Jenniffer M. Wormley

**** ***** **** **. #*.

Sacramento,Ca 95833

Phone:916-***-**** Email: acv9ot@r.postjobfree.com

EXPERIENCE:

Maximus Federal (Contract Position). 08/15- 03/16

Document Reviewer

Coordinate Injured Workers’ requests for independent medical necessity decisions.

Review data entered into case file for accuracy and correct logic.

Review case file to determine whether all relevant information has been submitted.

Contacts appropriate parties for required documentation if not received.

Initiates and maintains a productive relationship with participating parties including but not limited to DWC, Providers, Injured Workers, and Medical Professionals.

Succinctly summarize the facts of each case and the issues at dispute.

Decides if case is eligible to be sent to Medical Professional Reviewer.

Designate clinical match of Medical Professional Reviewer.

Ensure correct documents provided to Medical Professional Reviewer.

Prepare and disseminate the Final Determination letter, using the appropriate template.

Acquires all necessary information involving cases and may render a determination based on the information.

Research and determine authority cited to by prior level review organization.

Performs other duties as may be assigned by management.

Uc Davis Optical Shop (Contract Position). 02/14-08/14

Data Entry

Checking Prescriptions

Calling insurance company's

Calling patients

Sutter Health (Contract Position) 09/13-10/13

Schegistration

Eligibility and Authorizations

Called patients to get them pre-registered

Utilized MS4 and Epic Software

Xerox Medi-Cal (Contract Position) 05/13-8/13

Call Center

Responded to telephone inquiries and complaints

Gathered information, researched/resolved inquiries and logged customer calls in CRM

Communicated appropriate options for resolution in a timely manner

Informed customers about services available and assessed customer needs

Escalated inquiries to appropriate staff as required

Responded to requests for information on TARs

Responded to request for assistance with CHDP pre-enrollment application in addition to general program information and guidance

Referred providers to regional provider field representatives for onsite visit/education

Entered Family PACT client information from phone messages into the HAP eligibility system in accordance with DHCS timelines

Escalated calls with issues requiring more in-depth research to the Research Analyst

Edington Medical Group 06/06-03/11

Customer Service Rep/Scheduler/Scanner/Mailroom

Analyzed/Assisted in compiling and summarizing physician data/ notes and process reports

Scheduled independent medical examinations

Faxed, filed, mailed and electronically transmitted confidential patient documents while adhering to rules, regulations and tenants of The Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law

Demonstrated thorough understanding of medical records, medical transcription, medical administration and procedures to compile, verify and file

Handled 75-100 incoming calls per day

Researched and maintained client files, prepared mailings

Input/Retrieved information using company database (Citrix)), the internet, and MS Word/Excel.

CHW, Medical Foundation 12/01-05/05

Administrative Assistant

Took 50-75 inbound calls per day on patient accounts

HMO and PPO medical insurances

Prepared medical records for customers

Sent out records to customers or clients

Medical billing

Epic software

Entered Authorizations into the company database (IDX)

Entered and checked status on medical insurance claims.

EDUCATION:

1997-2001 Florin High School- Diploma Sacramento, CA.

2010-Present American River College, Sacramento, CA

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