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Medical Customer Service

Location:
Trenton, New Jersey, United States
Salary:
$46,000
Posted:
June 07, 2018

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Resume:

LaToya Little

*** ******** ***.

Trenton, NJ ****1

Email: ac5soz@r.postjobfree.com

609-***-****

Professional Summary: I have 12 years of professional experience in industries involving Health Services, Documentation, Data Entry, Accounting, Research, Case and Utilization Management, Property & Casualty Insurance, Clerical/Administrative and Customer Service. Well-versed in handling sensitive and confidential situations while using my high level interpersonal skills. Skilled in reviewing requests for accuracy of information and assisting with collection/transfer of data. Along with superb organizational skills, the ability to display keen attention to detail, multitasking and prioritizing that result in accuracy and completion. Technical Skills:

• M S Word

• M S PowerPoint

• M S Excel

• M S Outlook

• M S Access

● WordPerfect

● Windows XP

● Adobe Acrobat

● Lotus Notes

• T yping 60 words per minute

E ducation: A shford University – Graduated January 2016 Bachelor’s Degree

Organizational Management

Mercer County Community College- Graduated July 2007 Associate's Degree

Business Management

Experience:

Savoy Associates

Hamilton, NJ April 2017- Present

● Process Medical, Dental and Vision enrollments and/or employee terminations, ID card request and address changes etc. for carriers such as Aetna, QualCare, Oxford/United Healthcare, Amerihealth etc.

● Processing ID card request, name and address updates etc.

● Understand medical health plans and medical terminology

● Work within Microsoft Outlook and Internet Explorer for enrollments, terminations and change request

● Work closely with the Sales department and Regional Brokers/ representatives

● Data Entry, making and taking in/outbound calls to different calls to carriers for request and inquiries

Health Insurance Coordinator- State of NJ Department of Health- HIV/AIDS program D ecember 2016-February 2017 (Temporary job assignment)

● Data entry processing financial documents and applications

● Recording detailed geographical information for program

● Provided information to members regarding the Ryan White AIDS/HIV program Clinical Services Support Specialist

AmeriHealth, Cranbury, NJ A ugust 2014- July 2016

● Prioritizing, scanning and emailing Provider, Medical and Administrative Appeals

● Lookup member and appeal information using INSINQ, SLIQ, Navinet and maxMC

● Make outbound calls to Providers and Members regarding member consent or documents needed such as medical bills, clinical and operative/medical notes needed for Admin and Medical Necessity Appeals

● Set up cases for Par Provider No Referral request

● Work closely with Utilization Management Nurses to determine type of appeal requests

● Review incoming medical bills, identify ICD 9 and 10 billing codes and other documents to properly setup Admin and Medical Necessity appeal request Enrollment Specialist

AmeriHealth, Cranbury, NJ (Temporary Job Assignment) M ay 2014-August 2014

● Process Microsoft Word documents (Off Cycle Cancellations, Dependent to 30,) etc.

● Process Terminations, Admin and Group Changes using ROAM database

● Understand Healthcare benefits affected by Obamacare

● Work closely with Sales and Marketing Operation Teams Administrative Assistant

Abbott Point of Care, Princeton, NJ (Temporary Job Assignment) O ct. 2012- April 2013

● Contact customers/patients, physician offices regarding updating a customer’s file

● Ensure that patient’s files are up-to-date by reviewing patient/healthcare provider questionnaires, prescriptions, approval letters and product orders

● Place orders via email with Abbott Customer Service for Compassionate Program Users

● Return voicemails to customers, physicians regarding patient prescription updates and placed orders

● Create files for new Compassionate Program Users

● Place office supply orders; deliver assigned Supervisor’s mail, process correspondence for meeting minutes

● Document and track all financial invoices accounts receivable, accounts payable Managed Care Coordinator

Horizon NJ Health, West Trenton, NJ (Temporary Job Assignment) J uly 2011 -Oct. 2012

● Handles initial screening for pre-certification requests from physicians/members via incoming calls or correspondence based on scripts and workflows and under the oversight of clinical staff

● Assist with Complex Needs Assessments or Individual Health Screenings for Case Management

● Print and fold outgoing correspondences to members

● Sort and approve all authorizations: PCA, Medical Daycare, Home Health and Occupational, Physical therapies

● Scan and Link Clinical Information such as: Physical, Occupational & Speech Therapy Authorization Request Forms and/or Personal Care Assistant Authorization Request Forms to proper member cases

● Understand medical terminology and explain HIPAA, COBRA and medical benefits

● Train co-workers and new hires in Utilization Management work process

● Provide a requested authorization count daily via email Benefits Specialist (Temporary Job Assignment)

Oct. 2010 - May 2011

ACS, Cherry Hill, NJ

● Discuss and explain medical, dental, vision and other health and welfare benefits

● Practice HIPAA Privacy Act and Laws and explain COBRA regulations

● Processing Annual Enrollment Elections over the client’s website

● Worked for clients such as: 7-Eleven, Starwood, Mars and Rite Aid



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