GLORIA HANLEY
**** ** ***** *** •BROOKLYN, NY ***13 • 347-***-**** • **********@*****.***
PROFESSIONAL SUMMARY
Self-motivated and forward-thinking professional with over 20 years of Customer, HealthCare & Human Services experience
EMPLOYMENT SUMMARY
LONG LIFE REFERRAL NETWORK
Volunteer, Supported Employment Coordinator June 2022 - Sept 2022
Develop community based employment opportunities for people with IDD
Provide work related support service
Communicate with employers & provide clients coaching support
Provide an appropriate level of support and services to candidates, their families, employers & coworkers
Implement training & coaching plans to ensure employer standards are met
PROJECT PANDEMIC SHIELD /PPS CLINIX
Community Health, Lead HealthCare Navigator Aug 2021 - Dec 2021
Serve as a Health Service Agent in the community (NYS Public Health Leader)
Assist patients to learn and utilize the PPS Digital Suite and self-administered Covid Tests
Manage Covid Test Inventory and assist in setting up Covid Test Sites
INDEPENDENT LIVING ASSOCIATION
Direct Care Counselor (part-time) Jan 2020 - Oct 2021
Assisted and motivated disabled individuals
Monitored and recorded client's goals, objectives & behaviors
Provided Direct Care service and medication to clients
Provide DayHab Services during Covid
EMBLEMHEALTH CARE
Grievance & Appeals Supervisor May 2013 – February 2015
Review and audit responses sent to our inquirers to ensure all issues in the cases are addressed
Review, audit and finalize case management accounts, member/provider contract and DOI cases
Attend company Task Force meetings to address corporate issues and concerns (DOI cases)
Run, maintain reports and review inventory to ensure inquiries were responded to within the time frame
Adhere to all CMS and OPWDD processing guidelines
Manage staff and inventory
Facility Reconciliation Senior Analyst Feb 2011 – May 2013
Resolved issues identified by facilities and hospitals
Submit Business Requirement Reports for systemic enhancements on issues identified
Participate in departmental meetings and submit written summations to corporate peers
EMBLEMHEALTH CARE
Medical & Hospital Claims Adjustment Supervisor Oct 2008 – Feb 2011
Ran and maintained daily reports to ensure claims were processed in a timely manner
Handled escalated claims issues and follow-ups on aged payment recoupments
Manage staff and inventory
Participate in departmental meetings
EDI Network Analyst March 2004 – Oct 2008
Responsible for online implementation and testing of new group accounts for the Network Access Database
Review and finalize medical and hospital EDI files not completed on the initial submission
Work with the IT and Rates departments to ensure NA database reflect all mainframe information correctly
Train and educate new team members and temporary employees
GROUP HEALTH INCORPORATED
Quality Assurance/Methods Analyst Feb 2000 – March 2004
Perform and analyze Methods Studies for several departments
Prepare and generate Root Cause reports that reflect the results of the various Method studies and audit findings
Execute Audits on various departments via the phone and paperwork production
Customer Service Representative Jan 1994 – Feb 2000
Informed subscribers, providers, and health facilities on the status of claims and inquiries
Confirm member benefits for providers, facilities and hospitals
Acted as a face-to-face information liaison to subscribers/providers
EDUCATION & Certifications
Registered Behavior Technician
Mental Health First Aid: Certificate
Certified Human Rights Consultant
Borough of Manhattan Community College: Business Management
CPR, AED and SCIP Certifications
Technical Institute of America: Medical billing & Coding (ICD10)
Technical Institute of America PMP: Certificate
Technical Institute of America: Quick Books: Certificate
eCornell: NYS Public Health Leader: Certificate
USIAHT: Certified Human Rights Trafficking Educator
WHO: Disaster Relief Food Safety Training: Certificate
Training in Assistive products: Certificate
REFERENCES
Francis Tompkins, previous Manager at EmblemHealth 718-***-****
Angela Hope Weusi, Social Worker at Long Life 917-***-****
Omar Lamont, Team Lead at PPS/Clinix 347-***-****
Sharnae Lance RN, Friend 347-***-****