Medical Customer Service
Resume:
LaToya Little
Trenton, NJ ****1
Email: **************@*****.***
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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