date records of employee attendance, payroll information, vacation requests.
- Conducted performance reviews for team members.
- Coached, mentored and trained team members in order to improve their job performance.
- Scheduled interviews for potential candidates and conducted reference checks prior to hire.
Assistant Director Transportation Services
Post Falls School District
Post Falls
08.2017 - 07.2019
- Evaluated employees' performance regularly to provide feedback and recommend improvements as needed.
- Supervised a team of drivers, dispatchers, and support staff members.
- Developed positive relationships with students through friendly interactions.
- Kept up-to-date on changes in local roads, traffic patterns, and construction projects that may affect routes or schedules.
- Communicated effectively with parents regarding student transportation issues.
- Reported student behavior incidents promptly to the appropriate personnel.
- Complied with district policies and procedures concerning student discipline.
- Promoted good public relations by responding courteously to inquiries from parents or members of the community.
Bus Driver
Post Falls School District
Post Falls
08.2016 - 08.2017
- Reported any incidents that occurred during route travel to management personnel immediately.
- Monitored student progress during trips to ensure safety and security of all passengers.
- Inspected safety features of vehicle such as lights, brakes, steering, and emergency exits.
- Maintained records regarding daily attendance, student behavior issues, or other pertinent information.
- Assisted special needs students with physical activities such as walking or transferring from wheelchairs onto the bus seat.
- Responded quickly and appropriately in case of an emergency situation on board the school bus.
- Performed pre-trip inspections on the bus to ensure it was in safe working order.
- Communicated regularly with teachers, administrators, parents and guardians, therapists and other staff members involved in a student's care plan.
- Followed designated routes, stopping at designated locations, and operating equipment such as wheelchair lifts.
- Maintained professional demeanor at all times while interacting with students, families, faculty members and other personnel associated with the school district.
Education
High School Diploma -
Turlock High School
Turlock, CA06-1993
Some College (No Degree) - Liberal Studies
California State University, Stanislaus
Turlock, CASome College (No Degree) - Early Childhood Education
California State University, Sacramento
Sacramento, CASkills
- Policy writing
- Quality assurance
- Clinical evaluation
- Prior authorization
- Insurance verification
- Customer relationship management
- Problem-solving
- Patience under pressure
- Parent communication strategies
- Love for children
- Parent-child relationship building
Certification
- CDL CLASS B
Affiliations
- ACTIVE SOFTBALL COACH
- CHILD CHURCH EDUCATION PROGRAM
Timeline
Care Management Representative
Premera Blue Cross Of Washington
07.2022 - Current
Environmental Services Director
Gritman
12.2021 - 08.2022
Environmental Services Manager
Kootenai Medical Center
07.2019 - 12.2021
Assistant Director Transportation Services
Post Falls School District
08.2017 - 07.2019
Bus Driver
Post Falls School District
08.2016 - 08.2017
High School Diploma -
Turlock High School
Some College (No Degree) - Liberal Studies
California State University, Stanislaus
Some College (No Degree) - Early Childhood Education
California State University, Sacramento
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