Assistant Customer Service
Resume:
Michele Ann Sesok
Vineland, NJ 08360
ac54lb@r.postjobfree.com
Professional Experience: Thirty two years in administration of delivery of health care services to the elderly, pediatric, disabled and medically needy population. Consistent record of solving member concerns and navigating the health care system for a positive member outcome. I have been successful with developing working relations with health care providers for developing a strong referral base.
Significant experience
Managerial - Successfully managed teams from the 12 – 150 in healthcare settings. Completed training protocol and trained employees.
Financial – Monitoring healthcare costs based on member needs. Have a strong knowledge in Medicaid, Medicare, MCO, Dual Medicare/Medicaid coverage and private insurance. Understand and worked with the appeals process.
Customer Service - Successful at handle consumer/member concerns and issues. Developed positive working relationships with community resources. Have reviewed member/provider concerns and been able to come up with solution to meet the consumer’s needs. Communicated with Local State Departments to correct eligibility issues for consumers. Investigated reports of abuse and completed reporting on such issues.
Fraud analysis – Have investigated fraud situations and reported such to appropriate departments.
Quality – Completed state and company audits on and offsite. Completed quality reports. Assured providers were providing quality care and addressed issues as needed. Participated in State Surveys and submitted corrective action plans.
Marketing/Community Relations - I have a successful track record of building a census from 75% - 100% for a community that was lacking census development plans and 0%-90% on a new construction. I’m well versed in referral sources and am able to develop working relationships to increase referral base. I have been a member of a local chamber and rotary to develop business contacts for facilities that I have worked with. My public speaking has been to small groups of 5 to large groups of 100.
WORK EXPERIENCE:
Horizon NJ Health – Government Services
January 2014 – June 2018 – Supervisor MLTSS
Atlantic County Intergenerational Services
September 2008 – January 2014 Coordinator of Long Term and Alternate Care for the Elderly and Disabled
--Supervised Waiver Case Managers
Juniper Village at Williamstown
August 2005 – September 2008 Director of Community Relations
NewSeasons Assisted Living, Sewell, NJ
July 2004 – August 2005 External Community Sales Manager
Wildwood Housing Authority, Wildwood, NJ
May 2004 – July 2004, Program Director
Complete HealthCare Resources-Challenge Marketing Division, Horsham, PA
September 2001 – May 2004
Cardinal Retirement Village, Sewell, NJ
February 1997-July 1998 Director of Assisted Living
July 1998-September 2001 Director of Community Development
Interim Administrator at DuBois Village-Assistant Living Facility. Handled day-to-day operations of a 58 apartment assistant living facility while maintaining supervision over my office at my permanent position.
Baker House, Vineland, New Jersey
December 1996-February 1997 Program Director
North Cape Nursing and Rehabilitation Center, Cape May, NJ
January 1996-December 1996 - Director of Social Services/Admissions
Lutheran Home at Ocean View, Ocean View, New Jersey
July 1988- December 1995 Social Service/Admissions Director
May 1987-July 1988 Social Service/Admissions Assistant
EDUCATION AND CERTIFICATION:
York College of Pennsylvania, York, PA; May 1987
Bachelor of Science-Long Term Care Administration;
Minors: Gerontology and Management
Widener University, Chester, PA; December 1989
Certificate of Long Term Care Administration
Certified Social Worker
Certified Hospice Volunteer
Licensed Assisted Living Administrator--New Jersey
Certified Assisted Living Administrator Pennsylvania
Alzheimer’s Association Support Group Facilitator Training
CIVIC AND PROFESSIONAL: Fraternal Order of the Eastern Star, NASW, Past NASW Unit Chair – Camden, Gloucester and Salem Counties chapter, Soroptimist International of Cumberland County
References furnished upon request
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