Roxanne Michel

*** ******* ***** ********* #***

Ladson, South Carolina 29456

abmm3i@r.postjobfree.com

317-***-****

SUMMARY

A proven health care administrator in the Indiana Medicaid Managed Care

industry. Recognized for superior performance in customer service and

outreach. Demonstrated expertise in networking and communication skills.

Specialties include relationship building with members, pharmacies and

healthcare professionals.

PROFESSIONAL

Centerstone of America, Martinsville, IN

2014

Mental Health

Adult Support Specialist

Case management for mentally ill adults.

Kept detailed notes to bill Medicaid/Medicare daily.

Jacobson Solutions, Chicago, IL 2013-2014

Insurance Staffing Company

Provider Services

Research Claims for providers using Facets

Quote Commercial, Medicaid, and Medicare benefits then documented in CCB.

CENTENE/MHS, Indianapolis, IN 2010-2013

Indiana Health Care Plan.

Right Choice Program Administrator

Networked with healthcare professionals to coordinate care for RCP Members.

Educated members on the Right Choice Program to improve health outcomes and

stop over utilization.

MDwise, Indianapolis, IN 2003-2010

Indiana Managed Health Care Plan.

Pharmacy Technician (2006-2010)

Networked with healthcare professionals to get referrals for Right Choice

Members.

Provided support and education to Case Managers and Right Choice Program

members.

Coordinated annual training and materials for training on Pharmacy Benefit

Manager.

Maintained monthly invoicing and billing for delivery systems for Pharmacy

Benefit Manager.

Assisted in the implementation of the Right Choice Program and Pill

Splitting Program.

Coordinated Healthy Hoops program for MDwise children patients including

asthma screening.

Distributed educational information to participants.

Grievance Coordinator/Quality Coordinator/Customer Service (2003-2006)

Reviewed documents, investigated and coordinated grievances and appeals.

Initiated case files for each grievance and appeal ensuring compliance with

organization.

Researched, responded and tracked all written and faxed correspondence,

including complaints, appeals grievances independent review requests, PCP

dismissals, and fair hearing requests from members and providers.

Managed and resolved member's quality complaints.

Educated members on Medicaid Plan.

Processed PMP changes, change of address, and assisted with billing

questions.

1 EDUCATION AND CERTIFICATIONS

2005 Indiana University, Bloomington, IN Certificate in

Medical Billing and Coding

2009 IUPUI Greenwood, IN

Certificate in Project Management

2011 IUPUI, Greenwood, IN

Pharmacy Technician License

REFERENCES

Dr. Kelly Franks-Henderson abmm3i@r.postjobfree.com 317-

366-9584

Patricia McElroy, RN,MSN,ANP abmm3i@r.postjobfree.com

765-***-****

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