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Amerigroup Washington - Outreach Care Specialist II-PRC Resume Example

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OUTREACH CARE SPECIALIST II-PRC
Professional Summary
Highly organized and detail-oriented administrative professional with more than 20 years experience. Extensive knowledgeof all office functions, hasa solid background in the healthcare field, excels at multi-tasking in a fast paced environment, and completing projects within time and budget constraints.
Skills
  • Excellent planner and coordinator
  • Works well under pressure
  • Professional phone etiquette
  • Excellent communication skills
  • Meticulous Attention To Detail
  • Accurate and detailed
  • Microsoft Office Proficiency
  • Database management
  • IDX, QNXT, Care Advance, Informacare, JIVA, CaseTrakker, and Interqual
  • Extensive knowledge of ICD-9, CPT codes, and Medical Terminology.
Work History
Outreach Care Specialist II-PRC, 02/2014 to 02/2016
 Amerigroup Washington – Seattle, WA
  • Complete PRC Referral requests including: verification of member eligibility, benefit availability, provider contracted status, diagnosis and treatment request ICD-9 and CPT codes, and COB Status Contact physician offices for missing or additional information.
  • Serve as first line of contact for members, provide telephone triage, and respond to urgent telephone requests for authorizations and prescription overrides as needed.
  • Maintain thorough and accurate documentation.
  • Manage various spreadsheets and month end reports.
  • Maintain PR&C Access Database.
  • Providing triage and sending correspondence as required.
  • Process development and improvement.
  • Claims review
Clinical Support Associate II-UM/CM, 08/2010 to 07/2014
 Health Integrated – Lynnwood, WA
  • Receive referrals and create cases for medical and behavioral health case management clinicians
  • Perform initial outreach to members to engage them in case management
  • Complete audits for case management clinicians
  • Perform outreach to hospital staff, providers, and members to provide coordination of care
  • Serve as first line contact for hospital staff, providers, and members
  • Maintain timely, thorough, and accurate documentation.
Care Specialist-PRC, 02/2006 to 08/2010
 Molina Healthcare – Bothell, WA
  • Complete authorization requests including: verification of member eligibility, benefit availability, provider contracted status, diagnosis and treatment request ICD-9 and CPT codes, and COB Status Contact physician offices for missing or additional information.
  • Serve as first line of contact for members, provide telephone triage, and respond to urgent telephone requests for authorizations and prescription overrides as needed.
  • Maintain thorough and accurate documentation.
  • Manage various spreadsheets and month end reports.
  • Maintain PR&C Access Database.
  • Providing triage and sending correspondence as required.
  • Process development and improvement.
  • Claims review
Office Manager, 02/2005 to 02/2006
 Bothell Pediatric and Hand Therapy – Bothell, WA
  • Manage the daily schedule for the office
  • Provide assistance and input to Marketing Manager
  • Provide day-to-day supervision and management of the therapy aides
  • Daily maintenance of accounts receivable, budget tracking, deposits, and accountability reports
  • Maintain all office equipment including postage meter, copier, fax machine, LCD, etc
  • Maintenance and ordering of office inventory and supplies
  • Verified benefits, obtained pre-authorizations formedical service and equipment.
  • Managed office supplies, vendors, organization and upkeep.
Surgery Coordinator, 02/1999 to 02/2001
 Pacific Medical Centers – Seattle, WA
  • Schedule surgical cases at hospital and outpatient surgery centers for multi specialty clinic.
  • Provide preoperative teachings and routine to complex financial counseling to patients
  • Obtain medical records and compile surgical charts and obtain referral authorization
  • Provide back up to Personnel Master Scheduler
  • Compile and produce statistical data utilizing a spreadsheet format
  • Produce and edit correspondence from surgical department
  • Assist Providers and Registered Nurses to insure quality patient care, and triage patient calls
  • Interface with the medical community and various organizations
  • Train new employees
Customer Service Associate, 02/2001 to 02/2005
 Blue Nile – Seattle, WA
  • Provide excellent customer service
  • Resolve routine and complex issues
  • Research and follow through with special requests
  • Maintain vendor relations
  • Perform various administrative duties including special projects and providing back up for customer email system using Talisma software.
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Resume Overview

Companies Worked For:

  • Amerigroup Washington
  • Health Integrated
  • Molina Healthcare
  • Bothell Pediatric and Hand Therapy
  • Pacific Medical Centers
  • Blue Nile

Job Titles Held:

  • Outreach Care Specialist II-PRC
  • Clinical Support Associate II-UM/CM
  • Care Specialist-PRC
  • Office Manager
  • Surgery Coordinator
  • Customer Service Associate

Where can I find a Amerigroup Washington Outreach Care Specialist II-PRC resume example in Bothell, Washington ?

This is an actual resume example of a Outreach Care Specialist II-PRC who works in the Office Assistants Industry. LiveCareer has 151593 Office Assistants resumes in its database. LiveCareer’s Resume Directory contains real resumes created by subscribers using LiveCareer’s Resume Builder.

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