Program Coordinator I Resume Example Superior Health Plan /Centene Corporation

PROGRAM COORDINATOR I

Summary

Customer-focused Representative with a proven capacity to troubleshoot issues to ensure customer satisfaction.

Accomplishments

Exceeded corporate target for customer satisfaction for consistently every month. Promoted to Senior Representative in a year. Perfect attendance every month

Experience

Program Coordinator ISuperior Health Plan /Centene Corporation － Dallas, TX

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.
Coordinate services with community based organizations.
Attend marketing and outreach meetings as directed to represent the plan.
Produces and mails routine CM letters and program educational material.
Data enter assessments and authorizations into the system.

Customer Service RepresentativeTower Watson -One Exchange － Dallas, TX

Accept Incoming calls from Medicare eligible retiree's being moved off group medical plans to individual plans Assist retiree's with billing and reimbursement issues on their funding they receive from their retirement groups Transfer calls for enrollment over to licensed agents Transfer calls over to funding for direct deposit and claims issues Setup Retiree's in company's database (SSC).

Senior Representative Customer CareCVS CareMark － Richardson, Texas

Accessed and/or coaches customers and less senior colleagues via telephone in need of assistance with their prescription benefits Diffused irate customers and solves escalated problems with their prescription benefits Identified the needs of the customer and educated them on the benefits available to them Provided resource solutions utilizing CVS Caremark databases and references Responded to customer satisfaction expectations through regular and constant attendance, scheduling flexibility and availability Demonstrated strong analytical skills with the ability to evaluate, develop, and deliver alternative sources of action.

Medicare Part D Specialist - Multi Skilled Representative

Took incoming calls from various Medicare Part - D clients and also handled calls from Company's own plan.
Educated members on their Medicare Part D plans parts: Deductible, TROOP, Copays and Coverage Gap (Doughnut Hole).
Received several awards for top representative of the month and well as having the top quality scores on monthly monitors.

08/2003 to 07/2014

Prior Authorization Dept. - PA Coordinator ICVS Caremark － Richardson, Texas

Accepted incoming calls from New York Medicaid providers on medications requiring prior authorizations

Advised providers on outcomes on prior authorizations requests and advised when further review.

Performed input of faxed prior authorization requests received from New York Medicaid providers

Called New York Medicaid providers of requests received for medications Advised of approvals and denial

Education

DiplomaWoodrow Wilson High School － Dallas, TX

Software and Equipment

Avaya Phone System, Amisys, Microsoft Office (Word, Outlook, Excel ), PeopleSafe

Resume Overview

Companies Worked For:

Superior Health Plan /Centene Corporation
Tower Watson -One Exchange
CVS CareMark
CVS Caremark

School Attended

Woodrow Wilson High School

Job Titles Held:

Program Coordinator I
Customer Service Representative
Senior Representative Customer Care
Medicare Part D Specialist - Multi Skilled Representative
Prior Authorization Dept. - PA Coordinator I

Degrees

Diploma

Program Coordinator I Resume Example

Resume Score: 80%

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