Experience

Orangeburg Consolidated School District Five Technology Cent
• Medicaid Service Coordinator


CALHOUN COUNTY HEALTH DEPARTMENT

• United States
• Government Administration
• 1 - 100 Employee

• Human Services Specialist 2

  • Oct 2014 - Oct 2018

  • Determines/re-determines Medicaid eligibility according to Medicaid policies and procedures. • Verifies eligibility information provided by the client using proper sources. • Completes the required forms to render timely and accurate case decisions using appropriate payment category and by using federal and state regulations defined by Medicaid policies and procedures. • Collects and accurately prepares case files and client history information and enters data in MEDS according to timelessness schedule indicated by Medicaid policies and procedures. • Prepares reports. • Provides external customer service to the public by answering calls, returning phone calls with 24 hours. • Provides internal customer service by attempting to work in harmonious and professional relationships. • Attends meetings and training sessions. • Performs emergency preparedness/shelter duties as assigned by supervisor. Show less



Blue Cross NC

• United States
• Insurance
• 700 & Above Employee

• Appeals Coordinator

  • Jan 2013 - Sep 2014

  • Aggressively pursuing approvals, overturning denials, seeking alternative methods of coverage, and establishing precedence with key payers. • Interpret medical policy guidelines • Use FDA approval letters, compare Medicare policy guidelines with the patient’s indications • Engage in patient advocacy groups • Use Hayes report and indicating higher ranking; use BCBS Technology Assessment Committee report and indicating higher ranking • Implement any other appropriate means to gain a favorable outcome • Use historical approvals with same similar payers • Leverage clinical expertise related to cardiac care; arrange and prepare physicians for peer review; write draft letters of medical necessity for prescribing physician Show less