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Customer Service Project Coordinator

Location:
United States
Salary:
20.00
Posted:
December 11, 2019

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Resume:

Brandi Smith

**** ****** *** ****

614-***-****

ada1v1@r.postjobfree.com

Work Experience

Centene, Corp. Buckeye Healthcare-Columbus, OH March 2019-Current

Grievance and appeals Coordinator

• As a Grievance and Appeals Coordinator, you will be reviewing and auditing grievance cases to ensure the correct action was taken. You will be responsible for handling around 15-20 cases at a time. The Grievance and Appeals Coordinator will need healthcare experience and strong critical thinking skills.

Hedis Project Coordinator

Responsibilities: • Comply with records management programs, including retention schedule requirements • Comply with policies and procedures for document management including standardized naming conventions. • Comply with all HIPAA requirements • Complete all training regarding document management procedures and work flow. • Ensure all documents are managed and routed supporting HEDIS(R) data collection efforts. • Escalate any concerns related to document management to leadership. • Identify documents and appropriately route and process documents • Conduct document indexing. • Resolve document indexing or routing exceptions • Support invoice processing to pay for medical charts received. • Works with limited guidance • Translates concepts into practice • Uphold Buckeye Health Plan Cultural Values

United Health Care - Columbus, OH December 2014 to December 2016

Hedis Project Coordinator

Responsibilities: • Comply with records management programs, including retention schedule requirements • Comply with policies and procedures for document management including standardized naming conventions. • Comply with all HIPAA requirements • Complete all training regarding document management procedures and work flow. • Ensure all documents are managed and routed supporting HEDIS(R) data collection efforts. • Escalate any concerns related to document management to leadership. • Identify documents and appropriately route and process documents • Conduct document indexing. • Resolve document indexing or routing exceptions • Support invoice processing to pay for medical charts received. • Works with limited guidance • Translates concepts into practice • Uphold Buckeye Health Plan Cultural Values

Aetna Better Health of Ohio - New Albany, OH August 2010 to December 2014

Member Service Rep/Call Center

•• Handles customer service inquiries and problems via telephone, internet or written correspondence.

•• Explains member's rights and responsibilities in accordance with contract

•• Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals

•• Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system

•• Educates providers on our self-service options; assists providers with credentialing and recredentialing issues.

•• Responds to requests received from Aetna's Law Document Center regarding litigation; lawsuits.

•• Handles extensive file review requests

•• Assists in preparation of complaint trend reports.

•• Assists in compiling claim data for customer audits

Immediadent., Ohio May 2005 to January 2010

Patient Coordinator

•• Responsible for providing exceptional patient care and ensuring optimal operational flow

•• Receive patients into the practice, schedule patients, verify and submit insurance, and work with the patients through options to ensure they can receive prescribed treatment plans

VSP- Vision Service Plan. Ohio January 2000 to May 2005

Customer Service Rep/Call Center

•• Efficiently and effectively answers incoming calls and processes orders

•• Requires in-depth knowledge of products, services, policies and procedures.

•• Responds to inquiries for orders status, shipping status and stock availability

•• Resolves customer complaints, troubleshoots issues to determine best path for resolution.

•• Initiates action forms, tracks call types

•• Maintains support service levels and Customer Service standards

•• Performs all other duties as assigned

Education

American School of Technology

Columbus State Community College

Westland High School

Westland High School



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