DIANE SELLERS

**** ******* *** *********, ****, *4109 · 216-***-****

adue14@r.postjobfree.com

Obtaining Processing claims and or data entry including administration position providing the strengths and knowledge that has been obtained to deliver excellent services with expansion of skills. Highly motivated, organized, prioritize with what is most important. Strong points but not limited to; strong work ethics, work well independently or with team, and being proactive. Longevity in a position I can grow in and loyal employer who values but also is aware with the quality of work that is being provided.

EXPERIENCE

SEPTEMBER 12, 2016 – CURRENT

PATIENT NAVIGATOR, Caresource

In this position the services provided is alerting CM of late annual assessments/FSA/ HRA and initial assessments. Alerting CM of new MyCare member as well as Partnering with CM to resolve issues that arise for MyCare LTC Member. Controlled the decrease in hospital/SNF stay. Governed the follow up outreach for Member transitioning back into the community. Actively build and maintained rapport with CMs Long Term Care Facilities. Authorized reporting fraud through claims and recording that information on master sheet to provide to UM department. Review assessments, claims and documentation history to discuss with assigned CM. Collaborating with LTC facilities to ensure MyCare Members doctor’s appointment are scheduled and needs are met. Advised collecting/managing and monitoring the status of patient medical records along with documentation. Advised to specific CM pertaining to Member CTP goals. Education provided to LTC members and staff regarding medical benefits.

Data transfer from HEDIS measures.

Utilizing CCA and Altruism System.

Researching claims for ER visits, Hospitalization, ER systems, doctors’ visits, specialty visits, room, and board, specialize equipment and more.

Assigning correct ICD codes to Member’s health information.

Transferring ICD codes over to new system (Altruism).

Controlled HCC project- emailing, faxing letters of Member’s major/chronic diagnosis to PCP’s and transferring data to large spread sheet for the UM department.

Documenting accurate information into system

Actively tasking CM to follow new SNF Members.

Pulling Vendor report and transferring data to master tracker.

Data entry of CM caseload including new MBRs address, PCPs, Nursing Facility, POAs, LGs numbers and current CM assigned.

Developing and maintaining SNF/SCE/Transitions/ opt-in, opt-out/claims/MyCare Gaps in Care/population of MyCare LTC MBRs/ Expired MyCare Members/ CW spreadsheets.

Work independently on multiple projects.

Organizing, storing, and filing information in order.

CareStar project (product line under CareSource)- transferring data to private Q drive.

Actively making outreach to confirm Members receiving vaccination.

Completing Audits while marking what is missing on master tracker and sending it to TL.

Administered in redistributing the caseload to accommodate and additional Care Manger.

Enforced passion of data analysis and quality assurance.

Maintain the privacy of patients by following HIPPA regulations.

Attend med advisements.

Actively participate in Patient Navigator meetings.

Participating in workshops and training to receive more education.

Verifying eligibility and demographic prior to each visit.

Travel to each facility as needed for members visit.

Educating Members new members on MyCare, their CM, and providing contact information for assigned CM.

Pulled SNF report daily.

SEPTEMBER 19, 2013 – NOVEMBER 15, 2015

GUARDIANSHIP ASSISTANT INTERN, adult graudianship services

Serve to assist in the provision of guardianship services for the program. Develop skills to work with clients/families and interface with community services providers, while being exposed to management, policy, and administrative assignments to become orientated with how the agency fits in the scheme of overall delivery of services.

Visit Clients in-home/care facility to conduct enrollment assessments and/or to ensure proper care.

Conduct surveys to clients, care facilities, courts, and other agencies.

Maintain documentation of service performed in proper databases.

Managed accounting and billing departments to ensure proper payments are received/applied to records.

Attend Program Board and other meetings as assigned.

EDUCATION

AUGUST 2020-CURRENT

BACHELOR OF ARTS IN PSYCOLOGY, Northcentral University

The overall GPA currently is 3.58. At the current time the skills gained is learning how to apply information literacy and analyzing new information. Retaining information on how the body functions and the importance of delivering the knowledge gained. Strengthening the understanding of different concepts of philosophy and applying to everyday life.

MAY 2015

ASSOCIATE OF SCIENCE IN SOCIAL WORK, Cuyahoga Community college

The carried GPA during school is 3.25. During this time services of volunteering at school to educate others on major in social work. Administering services to research jobs for the community. Providing support and encouragement to new peers entering college. The skills gained during the duration of time includes empathy, sympathy, and understanding how to provide meaningful counseling to others. Administrated proposals for community programs and researching issues that are important. More expertise that was gained boundary setting, social perceptiveness, active listening, awareness of gestures, coordination, organization, time management but not limited to many other skills.

SKILLS

Microsoft Teams

Power Point

Strong organization

Multi-tasking

Data Entry

Communication

Technical

Administrative management

Scanning, emailing, and faxing

Researching information

Prioritization

Resource Management

Attention to details

Microsoft Word

Outlook- Calendar management

Excel/ Access

Customer Service

Strategic Planning

Interpersonal

Problem-solving Abilities

General Office Duties

Time and task management

Organizing meetings

Goal setting

Analytical skills

ACTIVITIES

Administering services to Mother2Mothers, a program dedicated to mothers with disabled children. Providing encouragement and resources to mothers who need assistance. Educating others on veganism while attending Vegan workshops.

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