Experience

Versant Health

• United States
• Insurance
• 300 - 400 Employee

• Implementation Coordinator

  • Nov 2022 - Present



Blue Cross NC

• United States
• Insurance
• 700 & Above Employee

• Account Implementation

  • Aug 2019 - Jul 2022

  •Lead and manage all aspects of the pre-sale process as well as post-sale implementation activity of highly customized, political and/or high profile large and national accounts. •Partner with and leads field staff personnel to facilitate the implementation of the terms of agreement between the BCBSNC and the customer. This includes the design and execution of an internal implementation strategy. •Lead post-sale coordination of benefits, eligibility, and administrative services to… Show more •Lead and manage all aspects of the pre-sale process as well as post-sale implementation activity of highly customized, political and/or high profile large and national accounts. •Partner with and leads field staff personnel to facilitate the implementation of the terms of agreement between the BCBSNC and the customer. This includes the design and execution of an internal implementation strategy. •Lead post-sale coordination of benefits, eligibility, and administrative services to accurate and timely implementation. •Identify, evaluate and resolve complex implementation issues and collaborates closely with various levels of employees including senior management.,. •Represent BCBSNC and form professional liaisons with consultants, group/benefit administrators, systems experts, personnel from other plans, health care providers, vendors, etc., in identifying current and emerging complex implementation issues and in determining and evaluating potential solutions to these issues. •Identify and assess barriers, lead and facilitate cross-functional workgroups, negotiate through technical and operational issues, develop action plans and communicates key implementation messages to all necessary audiences. •Track and manage implementation issues in order to lead overall improvement initiatives. •Audit ID cards, quotes, contracts, benefits •Mentor the Account Implementation Generalist in the documentation of implementations, selecting the appropriate resources, meeting facilitation and problem solving as well as technical and analytical aspects of implementation. •Assist in Facets migration projects. •Meet department goals and objectives and provide efficient and quality service to large non-standard accounts. Show less •Lead and manage all aspects of the pre-sale process as well as post-sale implementation activity of highly customized, political and/or high profile large and national accounts. •Partner with and leads field staff personnel to facilitate the implementation of the terms of agreement between the BCBSNC and the customer. This includes the design and execution of an internal implementation strategy. •Lead post-sale coordination of benefits, eligibility, and administrative services to… Show more •Lead and manage all aspects of the pre-sale process as well as post-sale implementation activity of highly customized, political and/or high profile large and national accounts. •Partner with and leads field staff personnel to facilitate the implementation of the terms of agreement between the BCBSNC and the customer. This includes the design and execution of an internal implementation strategy. •Lead post-sale coordination of benefits, eligibility, and administrative services to accurate and timely implementation. •Identify, evaluate and resolve complex implementation issues and collaborates closely with various levels of employees including senior management.,. •Represent BCBSNC and form professional liaisons with consultants, group/benefit administrators, systems experts, personnel from other plans, health care providers, vendors, etc., in identifying current and emerging complex implementation issues and in determining and evaluating potential solutions to these issues. •Identify and assess barriers, lead and facilitate cross-functional workgroups, negotiate through technical and operational issues, develop action plans and communicates key implementation messages to all necessary audiences. •Track and manage implementation issues in order to lead overall improvement initiatives. •Audit ID cards, quotes, contracts, benefits •Mentor the Account Implementation Generalist in the documentation of implementations, selecting the appropriate resources, meeting facilitation and problem solving as well as technical and analytical aspects of implementation. •Assist in Facets migration projects. •Meet department goals and objectives and provide efficient and quality service to large non-standard accounts. Show less



TrialCard

• United States
• Pharmaceutical Manufacturing
• 500 - 600 Employee

• Reimbursement Specialist/Quality Control

  • Nov 2018 - May 2019

  • Knowledge of HIPPA guidelines • Review documentation from call center agents, ensure accuracy • Application Administration, application maintenance. Application configuration • Maintain multiply email inquirers • Obtain prior authorization for medications • Obtain Business associate agreements between providers and Trial card • Assist in enrolling providers into cover my meds program • Maintain service request • Initiated additional information needed through cover my… Show more • Knowledge of HIPPA guidelines • Review documentation from call center agents, ensure accuracy • Application Administration, application maintenance. Application configuration • Maintain multiply email inquirers • Obtain prior authorization for medications • Obtain Business associate agreements between providers and Trial card • Assist in enrolling providers into cover my meds program • Maintain service request • Initiated additional information needed through cover my meds to providers • Enrolled members into The Link Program- savings on medications • Submitting referrals and review of referrals • Verifying health insurance coverage Show less • Knowledge of HIPPA guidelines • Review documentation from call center agents, ensure accuracy • Application Administration, application maintenance. Application configuration • Maintain multiply email inquirers • Obtain prior authorization for medications • Obtain Business associate agreements between providers and Trial card • Assist in enrolling providers into cover my meds program • Maintain service request • Initiated additional information needed through cover my… Show more • Knowledge of HIPPA guidelines • Review documentation from call center agents, ensure accuracy • Application Administration, application maintenance. Application configuration • Maintain multiply email inquirers • Obtain prior authorization for medications • Obtain Business associate agreements between providers and Trial card • Assist in enrolling providers into cover my meds program • Maintain service request • Initiated additional information needed through cover my meds to providers • Enrolled members into The Link Program- savings on medications • Submitting referrals and review of referrals • Verifying health insurance coverage Show less



