Jacqueline Ghee Pugh

ad4tox@r.postjobfree.com 10130 Strome Avenue Apt 307

704-***-**** Raleigh, NC 27617

Objective

To obtain a position that includes assisting patients or customers in correspondence to their health care needs.

Work Experience

Express Scripts

Patient Care Advocate (Remote), Raleigh, NC November 2023-Current Provided customer support. Researched and resolved mail order claims. Processed mail order prescriptions for members internationally and provided excellent customer service and satisfaction.

Everise/WellCare

Customer Support Associate, Raleigh, NC September 2022-November 2023 Assisted brokers with questions concerning WellCare Medicare policies. Answered questions related to health care benefits. Educated brokers and members on WellCare Medicare plans. Provided excellent customer service support to brokers. First Source Health Solutions, Raleigh, NC June 2021-July 2022 Customer Service Representative

Processed information, payments, and requests from customers in regards to outstanding balances on accounts. Communicated effectively and assisted in ensuring customers successfully could make changes to, inquire on, or make payments on accounts.

Maximus, Raleigh, NC February 2020-June 2021

Customer Service Representative

Responsible for assisting customers in selecting Medicade benefits and facilitating the completion of caller requests. Helped customers to be able to process life changes, disenrollment requests, demographic and personal information updates, and special enrollment period requests. Answered incoming calls and responded to inquires from customers that included the general public, current enrollees, caregivers, and many other individuals and families.

Covance/Labcorp,Raleigh, NC November 2020-January 2021 Program Data Entry Specialist

Responsible for educating and informing patients of their medical benefits. PracƟced entry data entry and obtain approval from Provider for medical drugs such as Ozurdex. Enter data entry to obtain prior authorization .

Broadway Home Care, Raleigh, NC September 2019- March 2020 Personal Care Assistant

Responsible for assisting residents with bathing, showering, grooming, and other personal hygiene tasks. Assist residents in activities like reading, talking, and playing games. Assist clients with light cleaning, cooking, running errands, driving to doctor appointments, as well as companionship.

Home Watch, Raleigh, NC October 2018- August 2019

Personal Care Assistant

Responsible for assisting residents with bathing, showering, grooming, and other personal hygiene tasks. Assist residents in activities like reading, talking, and playing games. Assist clients with light cleaning, cooking, running errands, driving to doctor appointments, as well as companionship.

Home In Stead/ Companion, Wake Forest, NC June 2017- Dec 2017 Caregiver/ Senior Care

Companion for patients and performed tasks and provided assistance with care services such as bathing and grooming. Also provided assistance with toileting and incontinence issues the patience may have. Provided reminders regarding the patient’s times to take medication and gave appointment time reminders. Assisted the patient by performing light housekeeping tasks around the home and prepared meals throughout the day. Cared for patients who have been diagnosed with Alzheimer’s and other diseases. Provided transportation to assist the patient in going places such as medical appointments.

Sundance Cleaning, Wake Forest, NC August 2015- May 2017 Residential Team Leader

Responsible for driving other employees and cleaning necessities to and from the homes of customers. Cleaned residential homes and commercial model homes according to company standards. Delegated and oversaw other employees designated to my task force, while making sure they also reached the company standards when working. Provided excellent customer service by making sure that every customer reaches the highest level of satisfaction possible.

Humana/ ACS, Raleigh, NC Aug 2008- Dec 2010

Inbound/Outbound Call Center Representative

Answered high volume inbound calls from Medicare participants concerning Medicare policies. Helped members become knowledgeable of Medicare policies. Assisted members with benefit questions. Explained Medicare’s maximum prescription limit to members. Processed pre-authorizations for prescription/pharmacy over-rides for members. Authorized to process credit card payments towards participant’s insurance policy each month upon member’s request. Trained new customer service representatives how to assist members with questions pertaining to their Medicare policies. Stayed in compliance with Medicare and HIPPA guidelines. Anthem Blue Cross and Blue Shield, Richmond, Virginia Feb 1998– Nov 2005 Medical/Dental Claims/Customer Service Representative Processed and paid medical and dental claims. Processed claims according to DRG

(diagnosis related group) guidelines. Processed and completed total case management claims. Answered high volume inbound calls in que from members or providers concerning medical, dental, and hospital claims/benefits. Averaged 80-125 calls daily. Maintained daily quota status. Returned outbound calls to members and providers concerning medical and dental claim inquires. Updated member’s personal information, submitted requested medical forms and id cards, in compliance with HIPPA guidelines. Quality Assurance.

World Access, Richmond, Virginia Dec 1996– Feb 1998 Insurance Claims Processor

Answered inbound and outbound inquiries pertaining to medical/dental insurance claims. Processed and paid claims according to member’s vacation trip coverage insurance. Processed and paid claims for illness or injuries that occurred while vacationing outside the United States according to member’s purchased trip insurance policy.

AETNA, Richmond, Virginia Aug 1993- Sept 1995

Medical/Dental Claims Processor

Processed medical and hospital claims .Paid hospital claims according to diagnosis related group (DRG) coding procedures.

Provident, Richmond, Virginia June 1990– June 1992 Medical Data Analyst

Utilized data entry skills. Job duties consisted of entering member’s personal medical information in computer system pertaining to medical and dental claims. Prepared claims for processing.

Qualifications

• Customer Service Representative/Advocate/Caregiver for Elderly

• Medical/ Dental Claims Processor

• PC Proficient

• Excel, Microsoft, Word Processing Skills

• Multi-Phone Line Representative

• ICD9 Coding Experience

• Total Case Management Processor

• Medical Terminology

• Patient Transporter/Patient Communication Skills Education

Wake Technical Community College, Raleigh, North Carolina August 2014-present A.A.S. Degree (Health Administration) May 2019 A.A.S. Degree

(Associate of Applied Science Degree Nursing) May 2022 Awards and Certificates

Certified Nursing Assistant Program

Wake Technical Community College Raleigh, North Carolina June 18, 2013- August 1, 2013

Contact this candidate