Case Manager Health Systems
Resume:
It is time for a career! Dedicated, devoted, focused individual who is ready for the next phase of a career in healthcare. With 20 years of experience in aiding individuals and groups to drive practical solutions to conflicts, most recently, in the military under the healthcare umbrella. Organized and dependable with success in managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. The end goals is always customer satisfaction!
Work History
2023-11 - Current
Healthcare Facilitator for Tricare Claims
WPS Health Systems C/O Proven Process Group, Wisconsin Dells, WI
Promoted Tricare products for continuous learning within organization monthly, raging from 10 to 25 participants by sharing best practices and lessons learned from various facilitation experiences regarding Tricare Claims under UB-04's, 1500's and DD2642 forms..
Streamlined registration processes for workshops, reducing wait times and improving overall attendee satisfaction.
Collected and analyzed participant feedback, consistently implementing suggestions for improvement in subsequent sessions.
Collaborated with subject matter experts to develop accurate, relevant content for delivery at industry conferences or professional development events.
· Assess training needs through surveys, interviews with employees, focus groups, or consultation with managers, instructors, or customer representatives.
· Design, plan, organize, or direct orientation and training programs for employees or customers.
· Offer specific training programs to help workers maintain or improve job skills.
· Present information with variety of instructional techniques or formats, such as role playing, simulations, team exercises, group discussions, videos, or lectures.
· Obtain, organize, or develop training procedure manuals, guides, or course materials, such as handouts or visual materials.
2022-09 - 2023-11
Medical On Boarding Case Manager
Concorde Inc, Philadelphia, NY
Handles all Cadet medical forms such as DD2808, DD2807-2, Optometrist, and Hearing exams to ensure all fields are filled out resulting in their transition from being one of many cadets who join military after high school
Chasing medical, optometrists when forms are improperly filled out with help of from following databases: DODMET, Basic for case notes, Concentra, if need be, and Outlook for replies via fax or email
Transition of documentation occurs with help of Adobe.
Enhanced communication between clients and providers through consistent follow-ups and progress updates.
Advocated for client rights when interacting with external agencies or institutions, ensuring fair treatment at all times.
Enhanced communication between clients and providers through consistent follow-ups and progress updates
Promoted safe environment for vulnerable populations by reporting suspected abuse or neglect as mandated by law
2011-04 - 2022-06
Contractor: Tricare and DOD DMDC Trainer
InspiriTec, Philadelphia, PA
Worked on multiple contracts at this company such as: Susperstorm Sandy: 04/2011 to 08/2011
Responsible for intaking victims of New Jersey, information to get grants to restore their homes affected
Affordable Care Act: 09/2011 to 09/2014: Handled all Medicaid applications for state of Pennsylvania using Compass' website
Contractor for DoD re: DMDC 11/2014 to 06/2022: Trained new hires on DEERS database on military benefits for themselves and families
Including Tricare, Medicare, Other Health Insurances, VA database, Express Scripts, etc
Meeting with Quality Assurance, retraining reps with low scores through spreadsheets, and monthly enhancement training included
Lastly, rewrote training material to meet demand of Governments' request.
2014-09 - 2018-12
Team Lead
Pond Lehocky Stern & Giordano LLP, Philadelphia, PA
Daily intake of 200 calls for registration for Medical Assistance on Compass website
Summarize information provided and enter information into ACA call tracker daily
Reconciliation via spreadsheet with E-signatures from callers while auditing calls for compliance purposes through 4 different excel spreadsheets
Meetings with Department of Public Welfare for ways to better all application processes for callers
Reading Rights and Responsibilities for customers for accreditation purposes and CHIP sometimes
Compliance with Commonwealth of Pennsylvania for auditing purposes
Taken over 300 calls daily for victims who wanted to gather information from website: www.sandy help.nj.gov
Worked with DCA (Department of Community Affairs) with extension of programs for renters, homeowners and businesses in New Jersey Counties
Helped over 300 callers daily identify with grant applications for businesses, homeowners and construction workers
Taken courses on OMAP (Medical Assistance applications) and Customer Service courses to assist callers in medical assistance application
Intake Specialist for Social Security Disability Insurance, Supplementary Security Income, Worker's Compensation, and Referrals Disability Justice: Pond, Lehocky, Stern & Giordano, Daily intake of 300 calls in 50 states for legal representation for Workman's Compensation, Social Security Disability Insurance, and SSI claims-in Needles and Litify databases
Collaborate with Legal Analysts, and Lead Review team, who review intakes to see if thereare cases such as SSDI, SSI and Worker's Compensation, or thrid party- referrals.
