Medical Service

Candice M Morgan

*** * ****** ****, ******* AZ – (602) 460 – 0120

************@*******.***

Objective

Experienced and professional Medical/Behavioral Authorization Specialist that has decided to make a career change to do something outside my box. I would like to opportunity to show that I have what it takes to be an asset to the company.

Experience

Prior Authorization Medical AHCCCS

Aerotek Phoenix, AZ - Centene / Arizona Complete Health Tempe, AZ

12/2019 – 02/2020

Verify eligibility including coordination of

Utilization Management (UM)

Verification of active/inactive Providers

Build impatient (IP), and outpatient (OP) notifications

Receive/process prior authorization requests via Fax from medical providers, and facilities

Letter processing

Care Coordinator

Optum-LHI / UnitedHealthGroup, Phoenix, AZ

5/2018- 7/2018

Responsible for providing expertise and customer service support to members, customers, and/or providers. Direct phone-based customer interaction to answer and resolve a wide variety of inquiries. This was a (SCA) must support a government Service Contract Act agreement.

Medical Records Technician Sorter

Optum-MSLA / UnitedHealthGroup, Phoenix, AZ

1/2018- 5/2018

The Medial Records Sorter Sorts organizes medical records previously downloaded from the Veteran Administration’s Veterans Benefit Management System (VBMS) and creates an electronic case File (C-File) containing medical records pertinent to the Veteran’s claimed conditions.

Prior Authorization Coordinator Specialty Behavior Health

United Healthcare MVUM - Tricare, Phoenix, AZ

1/2014 – 1/2018

Verify eligibility including coordination of benefits, and patient demographic information

Utilization Management (UM)

Assist team members with database loading

Add providers in the Careone Network

Verification of active/inactive Providers

Build impatient (IP), and outpatient (OP) notifications

Maintain patient records, demographic information in accordance with HIPPA guidelines

Receive/process prior authorization requests via eFax from DOD medical providers, and facilities Letter processing, and other duties as assigned

Cash Office / Claims Representative

Randstad Staffing/Accredo Health /Express Scripts, Memphis, TN

7/2012 – 6/2013

Matching checks with explanation of benefits (EOB)

Scanned checks, EOB’s, remits, and deposits

Monitor contacts of insurance companies to assure claims reimbursed properly in accordance with insurance contract

Work correspondence – (denials & zero pays) in a timely manner

Inventory data control

Claims processing and Customer Service

Adhere to all regulatory compliance areas, policies and procedures

Other duties as assigned

Account Installation / File Analyst / Account/Customer Service

Cigna Voluntary, Phoenix, AZ

1/2004 – 6/2012

Inbound and outbound calls regarding benefits, eligibility and claim status

Manage implementation of multiple systems for new account setup

Maintain member accounts/group contracts per contract release

Handle and resolve escalated issues, and implementation of auditing

Reformatting files for clients

Test and implement new processes and procedures

Assist with online enrollments

Communicate directly with internal and external partners

Education

1983 - 1985 Dabbs Area Vocational School (Office Admin.) Irondale, AL.

1985 - 1986 Raleigh Egypt High School Memphis, TN

Communication

Excellent written and verbal communication skills, Confident, articulate, and professional team player.

Leadership

Communication, relationship building, conflict resolution, critical thinking

* References available upon request *

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