Customer Service Assistant
Resume:
Jamela Knight
Detroit, Michigan *8223
******.******@*****.***
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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