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Customer Service Assistant

Location:
Detroit, Michigan, United States
Posted:
January 29, 2018

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Resume:

Jamela Knight

***** ********

Detroit, Michigan *8223

ac38xh@r.postjobfree.com

313-***-****

Objective:

As an experienced, caring, and motivated Administrator and LPN professional, I am in pursuit of an exciting position where I can contribute professionally to the growth and integrity of the organization. Having extensive experience in Administration, Utilization Management, Prior Authorization, Medicaid and Medicare Guidelines/Criteria, Home Healthcare, as well as in the field of Allergy, Asthma and Immunology I am aware of the importance of customer service excellence and bed-side manner.

Administrative Strengths:

Utilization Management

Prior Authorization, Inpatient/Outpatient

QNXT, Profax, Propat, Milliman, Interqual

Knowledge of Medicaid/Medicare

Customer Service/Conflict Resolution

Account Receivables/Payroll

Revenue Cycle

Development of Staff/Management

Multiple Computer Applications

Clinical Strengths:

Detailed history taking to enhance clinical decision-making

IV Starts

Venipuncture

Experience:

Meridian Health Plan 10/2017 – Present

Utilization Management Pre-Service Review Nurse

Insures that authorization request, provider inquiries and member inquiries are handled appropriately within established time frames.

Utilize clinical decision making and establish medical criteria to approve services based on information obtained from provider.

Collaborate with inpatient reviewers, case managers and other staff for care coordination.

Seeks out opportunities to improve HEDIS, NCQA, URAC and general accreditation and QIA activities.

State of Michigan/Huron Valley Women’s Facility 05/2017 – 10/2017 Correctional Nurse

Provide health care by assessing, diagnosing and treating inmates

Administration of medication

Assist Physicians

Ensure appropriate record keeping and notify facility management Aetna Insurance 12/2014 – 11/2016

Prior Authorization Nurse/MI Duals (Medicaid – Medicare) Utilization Management

Promote and support quality effectiveness of healthcare services and benefit utilization

Utilized clinical skills and experience to review documentation along with criteria/guideline, policy and procedures to make timely and accurate medical necessity determinations

Effectively communicate with providers regarding requested authorizations

Demonstrated ability to multitask, prioritize and effectively meet the needs of provider as well membership

LPN/Assistant Office Manager 07/2012-12/2014

Asthma Allergy & Immunology Institute, Southfield, MI

Spirometry and nebulizer treatments

Patient education through family consultations coupled with continuity of care

IVIG, Xolair and Allergy Immunotherapy administration and monitoring

Drug desensitization

Methocholine treatment

Obtaining Prior Authorizations for Medications/Treatments

Management of Front office Staff and Medical Assistants

Monitoring and Execution of the Day to Day Operations both Clinical and Administrative LPN 09/2010-06/2012

Assured Home Nursing, Birmingham, MI

Administered medications and injections

Maintain a record of medical intake and patient's health

Skilled at tracheotomy care, intravenous and oxygen therapy

Instructed patient regarding preventive care and health management LPN Intern November 2011

Bowling Green Manor, Bowling Green, OH

Administer prescribed medications, and note times and amounts on patients' charts

Observe patients, charting and reporting changes in patients' conditions, such as adverse reactions to medication or treatment, and taking any necessary action

Measure and record patients' vital signs, such as height, weight, temperature, blood pressure, pulse and respiration

Home Healthcare Aide 05/2009- 11/2010

United States Home Health, Southfield, MI

Provide routine, personal healthcare, such as bathing, dressing, or grooming, to elderly, convalescent, or disabled persons in the home of patients or in a residential care facility Director 06/1992- 06/2010

Blackwell’s Christian Academy, Detroit, MI

Conduct or participate in workshops, committees, and conferences designed to promote the intellectual, social, and physical welfare of students

Advise teaching and administrative staff in curriculum development, use of materials and equipment, and implementation of state and federal programs and procedures

Observe work of teaching staff to evaluate performance, and to recommend changes that could strengthen teaching

Develop instructional materials to be used by educators and instructors

Teach basic skills such as color, shape, number and letter recognition, personal hygiene, and social skills

Organize and lead activities designed to promote physical, mental and social development, such as games, arts and crafts, music, storytelling, and field trips Assistant Director 06/1986- 06/1992

Blackwell’s Christian Academy, Detroit, MI

Assisted with Lesson Plans

Customer Service/Account Receivables

Assisted with State License Guidelines

Staff In Service Training

Education:

Alabama State University – Montgomery, AL. 8/1986 – 5/1991 Business Administration / Early Childhood Development Brown Mackie College - Findlay, OH 5/2010 – 11/2011 Practical Nursing

Certifications:

Licensed Practical Nurse (LPN)

Certified Nursing Assistant (CNA)

Cardiopulmonary Resuscitation (CPR)



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