Service-oriented professional experienced working in fast-paced environments demanding strong interpersonal skills. I’m friendly and enthusiastic team player willing to carry on a tradition of outstanding customer service.
Overview
10
10
years of professional experience
Work History
Clinical Administrator coordinator
Centene Corporation
05.2019 - Current
Familiarity with major psychiatric terminology
Understanding of Medicare compliance and regulatory guidelines
Applying specific policies or standards to daily work to assure compliance with relevant regulations.
Resolve and investigate claims inquiries from Claims Processors for payment/denial of claims.
Resolve and analyze failed authorizations to ensure timely process for member treatment.
Project -Med-trans
United Healthcare Group
03.2019 - 05.2019
Activated will calls
Coordinated with various companies to obtain pickup times for members.
Assigned alternative drivers when necessary.
Checked and confirmed addresses for scheduled pickups and drop-offs.
Directed incoming calls to designated departments.
Resolution Specialist
United Healthcare Group
06.2015 - 05.2019
Answer calls from providers about issues related to benefits, authorizations, and claims.
Help guide and educate providers on the benefits, use of the plan, and claims or inquiries.
Demonstrated proficiency in managing various tasks simultaneously.
Meet the performance goals for the position in the areas of call quality, customer satisfaction, and first call resolution.
Guided individuals through online portal functionalities.