Elaine M. Nigriny

Elaine m. nigriny

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location of Elaine M. NigrinyClifton Park, New York, United States
Followers of Elaine M. Nigriny552 followers
  • Timeline

  • About me

    NYS Department of Health ~ Medicaid Pharmacy Policy NYRx & EPIC

  • Education

    • Devry university

      2023 - 2024
      Healthcare information technology ~ data analytics

      Ensure the quality of medical/health records by verifying their completeness, accuracy, and proper entry into computer systems. Use computer applications to assemble and analyze patient data for the purpose of improving patient care or controlling costs. Participating in the release and access of information by authorized entities and patients.Often specialize in coding diagnoses and procedures in patient records for reimbursement and research. Additional roles for RHITs may include… Show more Ensure the quality of medical/health records by verifying their completeness, accuracy, and proper entry into computer systems. Use computer applications to assemble and analyze patient data for the purpose of improving patient care or controlling costs. Participating in the release and access of information by authorized entities and patients.Often specialize in coding diagnoses and procedures in patient records for reimbursement and research. Additional roles for RHITs may include cancer registrar, trauma registrar, stroke registrar, etc. — compiling and maintaining data on patients. Show less

    • Southern new hampshire university

      2024 - 2025
      Bachelor of general studies - business administration
    • Bryant & stratton college

      2022 - 2023
      Diploma in medical billing and coding 3.88

      Review patients’ records and assign numeric codes for each diagnosis and procedure.Possess expertise in the ICD-10-CM, ICD-10-PCS, and CPT® coding systems.Are versed in medical terminology, disease processes, and pharmacology concepts.

  • Experience

    • Samsung sds

      Dec 2008 - May 2010
      Northeast channel manager

      Managed business partners in the telephony SMB channel with revenues of 200K-1M+ Responsible for recruiting new business partners within large multistate territory Provided consultative sales support, technical support, and remote sales trainingAssisted partners in closing sales opportunities worth 25K+ through solutions and benefits focused selling techniquesDrove performance of business partners to meet or exceed program metrics of 40K+ per quarter of Samsung SMB sales - Developed individual business plans for business partners to help drive sales growth and identify key objectives and initiatives Communicated and implemented marketing programs and campaigns Show less

    • Verizon

      Jun 2011 - Jul 2012
      Sales manager

      Lead marketing initiatives by promoting the Product through community events, public speakingCoaches the sales team in the sales process, manages customer satisfaction throughoutLeads the sales team in focusing on developing solutions and strategic selling, lead motivate and develop 9 senior sales employeesManage an aggressive sales quota in a highly competitive environmentProven ability to further develop existing business and client relationships, cultivate new relationships and uncover new opportunities,Planned all outside events and seminars to drive businessPolished and professional, works effectively and well under tight deadlines Show less

    • Schenectady greenmarket inc

      Oct 2017 - Aug 2019
      Board of directors|chair of promotions|leadership skills|non profit

      Assumes leadership role in the department by leading a team to effectively articulate best overall interests of the Green Market. Responsible for working with the other board of directors regarding recommendations relevant to their department. Assess, prepare, and/or coordinate marketing and communications activities that support donor, outreach.

    • New york state department of health

      Dec 2018 - Feb 2021
      Case investigator covid 19

      Investigate reported COVID‐19 cases by interviewing infected individuals by phone to determine the likely source of illness, close contacts, and the potential for outbreak. Implement isolation and quarantine recommendations per protocol and teach measures to prevent further spread to contacts and the community, monitor symptom progression/resolution, provide case management and referral to appropriate community resources. Facilitate follow‐up testing where appropriate. Call contacts of newly diagnosed patients. Collect and record information on symptoms into the web‐based client resource management platform. Provide close contacts with approved information and instructions about quarantine procedures, and if appropriate, refer contacts for testing according to protocol and/or to the COVID‐19 Planning Coordinator for social resources. Monitor contacts. Work closely with and consult COVID‐19 Planning Coordinator and Contact Tracing team as appropriate. Maintain awareness of community. Use professional skills to identify individuals and groups whose behaviors place them at risk for health problems. Advocate for individuals and populations both within the health department and the community. Provide health information to the public and make referrals to appropriate agencies. Provide consultation and direct services to defined at‐risk populations.Maintain up‐to‐date case records and reports documenting service delivery and caseloadmanagement. Show less

