Ismail F. Lane

* ****** **** *****, *** A, Greensboro NC 27455 · 336-***-****

ad41ff@r.postjobfree.com

Motivated and detail-oriented graduate with a Bachelor of Health Administration. Seeking an entry-level position in healthcare administration to apply my knowledge of healthcare systems, business acumen, and organizational skills.

EXPERIENCE

FEBRUARY 2022 – SEPTEMBER 2023

PATIENT CARE COORDINATOR/SR. BENEFITS ANALYST, CIGNA

• Implemented, updates, and maintained automated, direct connect and other manual eligibility data.

• Explained member plan of benefits, member's rights and responsibilities in accordance with contracted arrangements, claim status information, benefit coverage, plan eligibility, dental, vision, pharmacy, HSA, provider details, care management, on-boarding, tool usage and available programs/resources.

• Performed medical/dental benefits verification requiring complex decision skills based on payer & process knowledge resulting in onboarding/no starting specialty patients.

• Negotiated pricing for non-contracted payers & authorized patient services & ensured proper pricing is indicated in RxHome.

• Used discretion & independent judgment in handling patient or more complex client complaints, escalating as appropriate.

• Processed simple and complex claims for payment reconsideration.

• Reviewed, assisted, and updated members on appeal process and determination. MARCH 2021 – DECEMBER 2021

PATIENT CARE COORDINATOR/A1A HEALTH ADVOCATE, AETNA/CVS

• Answered inbound calls regarding member's health care needs, while following up on commitments in a timely manner. Proactively made outbound calls to engage members and assisted them along their health care journey.

• Resolved member issues, while effectively making the right decisions for the members

• Explained member plan of benefits, member's rights and responsibilities in accordance with contracted arrangements, claim status information, benefit coverage, plan eligibility, dental, vision, pharmacy, HSA, provider details, care management, on-boarding, tool usage and available programs/resources.

• Interacted with Healthcare providers, clinicians, pharmacists, and many other professionals in an effort to provide total satisfaction and resolution to the member. Handled sensitive member information with discretion and prioritize effectively to meet member service goals / deadlines.

• Review, process, and adjudicate complex, sensitive, and/or specialized claims in accordance with claim processing guidelines.

• Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process.

• Ensures all compliance requirements are satisfied and that all payments are made against company practices and procedures.

• Identifies and reports possible claims over payments, underpayments and any other irregularities. Performs claim re-work calculations JULY 2019 – MARCH 2021

PATIENT CARE COORDINATOR/BENEFIT ADVOCATE, UNITED HEALTHCARE

• Reviewed and adjudicated complex, sensitive, and/or specialized claims in accordance with claim processing guidelines.

• Applied medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process.

• Ensured all compliance requirements are satisfied and that all payments are made against company practices and procedures.

• Identified and reported possible claims over payments, underpayments and any other irregularities.

• Performed claim re-work calculations.

• Made outbound calls to obtain required information for first claim or re-consideration. Works with Health Plan Operations and within the State Encounter system to research and resolve errors.

• Collaborated with colleagues to deliver a world class experience for our customers with honesty and integrity.

• Processed claims in high production, driven environment, following process instructions

(SOP’s) that are provided.

DECEMBER 2015 – MARCH 2019

PSE CLERK, UNITED STATES POSTAL SERVICE

• Made one or more sorts of outgoing and/incoming mail using the appropriate sort program or manual distribution.

• Removed sorted mail from bins or separations and places into appropriate trays or containers for further processing or dispatch based on knowledge of operating plans.

• Dispatched schedules at the instruction of supervisors and expediters.

• Provided service at public window for non-financial and financial transactions, while maintaining records of mail

• Examined balances in advance deposit accounts and recorded and billed required special services. 2

EDUCATION

Master of Business Administration - In Progress

JULY 2021 - SEPTEMBER 2023

Bachelors of Business in Healthcare Administration, Strayer University JULY 2021 - JUNE 2023

Associates of Business in Healthcare Administration, Strayer University SKILLS

• Healthcare Management

• Healthcare Information Systems

• Financial Analysis

• Data Analysis

• Regulatory Compliance

• Team Collaboration

• Strategic Planning

• Communication Skills

• Problem-Solving

• Time Management

• Proficient in Microsoft Office Suite

• Proficient in Rumba, UNET, ISET, Dialer,

Quickbase, ASD, Workforce Optimization,

RxHome

• Innovative solutions

• Adaptability

• HIPAA

• Medical Records

• EMR

REFERENCES

Can be furnished upon request.

3

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