Enrollment and Billing Specialist @ Aerotek/WellPoint
Enrollment Specialist/Customer Care Representative @ ACS/Xerox
Arlington High School
Experienced healthcare administrative support professional skilled in provider relations and patient accounts. Strong interpersonal and organizational skills with the ability to multitask in a variety of challenges and responsibilities. Recognized for ability to work effectively with other team members or independently with experience in performing administrative and customer service duties which require a range of knowledge of
Experienced healthcare administrative support professional skilled in provider relations and patient accounts. Strong interpersonal and organizational skills with the ability to multitask in a variety of challenges and responsibilities. Recognized for ability to work effectively with other team members or independently with experience in performing administrative and customer service duties which require a range of knowledge of organizational policies and procedures. Able to research, edit, document, verify, compose, edit, audit, prepare reports while working in a fast paced environment.
Service Support Coordinator Case Management/Medical Management @ Responsibilities include; assisting members and providers with coordination of care, referrals and pre certification. Follow up on members after hospital discharge and assist with appointment scheduling.
Contact members to follow up on calls made to the 24/7 nurse line.
Provide health education and disease coaching as well as assisting on site nurses with Case Management. Assist Social Workers and members with referrals to community services.
Assist patients with scheduling follow up appointments and referrals for outpatient procedures and specialist visits.
Evaluate members with needs for community resources and behavioral health issues and refer accordingly.
Assist with verification of Hospice and Nursing Home Placement From March 2014 to Present (1 year 10 months) Houston, Texas AreaEnrollment and Billing Specialist @ Verified enrollment status, made changes to records, researched and resolved enrollment system rejections; addressed ensures accuracy and timeliness of the membership and billing function.
Maintained enrollment database.
Responded to inquiries concerning enrollment processes.
Billed and collected premiums and reconciled payments.
Maintained and reconciled premium bill, self-bill and individually billed accounts. From January 2013 to December 2013 (1 year) Indianapolis, Indiana AreaEnrollment Specialist/Customer Care Representative @ Assisted individuals eligible for Medicare Part D with enrollment into prescription coverage plans and verified prescription drug coverage. From September 2012 to January 2013 (5 months) Indianapolis, Indiana AreaElectronic Medical Records Analyst @ Responsibilities include processing attestation forms from Indiana providers for incentive payments from the State of Indiana Electronic Health Records incentive program Title XIX. Related responsibilities also include verifying provider licensing, enrollment, service location eligibility, patient claim volumes, electronic medical record software compliance, LPI and NPI status, as well as contacting providers and representatives to answer questions regarding processing, payments and error messages received through CMS and Web Interchange. From September 2011 to June 2012 (10 months) Indianapolis, Indiana AreaAssistant Clinical Editor @ Duties include pulling monthly state pharmacy pricing reports via the internet to facilitate changes to drug pricing plans provided by state plans such as Medicare and/or Medicaid and coding and quality checking reports using Oracle Developer. Duties also included, pulling monthly state Preferred Drug lists to make changes to lists from preferred to non-preferred by loading drugs into specific categories, researching drugs by trade, brand or generic names using Microsoft Access, searching queries for GPI numbers for accurate drug information relative to drug NDC numbers as well as updating forms in Access database. From August 2010 to December 2010 (5 months) Indianapolis, Indiana AreaPharmacy Technician @ Current knowledge of Long Term Care (LTC) pharmacy policies & procedures & supports them. Assists the pharmacist(s) on duty as primary responsibility; performing these duties as the number one priority. Fill daily drug orders accurately and efficiently in a timely manner, under the supervision of a pharmacist. From August 2009 to June 2010 (11 months)
Health Care Administration, Health/Health Care Administration/Management, 3.0 @ Brown Mackie College-Indianapolis From 2011 to 2013 Arlington High SchoolThomas Carr Howe Donna Jones is skilled in: Microsoft Office, Microsoft Office 2007, Business Objects, AIM, EHR, Pharmacy Operations, Pharmaceuticals, Insurance Verification, Editing, Medicaid, PPO, Customer Service, Call Center, Processing, Auditing
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