MARY DIETERICH-CALLAWAY
Sandston
Summary
Client manager associate II with expertise in benefits analysis and compliance management. Demonstrated ability to enhance team efficiency and client satisfaction through effective communication and problem-solving. Skilled in provider relations and process streamlining to ensure timely and accurate service delivery.
Overview
32
32
years of professional experience
Work History
Client Manager Associate II
The Standard, Inc.
04.2024 - Current
- Compiled comprehensive benefits summary for life, disability, dental, and vision, enhancing clarity for Account Service Managers.
- Prepared detailed census for corporations, streamlining submission process to HR departments via Account Service Manager.
- Analyzed life and disability benefits to ensure compliance.
- Assessed rates, eligibility, and effective and termination dates for specialty lines.
- Responded to phone inquiries about life and disability benefits.
- Retrieved certificates for distribution to Account Service Managers.
- Obtained Schedule A 5500 tax documents for corporations.
- Managed OCC changes on account benefit information for accuracy.
- Forwarded enrollment and termination requests to the designated department.
- Instructed team members on benefit summary creation process, improving team knowledge and efficiency.
Account Service Coordinator
Anthem, Inc. (Elevance Health)
10.2021 - 04.2024
- Summarized benefits for life, disability, dental, and vision for Account Service Managers to facilitate informed decision-making.
- Collected and distributed certifications to Account Service Managers, ensuring compliance and timely access to necessary documentation.
- Request and pull Schedule A 5500’s tax documents for corporations
- Compose census’ for corporations to submit to their HR departments through Account Service Manager through Compass and WGS
- Ensured seamless operations by stepping in for absent Account Service Coordinators, maintaining workflow efficiency.
- Coordinated enrollment and termination requests with appropriate departments to maintain accurate account records.
- Processed OCC changes on account benefit information.
CSA
Anthem, Inc.
05.2019 - 10.2021
- Resolved claim-related issues promptly, enhancing member satisfaction
- Answer members' questions in regard to health coverage for HMO, PPO, OA and HDHP
- Help members with HSA, HRA and FSA questions
- Handled member calls to support clear communication
- Fax authorization requests for medical records
- Fill in for other departments to keep phone ASA down
- Assisted teammates on Microsoft Teams with inquiries, fostering collaborative support
- Proficient in Solution Central, Check Inquiry, CDHP
Billing Coordinator
Result (Commonwealth Anesthesia Associates)
06.2018 - 02.2019
- Service high volume medical practices including Chippenham, Johnston-Willis, St Francis, Colonial Heights, John Randolph, Boulders, Richmond Community, Monticello, Sono Spine, Digestive Care Center and Anesthesia Services of Lynchburg
- Billed anesthesia charges for medical services, ensuring accurate revenue capture.
- Submitted workers comp and secondary claims to appropriate insurances, enhancing claim resolution efficiency.
- Register patients: Collect and verify personal information while following HIPAA guidelines
- Managed returned mail, streamlining communication processes for improved correspondence.
- Answer phones and direct calls to the proper individuals
Service BDC (Business Development Center)
Haley Chrysler Dodge Jeep Ram
01.2018 - 06.2018
- Confirmed next-day appointments with service customers and adjusted schedules to enhance customer satisfaction
- Coordinated service appointments to ensure customer convenience
- Provided monthly reminders to service customers about necessary recalls and inspections to ensure vehicle safety
- Directed calls to service writers or parts department based on customer requests to streamline communication
Behavioral Health Network Educator
Optima Health
07.2017 - 12.2017
- Facilitated demographic update process, enhancing compliance accuracy.
- Attended Town Hall Meetings for CCC Plus to gather community insights.
- Responded to Provider and Practice Manager questions and claim issues
- Collaborated with Billing Managers and facility Administrators to review and clarify educational materials related to website, claims address, ERA/EFT, Provider Quarterly Newsletter, and important contact numbers.