Assist Case Managers and Asst Case Managers in any help pertaining to pre-hearing questions for clients
Daily intakes for Cessation, Request for Hearing, and Reconsideration cases throughout 50 states as well
Look for Mancini cases and Union employees (i.e
Carpenters, Electricians, PECO, SEPTA, and PGW), who may want to pursue cases against their employees to maintain monthly quota
Refers clients to Medicaid and rules of applying for it in state of Pennsylvania Continuous education on Medicare for clients once awarded Social Security Disability
Sometimes updated intakes are needed to be done for clients who rejected first time around
Sometimes call claimants back to make sure they fax either: DLI (Date Last Insured), AL Decisions (Favorable or Unfavorable Decisions), medications, treating doctors, or paystubs
Assist with Packet Team in sending out retainers, or IA Team (Initial Application Team) in making sure client's information is accurate on their application on www.ss.gov
For Exeter, Learning Tree, Hub, Boys Latin Charter School and ECFMG
Trained team on all aspects of operating procedures and company services
Monitored network performance and provided network performance statistical reports for both realtime and historical measurements
Built application platform foundation to support migration from client-server product lines to enterprise architectures and services
Reviewed daily requirements and forecasts and delegated work for optimal coverage
Delivered superior training and leadership to teams to boost performance and help team members achieve performance targets.
Education
2018-01 - 2019-05
M.D. in Health Management and Sustainability
University of Phoenix - Philadelphia, PA
2009-10 - 2012-05
Bachelor's degree in Healthcare Management
University of Phoenix-Online Campus - Philadelphia, PA
Additional Information
Secret Security Clearance, PII Training, Cyber Awareness Training, Rapids Training, DEERS database savvy, Medicare, Tricare, VA.Gov, IRIS, DIMS, SharePoint, IRRU
John Butler
Healthcare Management And Sustainability
Contact
Address
Philadelphia, PA 19135
Phone
ad5vwc@r.postjobfree.com
WWW
https://bold.pro/my/dejuan-peters/694
Skills
Call center Team Lead
Charts and Graphs via excel
Conference room set ups
Customer Service
Databases for Trcare, Medicaid, SSD and SSI
Representative experience
Emergency service calls
Following directions
Mastery of customer service
Service-oriented
Student government representative
Social services knowledge
Web technologies and services
Technical direction and product strategies
Customer service professional
Service focused
Scheduling services
Customer service background
Client service and support
Personalized customer service
Customer service and engagement
Information services
Service navigation
Service referrals
Case service plans
Executive taxi services
Service team support
Directing callers
Customer service standards
Social services
Customer service understanding
Team direction
Customer directing
Service quality optimization
Service scheduling
Customer service management
Customer service
Analysis Skills
Auditing
Business Consulting
Document Management
Records Management
Workers' Compensation
Business Management
DEERS Database (3 years)
Excel
Powerpoint
Business Development
Computer Networking
Statistics
Change Management
Portfolio Management
Process Improvement
Strategic Planning
Microsoft Excel
Administrative experience
Microsoft Powerpoint
Phone etiquette
Business Analysis
Project Management
Microsoft SharePoint
Management
IVR
Product development
Financial acumen
Relationship management
Documentation review
Presentation skills
FMLA
Benefits administration
OSHA
ADP
Research
Human resources
Supervising experience
Managed care
HIPAA
Leadership
Data collection
Typing
Patient monitoring
Behavioral health
Case management
Medical terminology
Pivot tables
Mobile devices
Program design
Quality management
Quality control
Discharge planning
Medical office experience
Management
Epic
Workday
Quality assurance
Continuous improvement
Proofreading
Microsoft Access
Root cause analysis
Financial services
EMR systems
Microsoft Office
ICD-9
ICD-10
Military
Adobe Acrobat
Survey design
PeopleSoft
HRIS
Employee orientation
Employee relations
Data collection
Practice management
Oracle EBS
Oracle
Kronos
Database management
IDS
Adult education
LMS
Calendar management
Employment & labor law
Developmental disabilities experience
Public relations
Compliance management
Salesforce
Program management
Computer literacy
Computer skills
Customer support
Research & development
Information management
Google Suite
Meeting facilitation
Motivational interviewing
Windows
Healthcare management
Software troubleshooting
Team Management
Technical Support
Analytics
Meeting Management
Task Delegation
Data Analysis
Contract Management
Operations Management
Business Administration
Feedback Delivery
Assertiveness
Icebreakers
Interpersonal Skills
Decision-Making
Software
Echos
Humana 360 Launchpad
Tricare.mil
Mainframe
Onbase
Trifecta
Sharepoint
One note
Float
Outlook
Adobe
LMS
Excel
Powerpoint
HIPAA and Cyber Awareness continuous Trainings
Olli
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