Medical management
Resume:
Deshawntae Russ
Tampa, FL
**********.******@*****.***
Authorized to work in the US for any employer
Work Experience
Medical Management Specialist
Anthem, Inc - Tampa, FL
September 2014 to Present
Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims.
● Analyzes problems and provides information/solutions. Operates a PC/image station to obtain and extract information and document information.
● Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
● Researches and analyzes data to address operational challenges and customer service issues.
● Provides external and internal customers with requested information.
● Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
● Refers cases requiring clinical review to a Nurse reviewer.
● Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
● Verify eligibility within the database system to members and providers Analyze faxed requests and documentation to determine coverage and approval utilizing criteria; utilize nurses for medical reviews when necessary
Process requests for Prior Authorization
Acts as a liaison between the payer and clinic schedulers/medical support staff Code each diagnosis of service and procedures according to standards
● Conducts clinical screening process.
Authorizes initial set of sessions.
Billing and Enrollment Specialist
Ultimate Staffing company - Tampa, FL
October 2013 to September 2014
Contracted
• Responsible for premium entry, daily maintenance, generating invoices and corresponding late notices, new business enrollment, group transfers, terminations, e-claims and routes
• Responsible for assisting with the quality assurance function for the team and maintaining production standards within the quality assurance guidelines
• Respond to inquiries relating to enrollment and billing issues
• Managing through phone and email on all client issues and solving problems
• Multi-task in a fast paced environment utilizing multiple tools at once
• Navigating through multiple computer screens to find information to resolve customer issues
• Participate in team meetings
FIS, ST. Petersburg, Fl
Customer Service Representative:
• Provides customer support to consumers via the telephone and/or Internet
• Handles customer inquiries and resolves simple and basic support issues, such as address changes, processing orders, warranty, or billing/payment
• Processes a high volume of consumer inquiries of FIS products and services, and resolves a targeted percentage of those inquiries
• Troubleshoots customer problems, identifies the root cause of the problem, and uses tool and resources appropriately to determine how to resolve customer problems
• Updates customer information and ensures accurate entry of contact information.• Meets the standards of the job, such as quality standards, adherence to schedule, and average handle time
• Handle call volumes of over 100 per day
Retention/Sales Representative
Alorica/Ryla - Tampa, FL
March 2010 to September 2013
Handled inbound, outbound customer calls dealing with customers accounts
● Ensure the customer understood their bill and questions regarding recent product and the services we provided
● Work simultaneously with multiple computer application and database
● Handle call volumes of over 60 per day
Universal Representative: Contracted
● Inbound and outbound calls dealing with customer inquiries and support
● Handled billing, credit issues, disconnected and open accounts
● Up Sell to provide customers with better packages and services
● Handle call volumes of over 70 per day
Team Lead Appointment Setter
Global Prospect - Tampa, FL
October 2007 to April 2009
Contracted
● Trained employees and monitored phones calls to ensure and sales tactics.
● Outbound and inbound calls assisting with timeshares inquires
● Enrolled customers in timeshare programs
● Conducted callbacks and follow ups to current customers
● Handle call volumes of over 50 per day
Education
High School Diploma
Gary Adult High School - Tampa, FL
2003
Skills
• Microsoft Excel (10+ years)
• Outlook (10+ years)
• Word (10+ years)
• coding (4 years)
• Medical Records (4 years)
• Excel (10+ years)
• Home Care (4 years)
• Microsoft Office (10+ years)
• Utilization Management (4 years)
• Microsoft Word (10+ years)
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