Experience

Columbia Doctors Group

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Medical Assistant

  • Sep 2020 - Present

  At the Onsite Temperature Screener the responsibility for the oversight and operational performance of an Onsite Temperature Screening Event at a customer’s work site. This position will function as the liaison with clients and any other onsite vendors. This position is responsible for ensuring the daily operations of the screening are carried out in an efficient, safe, systematic and reproducible manner. As a floater responsibilities are to be available when needed in any other departments. Such departments are pediatrics obgyn cardiology dermatology and radiology. Responsible for taking and documenting vital signs EKG and blood work. Show less



Data Concepts

• United States
• Information Technology & Services
• 1 - 100 Employee

• Grievance and Appeals Coordinator

  • Mar 2020 - Jun 2020

  Provide written acknowledgment of all member and provider correspondence. Independently review all receipts; interpret regulations and appropriately classify the inquiry. Make critical decisions regarding research and investigation to appropriately categorize and resolve all inquiries. Independently conduct thorough investigations of all member and provider correspondence by analyzing all the issues involved and obtaining responses and information from internal and external entities. Facilitate the investigation of complex cases presented by members and providers. Provide recommendations to management on cost saving opportunities, best practices and performance issues. Assist the Manager/Supervisor in developing workflows and process efficiencies. Prepare written responses to all member and provider correspondence that appropriately addresses each complainant’s issues and are structurally accurate. Show less



Mount Sinai Health System

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

• Certified Medical Assistant

  • Oct 2019 - Dec 2019

  Mount Sinai Cardiology Prepared patients for examination by performing preliminary physical tests; taking blood pressure, weight, and temperature; and reporting patient history summary. Secured patient information and maintained patient confidence by completing and safeguarding medical records. Kept supplies ready by inventorying stock, placing orders, and verifying receipt. Prepared patients for examination by performing preliminary physical tests. Saved doctors’ time by helping with office procedures. Communicated all critical patient information. Show less



Humana

• United States
• Insurance
• 700 & Above Employee

• Appeals Coordinator

  • Aug 2014 - Jul 2019

  Humana Health • Reviews clinical information for all appeals by using criteria that is nationally recognized, in order to determine the actual necessity of the services that are requested • Prepares reviews for cases that do not meet the required criteria • Coordinate and deliver verbal and written information regarding patient and provider appeals, and ensure all letters are in line with all required standards • Maintains files and logs related to all appeals • Coordinates hearings with various internal departments and agencies • Communicated effectively with patients, insurance providers and billing personnel for finalization of claims. Acted as liaison between hospital and insurance providers filing verbal appeals. Gathered benefit information to sort out any issues with claims payment. Prepared written correspondence and routine reports. Show less



Nation Wide Title Clearing

• Research Analyst

  • Mar 2013 - Apr 2014

  Responsible for receiving all incoming mail, entering all information in the database and determining what department the documents need to be routed to. Corresponded with clients such as Chase Bank, Citi Bank and Wells Fargo via telephone and in person. Responsible for faxing all documents for the client’s approval and then scanning them into the system for storage. Received several monthly awards for outstanding performance. As well as team incentives for meeting monthly goals Responsible for receiving all incoming mail, entering all information in the database and determining what department the documents need to be routed to. Corresponded with clients such as Chase Bank, Citi Bank and Wells Fargo via telephone and in person. Responsible for faxing all documents for the client’s approval and then scanning them into the system for storage. Received several monthly awards for outstanding performance. As well as team incentives for meeting monthly goals



WellCare Health Plans

• United States
• Insurance
• 700 & Above Employee

• Provider Relations Coordinator

  • Aug 2008 - May 2009

  Responsible for handling inbound and outbound calls from and to providers for the PFFS Medicare plan. Assisted providers in understanding the PFFS plan. Handled calls from providers that have CMS complaints as well as other escalated issues providers had concerns about. Reviewed and processed Medical claims. Reached out to providers to go over claim denials. Explained claim denials to the providers and assisted providers on how to correct Medical claims to be submitted for payment. These are some of the many responsibilities I had as a provider relation’s coordinator. Show less



UnitedHealth Group

• Hospitals and Health Care
• 700 & Above Employee

• Medicare Advocate

  • Mar 2008 - Jul 2008

  Responsible for contacting new members providing specific detail information on all Medicare benefit plans. Daily duties included outbound welcome calls and retention calling campaigns. Worked across different ancillary units to assist with claim, enrollment inquiries. Completed Florida Life Health Variable Annuity class. Responsible for contacting new members providing specific detail information on all Medicare benefit plans. Daily duties included outbound welcome calls and retention calling campaigns. Worked across different ancillary units to assist with claim, enrollment inquiries. Completed Florida Life Health Variable Annuity class.



Humana

• United States
• Insurance
• 700 & Above Employee

• Medicare Team Lead

  • Sep 2005 - Feb 2008

  Trained new hires on Medicare Billing/Enrollment, RX, and claims call types. Trained several classes on the use of the Pharmacy system Argus. Conducted a numerous amount of huddles on new information pertaining to Medicare and Medicaid. Assisted trainers in new hire classes with over 30 new hires in the class. Handle call escalation for customer service and sales issues. A key stakeholder on updating clients on plan changes and worked with market agents across the US to increase revenue sales. Abreast on all enrollment/disenrollment functions to enhance our relationship with our clients to increase customer satisfaction. Worked with the training dept. on process improvements to provide members with accurate up to date information as it relates to our competitors and changes in the Medicare space. I would prioritize the resources needed. Overtime, fte, subject matter experts, and put together a project plan with timeframes and completion dates. I would proactively identify a list of tasks that needed additional time and align the proper assistance to ensure timeliness. My dedication and drive towards excellence will be evident with accuracy and meeting each deadline. Show less



JPMorgan Chase & Co.

• United States
• Financial Services
• 700 & Above Employee

• Customer Service Associate

  • Feb 2002 - Aug 2005

  Evaluate research and resolve financial inquires related to credit card accounts. Exceeding call center standards for providing appropriate account options while maintaining world-class customer service experiences. Recognized several times by management for expertise in establishing customer rapport and maintaining customer credit card accounts. Promoted within 6 months to total assistance group, which handled escalated issues. Monitored employees and gave feedback on how to offer options to card holders and how to lower average handling time to service level needs. Show less