Experience

Gracepoint Wellness

• United States
• Medical Practices
• 200 - 300 Employee

• Pre- Certification Specialist

  • Jan 2014 - Present

  • Responsible for verifying funding for each patient who enters Central Intake and transferring or completing pre-certification within a timely fashion. • Maintains accurate documentation to reflect all contacts made. • Maintains good communication with other managed care staff, as well as Central Intake and CSU regarding funding and authorization issues. • Organizes data for monthly reports. • Maintains database of authorized services. • Conducts daily reviews of inpatient care with consumer’s insurance company. • Assists in appeals process for denied claims. • Acts as a liaison between agency fee-for-service managed care contacts and internal division providers. • Completes service activity logs, functional assessment ratings, and PERFS as needed. • Assist program manager in managed care implementation. Show less



UnitedHealth Group

• Hospitals and Health Care
• 700 & Above Employee

• Senior Customer Service Professional

  • Oct 2012 - Present

  • Provide excellent customer service through inbound, outbound, and written correspondence to members and providers regarding managed care products. • Create and update spreadsheets and guarantee of payments for international providers/members. ??? • Coordinate care with Frontier Medex to secure payments and medical evacuations. • Explain plan design to international providers in the attempt to negotiate contract details. • Provide decisive personalized service to members, providers, plan sponsors, brokers and vendors. • Respond to and complete requests in regard to: benefits and eligibility information, billing and payment issues, customer material requests, physician assignments and authorizations for treatment. • Use UNET, Siebel, IDRS, WAND and SharePoint daily. Show less



Aetna, a CVS Health Company

• United States
• Wellness and Fitness Services
• 700 & Above Employee

• Team Lead- Senior Customer Service Representative

  • Apr 2006 - Jun 2012

  • Handled escalated issues for the department. • Managed backlog for the customer service team. • Mentored and assisted with developing new representatives via side-by-sides and additional training. • Worked on the assist queue, collaboration work group, development work group and regional work group committees. • Monitored team results using CMS and RTA; pulled necessary reports. • Worked with Workforce Management to coordinate employee trainings. • Handled escalated issues for the department. • Managed backlog for the customer service team. • Mentored and assisted with developing new representatives via side-by-sides and additional training. • Worked on the assist queue, collaboration work group, development work group and regional work group committees. • Monitored team results using CMS and RTA; pulled necessary reports. • Worked with Workforce Management to coordinate employee trainings.