Summary of Qualifications:

Specialized DME (Durable Medical Equipment) Coordinator with over 20 years’ experience in Medical Management. Expert in verifying local / national coverage determination for in home equipment approval. Extensive knowledge of medical terminology and coding of equipment using ICD-10. Strong ability to communicate clearly and efficiently to members and staff. Detail oriented, multi-tasker with the ability to work effectively with a team and lead to achieve desired company outcomes.

Skills:

• CCS (Medical Management Program) • InterQual Program • Team Coordinator

• Written & Verbal Communication • Efficient Organization • Creative Problem Solving

• Instructional Techniques • Independent worker • Quality Customer Service

• Flexibility • Dependable • Resource Optimization

Computer Experience:

Software: Proficient in Windows 10, Microsoft Office Suite 2010, CCMS, InterQual, QNXT,

Encoder Pro, Logician, and other health care applications

PROFESSIONAL EXPERIENCE:

Health Partners Plans, Philadelphia, PA

Medicare DME Coordinator 09/2016- 09/2019

Approve DME (Durable Medical Equipment) Requests thru various DME Providers.

Process and maintain all DME Insurance Switches of Equipment, Retro Authorizations.

Process ODAG (Organizational Determinations) Requests by Members.

Complete all Authorizations, Denials and ODAG’s in a timely manner.

Complete Transport Denials. Build Home Care Auths for nursing staff to complete.

Source for Teachers, Philadelphia School District

Credentialing Specialist, (Temporary Position) 01/2016 – 02/2016

Credential Teachers for Substitute Positions within the Philadelphia School District

Assist with gathering onboarding information for Substitute Teachers

Assist with obtaining Clearances as well as documents for hiring process.

Cigna HealthSpring, Philadelphia, PA (2002 - 2015)

Care Senior Associate (Pre Cert Coordinator) 02/2004 – 07/2015

Approve DME Rentals and Purchases as well as Outpatient Procedures

Maintain all DME Rental Extensions, Retro Authorization, Provider Switches, Product Switches and Insurance Switch Authorizations for all Regions of Cigna HealthSpring

Answer calls in the queue

Resolve various issues with Authorizations and/or Claims for the benefit of Members and Providers

Worked on Special Projects with Management Team, i.e. Pended Claims Resolutions

Company Notary Public

Health Services Assistant 01/2002-02/2004

Provide support to Case Management & Social Work Team

Order DME and any other supplies and/or Homecare they may need

Members and arrange various appointments & transportation

Maintain Hospice, Coumadin, Long-Term Care Reports, minutes of all meetings, Census of Post Case Management Team

Company Notary Public, Maintained consistently by SVP, of BravoHealth

Ms. Donnie-Michéle Jay - pg. 1

Accomplishments:

Health Partner Plans Volunteer for the Foundation, Participated in the Blood Drive

Departmental Notary Public - requested to become Notary by VP of Managed Care Dept. of Tenet Health System in 1999.

Introduced the American Cancer Society’s Breast Cancer Walk to Bravo Health, (when it was formally Elder Health).

Volunteered to work Health Fairs with BravoHealth Sales Team, (when it was formally Elder Health).

Volunteer on various Walks for Charity with Elder Health, Bravo Health and HealthSpring and now Cigna HealthSpring.

Awarded the 2004 Volunteer of the Year Award, from Linda Creed Breast Cancer Foundation.

Received various Notes and Cards of Appreciation from Providers.

Received 5yr and 10yr Awards from BravoHealth and HealthSpring.

Cigna Champion Awards

Education:

Medical Coding and Billing Concentration, Matriculation Diploma - Penn Foster Career School - Scranton, PA (online)

General Studies/Liberal Arts - Community College Of Philadelphia - Philadelphia, PA – Credits

Personal Computer Training - Computer Learning Center - Philadelphia, PA

Continuing Education Training Unit - Healthcare Industry - Trained in DME Equipment & Patient/Member service needs

High School Diploma - Downingtown Industrial & Agricultural High School, Downingtown, PA

Ms. Donnie-Michéle Jay - pg. 2

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