Bridget Geiser

Work closely with the Grievance & Appeals team, Chief Medical Officer, Medical Directors and Quality Review Manager to ensure that grievances and appeals, & Potential Quality Issues are addressed in a timely manner

Work closely with the Grievance & Appeal Specialists to ensure that all concerns are investigated as part of the grievance and appeal research process

Review Member Billing concerns and make recommendations regarding processing and payment

• Review & process urgent/non urgent authorizations for medical necessity
• Utilize a variety of medical necessity, contractual, & benefit criteria to determine appropriate authorization decisions
• Obtain additional medical information as necessary from requesting providers
• Documented clinical reviews with accuracy and thoroughness

• Provided management to a team that had 50% growth during 5 months
• Recruited, interviewed & onboarded new employees
• Developed a 2 week training program for new employees
• Lead weekly team meetings with the clinical team to ensure all communication remained current
• Reviewed daily statistic to ensure productivity was active & aiming towards monthly production goals
• Audited Navigator Team calls to ensure quality was at highest standards possible
• Created an auditing tool to review all calls for quality
• Communicated with members to work on adherence on their blood pressure readings

• Provided retrospective review of commercial outpatient medical claims, including: surgery, ambulance, genetic lab studies, MAC anesthesia, investigational & other questioned claims
• Documented clinical claims review with accuracy and thoroughness
• Investigated Appeals & Grievances, ensuring that turn around times were met

• Provided management to team of 14 of both clinical & non clinical personnel who provided monitoring services to patients with hypertension
• Recruited, interviewed, & onboarded new employees
• Created initial policies for this new start up, regarding the clinical team

• Provided case management services to all members
• Provided telephonic follow up calls following admits, & ER visits
• Ensured that all members are familiar with accessing benefits, contact or selection of PCP

• Focused on educational classes: behavioral health, pain management, GI, neurological issues, headache diagnoses, & chemotherapy
• Participated in ongoing Pain Management classes at Stanford’s Empower Program to understand chronic pain
• Dealt with the aftermath of brother’s death from Covid

• Managed the UM team, & provided back up supervision to the Quality & Case Management Teams
• Managed prospective/concurrent/retrospective review of prior authorization requests
• Determined if medical requests required MD review- discuss with MD as needed
• Ensured turn around times (TAT) were meeting department & regulatory goals
• Gathered clinical information & coverage criteria as it pertained to each request
• Assisted with collection of information for Grievances & Appeals for presentation to committees & Health Plans
• Initiated and completed PQI investigations, documenting follow up action & CAPs
• Participated in audits, ensuring that all documentation was provided to auditors
• Maintained collection of HEDIS data during review of authorization requests
• Served as a liaison to health plans, physicians offices, & ancillary vendors
• Served as a resource for physicians, providers, staff & members
• Lead weekly staff meetings which included training & educational updates

• Reviewed prior authorization requests (PARs) for both in/out patient services, for medical necessity (600-800/month)
• Participated in audits, ensuring that all documentation was provided to auditors