Customer Service Des Moines
Resume:
Christina Trogdon
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Experience
Rising Phoenix Nutrition
Owner/Operator
● Provide education to individuals geared around a healthy lifestyle; including healthy food choices, exercise recommendations, and support.
● Provide excellent customer service to all exhisting and new clients.
● Provide support for business growth; maintains relationships and seeking new to build clientele
● Able to market business providing an increase in sales and revenue SAEG Ventures LLC, Tampa, FL (Remote)
Sole Contractor-Remote (March 2020-Current)
● Generate Medicare and Medicaid Quality reporting for Clients such as: HEDIS Gap Report, Individual Practitioner Performance Report, Possible Monies Missed Review.
● HEDIS Supplemental Data Submission
● Claims Reconciliation
● Research related to Projects, Upcoming Incentive & Quality uPrograms, and Business Grants. Anthem, West Des Moines, IA
Grievance & Appeals Rep II-Remote (Aug 2019-June 2021)
● Field member grievances via phone: Provide status, instructions, and resolution.
● Review Quality of Care: issues regarding member care both physical and mental.
● Track multiple states regarding Critical Incidents: PEGA, Quality of Care Tracker, and excel spreadsheet. Report Quality of Care issues to DHS for review.
● Assist in state reviews regarding possible negligent care from providers towar i ds members.
● Collaborate with leadership to determine the w.1efficient work flows to maintain management of work volume within each state worked in the central region. Conduct executive decisions for problem solving issues.
● Liaison between member and professional and non-professional peers to bring resolution.
● Inform medical review team of cases needing further review.
● Conduct training of new hires across all applicable systems and departments involving grievance
● Organize and maintain the Central Region (7 states) SharePoint: i.e. training, workflows, department policies and procedures, letters, forms, etc. Anthem, West Des Moines, IA
Community Based Case Manager-Remote (July 2018 – Aug 2019)
● Conducted training of new hires across all applicable systems and departments involving case management. Involved in Anthem’s leadership program HYPE (Healthcare Young Professional Exchange)
● Scheduled and coordinated person centered support plan meetings, admission meetings for members with cost savings in mind. Exceptional leadership and communication skills.
● Collaborated with care team to provide clinical resources and medical care for members.
● Conducted detailed assessments of member’s personal health goals and care plans.
● Provided psychological and emotional support resources to members as well as family members dealing with chronic or acute illnesses.
● Examined and discussed funding issues with patients and family members. Anthem, West Des Moines, IA
Medical Management Specialist (2017 – 2018)
● Assisted Case Managers in authorizing services members’ need to obtain personal health goals
● Fielded member and care team concerns and delegated accordingly.
● Researched billing inquiries and denials for reprocessing. Christina Trogdon
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● Built and approved member cases and authorizations in company database (FACETS).Lead and assisted various projects in a time sensitive environment for audit and reporting purposes to the state using various programs.
Tradehome Shoes, Fort Dodge, IA
Assistant Manager (2016 – 2017)
● Trained 7-8 sales associated to sell products within the store
● Interviewed/hired new employees
● Created and maintained weekly schedule
● Achieved and maintained 30% store gains, monthly, through personal sales
● Attracted and secured clientele from prior store loss
● Demonstrated excellent customer service
General Nutrition Company (GNC), Fort Dodge, IA
Sales Associate (2016 – 2017)
● Lead sales associate
● Educated customers on store products to help maintain a good healthy regimen
● Lead team in new accounts while helping to maintain and exceed store goals
● Maintained daily balanced cash register
● Demonstrated excellent customer service
Anthem, West Des Moines, IA
Grievance & Appeals Liaison (2015 – 2016)
● Answered calls from members regarding an appeal with a current decision regarding denial of their benefit or for their concerns regarding local physicians
● Researched members’ benefits for a customer satisfactory decision
● Conducted executive decisions for problem solving issues
● Acted as liaison between member and professional and non-professional peers for best resolution of member’s concern
● Presented cases needing medical review from the nurses on our team
● Obtained critical incident information for reporting purposes to the state Education
Southern New Hampshire University
Bachelor of Arts in Management, Concentration in Logistics & Operations Kaplan University, Urbandale, IA – 2004-2005
Associate of Applied Science for Medical Assisting Kaplan University, Urbandale, IA – 2004-2005
Medical Transcription Certificate
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