Experienced public health professional proficient in program practices and successful strategies for optimizing structures. Talented in building relationships, solving problems and planning initiatives. Organized and motivated employee eager to apply time management and organizational skills in various environments. Seeking opportunities to expand skills while facilitating company growth. Handles tasks with accuracy and efficiency. Empathetic skills with strong problem solving skills.
Skills
Research proficiency
HIPAA guidelines
Remote work from home
Training skills
Analytical
Microsoft Office
Organized and detail-oriented
Health information programming
Facets
Care Compass
Outlook
Macess
Sharepoint
Microsoft Edge
SOLS
Avaya
Computer skills
Reliable and trustworthy
Friendly, positive attitude
Data analyst
Experience
Health Program Representative, 11/2020 to Current Anthem, Inc. – Gainesville, FL,
Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
Worked closely with team members to deliver project requirements, develop solutions and meet deadlines.
Juggled multiple projects and tasks to ensure high quality and timely delivery.
Prioritized and organized tasks to efficiently accomplish service goals.
Demonstrated self-reliance by meeting and exceeding workflow needs.
Demonstrated leadership by making improvements to work processes and helping to train others.
Gathers and records appropriate member information accordance with policies and procedures via telephone.
Records call data as needed based on client requirements.
I am responsible for providing initial contact between distinct Care Management programs and specific identified members.
Contacts physician offices to obtain demographic information or related data as needed
Utilization Management Representative II/Medicare, 06/2016 to Current Iconma, L.L.C. – Manassas, VA,
Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
Determining contract and benefit eligibility, providing authorization for patient admission,outpatient precertification,and post service request.
Referring cases requiring clinical review to a Nurse reviewer.
responsible for the identification and data entry of referral requests into UM system in accordance with the plan certificate.
Responding to telephone and written inquiries from clients, providers and in house departments.
Authorizing initial set of sessions to provider.
Checking benefits for facility based treatment.
Developing and maintaining positive customer relations and coordinating with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
Processing Authorization approval letter and mailing process for Medicare members.
Customer Service Representative II, 10/2015 to Current Adia – Hookstown, PA,
Fielded customer complaints and queries, fast-tracking them for problem resolution.
Upheld strict quality control policies and procedures during customer interactions.
Provided outstanding service to new and long-standing customers by attending closely to concerns and developing solutions.
Asked probing questions to determine service needs and accurately input information into electronic systems.
Remained constantly aware of customer activity to ensure safe and secure shopping environment.
Worked with supervisor to develop customer service improvement initiatives.
An ability to be empathetic and the desire to go above and beyond to help resolve members questions at the first point of contact.
Flexible and quick learner, willing to adapt to changing customer and business needs.
A composed individual able to multi-task, navigating multiple computer applications and working efficiently while communicating and serving the customer.
Customer Care Representative, 12/2013 to Current ANTHEM Health Services – City, STATE,
Customer care Representative, acts as a trusted advisor and educator on health care related inquires.
Guide members and providers with their healthcare needs by explaining benefits, solving claim concerns, helping find a doctor via telephone calls or emails.
Thoroughly documents inquiries outcomes for accurate tracking and analysis.
Develops and maintains positive customer relations coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
Uses computerized systems for tracking, information gathering and troubleshooting.
Guide members and providers with their healthcare needs questions explaining benefits, solving claim concerns, helping find a doctor via telephone calls or emails.
Focus on proactive resolving members and /or providers questions and concerns using computer-based resources to find answers.
Education and Training
High School Diploma: , Expected in 06/1979 Kokomo High School - Kokomo, IN GPA:
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