Urvashi Patel

adbv1m@r.postjobfree.com

609-***-****

Has learning experience in SQL, PHP, HTML, CSS, Javascript

Certified PHP developer

Has an excellent verbal communication and can be a good team member

Has knowledge of MS Office applications and proprietary database management

EXPERIENCE

Aetna, Princeton, NJ

Care Management Associate February 2016-present

Placing outbound calls and handling outrace for enrollment.

Filling out "health risk questionnaires" with members.

Supporting the Care Management team.

Responsible for initial review and triage of Care Team tasks.

Identifies principle reason for admission, facility, and member product to correctly apply intervention assessment tools.

Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g. Health care providers, and health care team members respectively)

Performs non-medical research pertinent to the establishment, maintenance and closure of open cases

Provides support services to team members by answering telephone calls, taking messages, researching information and assisting in solving problems.

Adheres to Compliance with PM Policies and Regulatory Standards.

Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.

Protects the confidentiality of member information and adheres to company policies regarding confidentiality.

Provided benefits program coverage details and verified member plan eligibility

Processed claim referrals, new claim handoffs, nurse reviews and complaints,grievance and appeals(member/providers)

Handled incoming requests for appeals and pre-authorizations

Performed reviews of member claim history to ensure accurate tracking of benefit maximum

Capital Health, Trenton, NJ

Guest Relations Representative -March 2015- February 2016

Ensured that inquiries and requests are addressed in a friendly and responsive manner

Responded immediately to guest inquires; provided guest passes and information for patient visitors

Promptly and courteously answered phones

Performed clerical and administrative services as needed

Xerox, Hamilton, NJ

Contract Customer Care Assistant, November 2014 – February 2015

Responded to telephone inquiries and complaints using standard scripts and procedures

Gathered information, researched, and resolvedinquiries received either through written or telephone correspondence in a timely manner.

New Jersey Division of Consumer Affairs, Trenton, NJ

Contract Clerk, September 2013 – January 2014

Under direction of the Chief in the Bureau of Housing Inspection, performed varied clerical work including accurately sorting and filing mail, copying critical/vital records, and accurately input data in databases and/or spreadsheets

Answered incoming calls, transferred calls as necessary and conveyed messages in a timely manner

Performed exceptions and exemptions and other duties requiring knowledge of department laws, regulations, policies, and procedures, and frequent exercise of independent judgment

Performed all secretarial duties for Department Supervisor

Molina Information Systems, LLC, Trenton, NJ

Enrollment Clerk October 2004-June 2013

Reviewed, analyzed, evaluated, validated provider/producer information against business/credentialing

Requirement and maintained information in credentialing databases

Supported extensive research and analysis of sensitive provider/producer issues and addressed data

Integrity issues

SKILLS

Advanced knowledge of MS Office applications and proprietary database management

Excellent interpersonal, communication skills, and office etiquette

Ability to work in a strict deadline driven environment

Strong organizational and analytical skills

EDUCATION

Euclid Senior High School, Euclid, OH.

Certified PHP Developer

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