    • New york state of health

      Jan 2023 - Jul 2023
      Consumer services specialist iii

      Conducted detailed research of Medicaid policies and procedures to ensure accuracy in program operations.Implemented quality assurance measures to ensure compliance with applicable laws and regulations governing the program.Analyzed data related to client demographics, income levels, and service utilization.Assessed applications for Medicaid eligibility through various methods such as verification of documents, interviews, and review of existing records.Provided comprehensive support to clients regarding Medicaid eligibility and enrollment requirements.As a Consumer Services Specialist III at New York State Of Health (NYSOH), I assist customers with enrollment, eligibility, and benefits for various health insurance programs, such as Medicaid, Essential Plan, QHP, CHP, and Medicare. I use databases and systems such as HIPAA, Emedny, DOH Back Office, Siebel, and Oracle Knowledge to process applications, verify information, and resolve issues.NYHBE| HIPAA| Emedny| DOH Back Office| Processing| Medicaid| Essential Plan| QHP| CHP| Medicare| Siebel| Oracle Knowledge Show less

    • New york state department of health ~ sso

      Oct 2023 - Sept 2024
      Healthcare program specialist~medicaid pharmacy policy & epic

      Lead in Pharmacy BML, triaging communications from stakeholders to call staff in Jira.Analyzing AND interpreting public or private health-related policy to assist consumers.Determining or reviewing eligibility for healthcare or consumer-assisted programs to ensure individuals meet eligibility criteria specified in State and/or federal laws, rules, and regulations.Performing utilization review of requests for medical treatment including prior approval or authorization activities, adjudication of claims for payment, and/or provider credentialing. Performing utilization review of requests for medical treatment including prior approval or authorization activities, adjudication of claims for payment, and/or provider credentialing. Participate in NYS EPIC and PDP quality control, auditing call center calls for policy guidelines.Assisting with the implementation of Medicaid, NYRx program policies and procedures to meet treatment and/or regulatory requirements of health care.Manage projects with tight deadlines while maintaining accuracy.Facilitated communication between stakeholders, ensuring all parties were informed of progress and changes in direction.Work effectively in a fast-paced environment both independently as well as part of a team. Excellent organizational, analytical, verbal, and written communication skills. Experience with data systems and proficiency using Microsoft Office programs (Word, Excel, Powerpoint, Outlook and Sharepoint) eMEDNY Show less

    • New york state department of health-nyrx & epic

      Sept 2024 - now
      Administrative specialist

      Administrative Assistant 1-Medicaid Pharmacy Policy NYRx NYS Department of Health Sept 2024 - PresentAssisting with the implementation of Medicaid, NYRx program policies and procedures to meet treatment and/or regulatory requirements of health care.Lead in the NYRx project management system, JIRA. Respond to inquiries from stakeholders and members, triage tickets created to call staff and SME’s. Lead in all calls into NYRx, respond and educate caller, create tickets for call staff or SME’s, triage tickets. Lead in MAXe tasks coming from Maximus, review and create tickets to send to appropriate call staff. Manage call staff schedule in excel to track tickets and follow that they have been completed. Manage electronic file system to ensure that tickets are being filled appropriately. Handle sensitive information according to NYS standards. Manage projects with tight deadlines while maintaining accuracy.Provide administrative support to the Program Manager, including special assigned tasks.Facilitated communication between stakeholders, ensuring all parties were informed of progress and changes in direction.Part of a team that does quality assurance calls with NYRx vendors to ensure policy is being followed, provide feedback to executive staff.Work effectively in a fast-paced environment both independently as well as part of a team. Excellent organizational, analytical, verbal, and written communication skills. Experience with data systems and proficiency using Microsoft Office programs (Word, Excel, PowerPoint, EmedNY, JIRA, Outlook and SharePoint). Show less

  • Licenses & Certifications

    • Building trust with business ethics

      Skillsoft
      Jan 2024
      View certificate certificate
    • Critical thinking: challenging assumptions

      Skillsoft
      Oct 2023
      View certificate certificate
    • Critical thinking: drawing sound conclusions

      Skillsoft
      Oct 2023
      View certificate certificate
    • Certified coding associate (cca)

      Ahima
      Aug 2023
    • Workplace diversity, equity, and inclusion in action

      Skillsoft
      Jan 2024
      View certificate certificate
    • Nysoh iso training

      Maximus
      May 2023
  • Volunteer Experience

    • Volunteer

      Issued by New England Mastiff Rescue on Apr 2003
      New England Mastiff RescueAssociated with Elaine M. Nigriny