Provider Enrollment Team Lead
Pediatrix Medical Group
12.2014 - 07.2017
- Promoted to Team Lead; Responsible for supervising 12 people
- Resolved provider concerns within government and managed care sectors to ensure compliance and maintain positive relationships.
- Facilitated training for new and established staff to enhance team skills and ensure consistent service delivery.
- Created assignments for new providers to ensure adequate coverage.
- Developed new coverage assignments to optimize service delivery.
- Created new location assignments to improve service coverage and meet provider needs.
- Auditing applications before sending to the provider and before sending to the plan
- Appeal letters to backdate effective dates that are issued by the plan if it is after the effective date we requested
- Assisted in managing new contract assignments in the managed care department.
- Completed contract updates to maintain accurate records.
- Assignment creation of termed providers
- Update Monthly Payor Info Sheet and Above the Red Line Documents
- Monitoring PTA Central Icon & EFAX Mail Icon
- Complete PE Weekly Aging Report
Provider Enrollment Associate II
Pediatrix Medical Group
09.2007 - 10.2014
- Complete provider contracts and obtain provider signatures before submitting to the health plan for approval
- Contacted Credentialing with health plans to secure necessary paperwork for provider enrollment with insurance plans
- Place follow up phone calls to health plans to check status of enrollment applications
- Responded to provider inquiries regarding application status and required paperwork to ensure clarity and support
- Documented application progress in OnBase system and Intellicred to maintain accurate records
- Audit applications prior to going to the provider for signature
- Generated detailed reports to track credentialing progress and provider enrollment status.
- Train new hires and temps
- Facilitated meetings and addressed managerial questions during supervisor's absence.
Claims Processor and Member Services Consultant
Aetna
03.1994 - 09.2007
- Claims Processor and Member Services Consultant for James River and Overnite.
- Provided written responses to benefit and claim inquiries online for all accounts managed from Highpoint, NC, enhancing customer communication.
- Managed ECHS bailout correspondence, ensuring accurate documentation and effective communication.
- Transitioned to remote work for Correspondence and Overpayment Unit, maintaining productivity and service quality.
- Research Consultant for James River, Overnite, and Landmark until the Richmond office closed in December 1998.
Education
Associate - Healthcare Management
College For America (SNHU)
Nursing Assistant & Practical Nursing Diploma -
Chesterfield Technical Center
High School Diploma -
Monacan High School
Skills
- Provider relations expertise
- Provider Enrollment
- Medical Billing
- Medical Claims
- Health benefits expertise
- Compliance management
- Benefits analysis
- Eligibility assessment
- Financial reconciliation
- Customer relationship management
- Office Administration
- Account coordination
- Team training
- Problem solving
- Time management
- Attention to detail
- Adaptability and flexibility
- Conflict resolution
- Team collaboration
- Written communication
- Customer Service Specialist
- Problem-solving skills
Part Time Employment
Lead Sales Associate, Virginia ABC Authority, 06/01/22, present
Timeline
Client Manager Associate II
The Standard, Inc.
04.2024 - Current
Account Service Coordinator
Anthem, Inc. (Elevance Health)
10.2021 - 04.2024
CSA
Anthem, Inc.
05.2019 - 10.2021
Billing Coordinator
Result (Commonwealth Anesthesia Associates)
06.2018 - 02.2019
Service BDC (Business Development Center)
Haley Chrysler Dodge Jeep Ram
01.2018 - 06.2018
Behavioral Health Network Educator
Optima Health
07.2017 - 12.2017
Provider Enrollment Team Lead
Pediatrix Medical Group
12.2014 - 07.2017
Provider Enrollment Associate II
Pediatrix Medical Group
09.2007 - 10.2014
Claims Processor and Member Services Consultant
Aetna
03.1994 - 09.2007
Associate - Healthcare Management
College For America (SNHU)
Nursing Assistant & Practical Nursing Diploma -
Chesterfield Technical Center
High School Diploma -
Monacan High School