Customer Service Manager
Resume:
Roxanne Michel
*** ******* ***** ********* #***
Ladson, South Carolina 29456
*************@*****.***
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 ***************@**.*** 317-
366-9584
Patricia McElroy, RN,MSN,ANP *********@*******.***
Contact this candidate