SEARCH

Program Coordinator I Resume Example

Resume Score: 90%

Love this resume?Build Your Own Now
PROGRAM COORDINATOR I
Professional Summary
Demonstrate sense of urgency in a busy call center environments in both retail and telecommunication industries. Possess exceptional ability to build productive relationships, resolve complex issues, and win customer loyalty. Excellent interpersonal skills, ability to work well with others, in both supervisory or support staff roles.
Skills

  • Accomplished leader 
  • Supervisory training
  • Independent judgment and decision 

  • Knowledge of Medicaid statutes and making regulations 
  • Promotes positive behavior
  • Highly Motivated
Work History
Program Coordinator I, 06/2014 to Current
Sunshine Health – Sunrise, FL
  • Initiate authorization requests for output or input services in keeping with the prior authorization list.  Research claims inquiry specific to the department and responsibility. 
  • Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results.  Assess and monitor inpatient census.
  • Screen for eligibility and benefits.  Identify members without a PCP and refer to Member Services.  Screen members by priority for case management (CM) assessment.  Perform transition of care duties to include but not limited to, contact the member's attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.
  • Data enter assessments and authorizations into the system.
  • Assist with special projects as needed.
Medicare/Medicaid Claims Representative, 10/2011 to 06/2014
Molina Healthcare of Florida – Doral, FL
  •  Meeting all department standards by 95% or higher.
  • Explain plan's procedures, protocols, benefits, services and information to members and providers as required.
  • Ensure that all assigned provider issues are resolved and communicated to the provider within appropriate timeframes and report resolutions that are unfavorable to the appropriate Provider Relations Representative.
  • Assist providers with escalated inquiries including but not limited to; verifying proper medical coding, claim status, explanation of benefits, negative balance requests, claim payments and denials, appeal procedures and appeal status.
  • Document all inquires and complaints completely and thoroughly, Adhere to all HIPAA, State and Federal requirements, and regulations at all times in existing and future lines of business.
Provider Service Advocate V- Lead Representative, 02/2007 to 12/2009
Blue Cross and Blue Shield of Florida – Miami, Florida
  • Resolved issues on escalated calls from providers in regards to claim issues.
  • Supported team members in claim inquiries both telephone and written.
  • Exceeded claims processing daily quotas 100% of the time.
  • Answered nearly 60 inbound calls daily to assist providers with claims, benefits, and contracting inquires.
  • Always meeting expectations in quality, adherence and production scores while gaining a deep understanding and foundation on health insurance functions on many levels.
  • Assisted providers with written and phone inquires regarding claims, benefits, contracts, and fees schedules.
  • Provided resolutions to providers via letter and documenting all issues.
  • Built working relationships with healthcare providers in order to insure excellent customer.
Service Advocate I, 02/2009 to 03/2011
At&t – Miami, FL
  • Exceeded monthly sales quotas 100% of the time. Trained and supported team members to assist with closing sales. Able to successfully up sale customer's on additional AT&T products.
  • Answered nearly 100 inbound calls daily to assist customers with various products, services and billing inquires. 
  • Consulted with customers to recommend and sell a variety of AT&T products and services to meet the customers' needs. 
  • Provided AT&T customers with a positive sales and service experience. Interacted with multiple online systems while speaking with customers. 
  • Assisted customer with billing inquires as well as assisted customers in making payments to their AT&T account.
Miami Bus Operator, 01/2005 to 01/2007
Miami Dade County Transit – Miami, Florida
  • Completed training required in all areas of bus driving and safety.
  • Provided excelled customer service to over 500 rider's per day.
  • Assisted passengers with information on city geography and routes.
  • Completed ethics related training.
Contracting Specialist -Lead Representative, Precision Response Corporation PRC Direct TV – Miami, Florida
  • Processed contracts for commercial accounts.
  • Distributed promotional materials to prospective and current customers through facsimile and e-mails.
  • Maintained customer accounts by applying payments, initiating connections and disconnections, and researching accounts through utilization of queries.
Education
High School Diploma: Vocational Studies, 1996
Miami Norland Senior High - Miami, Florida
  • Top 20% of class
Skills
balance, benefits, billing, closing, contracts, customer service, driving, facsimile, insurance, coding, promotional materials, protocols, speaking, quality, researching, safety, sales, Supervisory, telephone, phone, written
Build Your Own Now

DISCLAIMER

Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

Resume Overview

Companies Worked For:

  • Sunshine Health
  • Molina Healthcare of Florida
  • Blue Cross and Blue Shield of Florida
  • At&t
  • Miami Dade County Transit
  • Precision Response Corporation PRC Direct TV

School Attended

  • Miami Norland Senior High

Job Titles Held:

  • Program Coordinator I
  • Medicare/Medicaid Claims Representative
  • Provider Service Advocate V- Lead Representative
  • Service Advocate I
  • Miami Bus Operator
  • Contracting Specialist -Lead Representative

Degrees

  • High School Diploma : Vocational Studies , 1996

Similar Resumes

View All
Program-Coordinator-I-resume-sample

Program Coordinator I

Superior Health Plan /Centene Corporation

Garland, Texas