Devon Finnegan

Background

About Devon Finnegan

Over the past 8 years I have been honing my health insurance knowledge, which have included commercial employer based policies, early retirement, Medicare Supplemental Part F and New York State, Ohio State, California State managed Medicaid plans. While working for UnitedHealth Group customer service I became a subject matter expert and a common go to for our team. I was also a leader and trainer for our teams quality and time management production goals. From this role I transitioned into a hands on claim auditing cost recovery position where I was the face of Optum. I worked directly with hospitals to review the credit balance inventory and verify if the credits were valid. In the summer of 2019 I started working for a Managed Medicaid company. As an appeals and grievance representative for our Ohio state team I had to learn Ohio state fee schedules, mandates, and exceptions. I quickly adjusted to this role of researching a provider's request for claim review and determining if a claim was processed correctly based upon the provider's contract and state guidelines. I began to split my time between this and our projects team. On the projects team you review cases received with 25 or more claims with the same or similar denials. An opportunity arose with our New York team to help assist with the daily intake and triage of new cases. After a few months I was able to turn this from a one person role to a leadership position, which now includes 10 direct reports along with our vendor team. I was in charge of the training of all new hires but also to help to create a training workflow document. This position involved running daily reports for production for our entire New York team, daily compliance reports, and weekly inventory reports. I was also responsible for making sure the team stays within New York State compliance of all expedited requests be uploaded within 2 hours of receipt, and all other requests within 1 business day. I was the subject matter expert for New York on all intake/triage issues which includes issues or concerns regarding our clinical team. I was also the subject matter expert for our Senior Whole Health line of business, and appeal cases received. In August 2023 I transitioned to a BPO company as a supervisor for a state of California Medicaid plan. I currently oversee 3 Auditors, 3 Claims examiners, 5 Dispute representatives. Quarter 1 2021 my leadership team nominated me and I won the Molina Spotlight award. March 2023 my leadership team nominated me and I won Employee Recognition Recipients.