NICOLA KING

PO Box ****

Albany, NY *****

518-***-****

adhxl5@r.postjobfree.com

EDUCATION:

Sept. 2016 – Present, Clarkson University

Degree: Masters in Health care Management (MBA) Anticipated Completion June 2020

Sept. 2012– July.2015, SUNY Empire State College

Degree: Bachelor in Business Management & Economics

Sept. 2009 – Dec. 2012, Hudson Valley Community College

Degree: Business - Associate in Applied Science (AAS)

Courses: Sept 1993 – 1996 Individual Studies & Nursing Program

Sept. 1997 – Dec 1997, Schenectady County Community College

Courses: Anatomy & Physiology

Sept. 1989 – June 1993, South Colonie Central High School

Degree: High School Diploma

EXPERIENCE:

Dec. 2009 – Present, Residential Counselor, (PT), Warren Washington Albany ARC 4CP62335P3072691L

Assist adults with developmental disabilities with all daily life activities in residential setting

Preparing residents meals, housekeeping, administering medications, leading social activities and ensuring the safety and well-being of each resident

Oct. 2011 – Present, Care Management Associate Team Lead, Aetna

Provide guidance, directions, and instructions, delegating tasks, setting deadlines and setting team goals.

Perform intake of calls from members or providers regarding services via telephone, fax, and electronic submissions

Assist with network negotiations and deficiencies with providers

Responsible for initial review and triage of Care Team tasks and Training new hires,

Assist in the research and resolution of claims payment, Precertification issues and coverage and benefits

Screens patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan

Monitors non-targeted cases for entry of appropriate discharge date and disposition

Promotes/supports quality effectiveness of Healthcare Services

June 2002 – Sept. 2011, Customer Service Representative, Aetna

Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors

Explains member's rights and responsibilities in accordance with contract

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

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

Nov. 2000 – Feb.2012, Sales Associate, GAP, (PT)

Maintaining outstanding customer service as per Company standards, generating sales, merchandising, and safeguarding company assets.

Assist with floor moves, merchandising and housekeeping

Assist in processing and replenishing merchandise and monitoring floor stock

Sept. 1999 – Mar.2000, Licensed Insurance Agent, Combined Life Insurance of New York

Sell Accidental, Health & Disability Insurance

Calculate premiums and establish payment method

Oct.1998 – Feb.2000, Sales Clerk, Macys East

Cashier, Selling & Stocking merchandise and Customer Service

May 1995 – June 1999, Certified Nurse’s Aide, Albany County Nursing Home

Assist direct patient care, both medical and non-medical.

Jan.1996 – 1997, Certified Nurse’s Aide Van Rensselaer Manor

Assist direct patient care, both medical and non-medical

Contact this candidate