UNC Health

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Administrative Specialist

  • Nov 2013 - Oct 2018

  • Knowledge of HIPPA guidelines. • Project coordination, project program support • Answering phones and routing calls to correct departments. • Helping external and internal customers with questions. • Detailed scheduling of both future and add-on appointments. • Checking patient's inn and checking patients out. • Submitting referrals and review of referrals. • Verifying health insurance coverage. • Obtaining authorizations if needed for certain… Show more • Knowledge of HIPPA guidelines. • Project coordination, project program support • Answering phones and routing calls to correct departments. • Helping external and internal customers with questions. • Detailed scheduling of both future and add-on appointments. • Checking patient's inn and checking patients out. • Submitting referrals and review of referrals. • Verifying health insurance coverage. • Obtaining authorizations if needed for certain procedures. • Knowledge of icd-10 codes. • Filing and scanning forms and records.

• Dietitian Assistant

  • Jun 2010 - Jun 2014

  • Answered phone calls and directed calls to the appropriate extension • Strong customer service skills • Assisted with organization over group projects • Knowledge and experience using Microsoft, power point, excel, Epic • Completed data entry of specifications and client intake information • Conducted manual credit card payment processing on secured hospital application • Identified and confirmed patient information and their respective daily food orders • Assisted and… Show more • Answered phone calls and directed calls to the appropriate extension • Strong customer service skills • Assisted with organization over group projects • Knowledge and experience using Microsoft, power point, excel, Epic • Completed data entry of specifications and client intake information • Conducted manual credit card payment processing on secured hospital application • Identified and confirmed patient information and their respective daily food orders • Assisted and participated in daily operations of clinic in any capacity • Administrative assistant duties such as (copying, maintaining files, distribute mail, multitasking, scheduling etc.)



Blue Cross NC

• United States
• Insurance
• 700 & Above Employee

• Customer Service Specialist

  • Jun 2014 - Nov 2016

  • Responded promptly to client inquiries via telephone in a professional and efficient • Knowledge of HIPAA Guidelines • Claim processing • Provide benefits and claims information to providers /facilities/ members • Familiar with co-pay, deductible, co-insurance, out of pocket cost information • Performed HR duties, recruiter, job detail description, talent acquisition • Verify claim status denials, adjustments and turnaround times • Located and confirmed status of various… Show more • Responded promptly to client inquiries via telephone in a professional and efficient • Knowledge of HIPAA Guidelines • Claim processing • Provide benefits and claims information to providers /facilities/ members • Familiar with co-pay, deductible, co-insurance, out of pocket cost information • Performed HR duties, recruiter, job detail description, talent acquisition • Verify claim status denials, adjustments and turnaround times • Located and confirmed status of various medical authorizations • Verified procedure and diagnosis codes such as ICD-10 to ensure appropriate billing • Reviewed, submitted, and confirmed pharmacy rejections • Provided billing status and rate quotes to members Show less • Responded promptly to client inquiries via telephone in a professional and efficient • Knowledge of HIPAA Guidelines • Claim processing • Provide benefits and claims information to providers /facilities/ members • Familiar with co-pay, deductible, co-insurance, out of pocket cost information • Performed HR duties, recruiter, job detail description, talent acquisition • Verify claim status denials, adjustments and turnaround times • Located and confirmed status of various… Show more • Responded promptly to client inquiries via telephone in a professional and efficient • Knowledge of HIPAA Guidelines • Claim processing • Provide benefits and claims information to providers /facilities/ members • Familiar with co-pay, deductible, co-insurance, out of pocket cost information • Performed HR duties, recruiter, job detail description, talent acquisition • Verify claim status denials, adjustments and turnaround times • Located and confirmed status of various medical authorizations • Verified procedure and diagnosis codes such as ICD-10 to ensure appropriate billing • Reviewed, submitted, and confirmed pharmacy rejections • Provided billing status and rate quotes to members Show less