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Senior Care Associate Pitt Remote Resume Example

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Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
Summary

Enthusiastic individual with superior skills in working in both team-based and independent capacities. Bringing strong work ethic and excellent organizational skills to any setting. Excited to begin new challenge with successful team.

Skills
  • ICMS, UMS, CCMS, Trucare, and Amisys (retired)
  • CPF, Isaac, Providerlink , IComply, M&R Guidelines, Benefit Access, CIRF
  • Problem solving
  • Billing
  • Case management, Reporting
  • Patient Research
  • Coaching
  • Technical support
  • Customer service
  • Triage
  • Unix system
  • Word Perfect
  • Creating Workflows
  • Home care
  • Insurance
  • Inventory
  • Manual Letters and Letter errors
  • Associate Medical Director
  • Medical Coding
  • Medical Manager
  • Medical Terminology
  • Access
  • Excel
  • Outlook
  • Powerpoint
  • Sharepoint
  • Microsoft Word
  • Migration
  • Pivot table
  • Direct patient care and advocacy
Experience
Senior Care Associate - Pitt Remote, 10/2002 to 03/2020
Almo CorporationGroveport, OH,
  • Point person for any care associate, claims representatives, and nurse case management needing assistance with questions regarding case status or providerlink technical issues.
  • Provided coaching for other representatives to help with quality and productivity of their work.
  • Ability to assist various requests (Cigna, Great West, AZ Medicare, CA HMO, Transition of Care, Centralized Unit, CareAllies, Payor Solutions, Cigna Global, HGS, and the decision team).
  • Assisted supervisor with monthly audits of 20 care associates.
  • Urgent review staff for Cigna, Care Allies, and Great West taking incoming calls and processing faxes.
  • Organized weekend / holiday team schedules for each quarter and presented to upper management.
  • Prepared and posted inventory reports for upper management and running the Offline Activity report.
  • Assisted with numerous areas when numbers are high without it interrupting fax room workflow.
  • Research and loading providers in system, sending load forms for new providers.
  • Training gatekeepers on CCMS and Amisys systems.
  • Worked the State of CT Census for new admits and the census for 3 states to obtain discharge dates.
  • Gatekeeper: calling members and providers with determination, incoming calls for peer to peer requests and case status update. Filing, determination letters, triaged cases to prepare for nurse and AMD review, call out assignments, D&R sign offs, appeal requests, reconsideration, assist the AMD with problem cases, training new gatekeepers, research pending faxes, and Inventory report.
  • Created multiple workflows for supervisor to post to REN.
  • Problem solving technical issues within providerlink (Superuser).
  • Ability to prioritize and complete work timely.
  • CareAllies – created cases for AZ MC patients, distribute clinicals to IPCM’s, updated and closed cases with discharge dates, and worked the maternity to do list.
  • Intake calls for authorization requests.
  • Ability to quickly learn new programs and processes.
  • Working all aspects of the prior authorization process, allowed me to better service our customers and providers with any questions from the start of the authorization to the determination.
  • Attended departmental meetings, providing feedback to enhance future performance.
  • Worked closely with team members to deliver project requirements, develop solutions and meet deadlines.
Account Manager, 03/2000 to 10/2002
Teletech, American ExpressCity, STATE,
  • Answer the incoming calls from customers and assisting their banking needs.
  • Processed phone, mail, and web applications for new accounts.
  • Money transfers between accounts, ACH, and wires.
  • Set up ATM cards, online access, and run credit checks for Line of Credit and Overdraft Protection.
  • Processing returned mail, funding accounts with checks and ACH activation and ordering checks.
  • Logging customer complaints on various subjects and resolving the issues after researching information.
  • Provided customers with technical support when they were having difficulties with their online access after a system migration.
  • Part of the cross sell team for Retirement Kits.
  • Processed offline work.
  • Recognized as high achiever every quarter.
Medical Secretary / Assistant, 10/1996 to 01/2000
V. Chokkavelu, MD, IncCity, STATE,
  • Prepared patient charts, scheduled appointments and hospital procedures, answered phone, obtained HMO referrals, copying, faxing, filing, co-payments, and called in prescriptions.
  • Logged referral authorization numbers, prescriptions, hospital consults, and patient information into the Medical Manager system.
  • Obtaining the patient’s weight, prescription list, temperature, and documenting the chart with patient’s symptoms and questions.
  • Mailed out claims and statements and contacted the patient for collection of late payment.
  • Contacted home infusions and home care with IV orders.
  • Filled out culture reports, contacted patients on missed appointments, obtained lab results, distribution of incoming mail, and entered patient and insurance payment in the system.
  • Interviewed patients to collect medical information and insurance details.
Education and Training
: Medical Insurance Coding, Expected in 03/1999
Belmont Technical College - Belmont, OH,
GPA:

ICD 9 Medical Coding/ Claims Billing

Graduate: Medical Assistant , Expected in 05/1995
WV Business College - Wheeling, WV,
GPA:
High School Diploma, Secretarial Diploma: Business Office Education, Expected in 05/1988
Watkins Memorial High School - Pataskala, OH,
GPA:

Secretarial Diploma

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Resume Overview

School Attended
  • Belmont Technical College
  • WV Business College
  • Watkins Memorial High School
Job Titles Held:
  • Senior Care Associate - Pitt Remote
  • Account Manager
  • Medical Secretary / Assistant
Degrees
  • Graduate
  • High School Diploma, Secretarial Diploma

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