Who am I?
Who is Shannon Smalls?
Director of Provider Services
All Behavioral Health Authorizations Requests must be submitted in writing?
True
Where can you find information on Works Processes?
Sharepoint and Cengenius
Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.
How many males do we have on the Entire Team ?
3-
Rob Sessums
Jorge Garcia
Raul Granados
Rodney B. Long
All Prior Authorization request for non-participating providers can be initialed over the phone?
False-
All Prior Authorization request for non-participating providers will require authorization in writing.
*Non-participating providers should submit their PA request via fax because they will not have access to the Secure Provider Web-portal
What event does Centene Support in the month of June?
LGBTQ Pride Month (June Tenth)
What is Superior Health Plans Membership Goal for 2021?
Membership is 1,453,071 for 2021
How many agents have been here under 3 years? (Entire Team - Employee of PS)
3 Total -
Cecilia Idar 1.25
Suzanne Ledesma- 2.9
Tiffany Daniels- 1.25
Who is the Chairman, President and CEO of Centene?
Michael F. Neidorff
Authorization Modifications can be done over the phone or in the portal?
False-
Any modifications to a Prior Authorization must be requested in writing by the requesting provider, regardless of service type The requesting provider may fax in their modification request to 1-800-690-7030
Where can you also find Adjustment 120 letters other than in CenPas?
OMNI (filenet)
What is SHP's Goal Revenue $$$ for 2021 ?
$11.1 Billion
How many agents have been here more than 3 years but less than 5 ?
(Entire Team - Employee of PS)
8 TOTAL:
AIDA GUTIERREZ- 4.84
BETZALY D. ROSARIO- 3.81
CLAUDIA VALDEZ - 3.31
CYTNHIA BANKS- 3.8
JANNETT GARCIA- 3.05
JORGE GARCIA- 4.84
ROXANNE HERNANDEZ - 4.23
SAVANNAH HERNANDEZ - 4.19
The Fax# to Outpatient Medicaid Prior Authorization is 800-690-7030?
True
What systems can I image a claim?
OMNI, Filenet, and CenPas. (Claims Viewer)
What are the 4 core values?
What are?
Passionate Customer Service
Innovation
Integrity
Accountability
How many agents have been here 5+ years but less than 10?
(Entire Team - Employee of PS)
5 Total-
CRYSTAL GALVAN- 5.87
LILIA HERNANDEZ-5.01
LIZA SAUCEDO - 5.26
PERRIS SAUNDERS - 5.6
ROB SESSUMS - 5.22
How many Leads do we have? Bonus Q- And what are their names?
9 leads -
Bonus A-
Sarah Trevino
Jasmine N Lopez
Lindsay B McCrary
Isabel Torres
Margie Jasso
Rosa V Olivas
Rosie Ornelas
Mary Flashman
Alice P Medina
The Fax# to Inpatient Behavioral Health Requests is 833-859-1245?
False- that fax# is for Outpatient Transplant o 833-589-1245
The correct fax# is Inpatient Behavioral Health Request/Medical Records o 800-732-7562
Where do you go to research an EXEB claim?
EX EB's are because providers authorization was denied. Notes and/or Correspondences in Trucare - the authorization denial letter would've given them 30 days to appeal the auth.
Medicare -What is the Medicare Star Rating Goal for 2021?
Clms/Hyrid- What is the General & Administrative Per Mbr/Per Month Goal for 2021?
Medicare 4-Star Rating
General & Administrative Per Member/Per Month: $21.47 - This is a measure of Superior’s overhead expenses across our membership.
What agent has been here the longest, 10+ years?
Raul Granados 16 years