Jessica Martin

Detail Oriented, Fast Learner

Coconut Creek, FL 33063

adwo0k@r.postjobfree.com

+1-754-***-****

To soar and confront the future head on with a company that offers opportunities for me to grow, learn, and contribute to the firm by utilizing my strength, vision, and determination. Authorized to work in the US for any employer

Work Experience

Program Coordinator/ Case Management

Centene Corporation - Sunrise, FL

October 2015 to August 2021

Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.

• Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and responsibility.

• Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census.

• Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services. Screen members by priority for case management (CM) assessment. Perform transition of care duties to include but not limited to, contact the member’s attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.

• Coordinate services with community based organizations. Attend marketing and outreach meetings as directed to represent the plan. Produces and mails routine CM letters and program educational material.

• Data enter assessments and authorizations into the system. Claims specialist

EmblemHealth - Hollywood, FL

July 2012 to July 2015

Responsible for the quality, adjudication and cycle time for Medical claims.

• Maintain in -depth knowledge of claim processing systems

• Process medical claims for all lines of business

• Review submitted claims

• Confirming and verifying benefits

• Reviewing EOB's

• Interpreting and making decisions using independent judgment on moderate-to-difficult claims

• Researching information

• Continuously staying updated with policy and/or procedural changes

• Support files and limitations required in order to evaluate accuracy and recommend necessary program changes and/or enhancements

Customer Service Rep

EmblemHealth - Hollywood, FL

August 2011 to July 2012

Received inbound calls from customer

Assisted with inquiries for Members regarding their Health Plan Researched billing information for members as requested Printed, Fax, emailed & mailed out information for member in regardless to benefits Meet & exceed performance goals as required by EmblemHealth Policy As well I was placed on the Outbound Team for the customer service department placing Welcome calls to new member & answering any & all questions they may have regarding their new health plan. Meet all goals daily as set in placed for the outbound department. Technical Support for AT&T mobility BlackBerry Specialist Teleperformance - North Lauderdale, FL

August 2010 to August 2011

Answer Inbound calls

• Assist customers with any questions regarding their Account

• Trouble shoot & repair customer Black Berry devices

• Process exchanges for customer whom device is determined after troubleshooting it needs to be replaced

• Meet & exceed performance goals & guidelines set in place by AT&T as well as Teleperformance Education

Nursing

Valencia Community College

2005 to 2007

HSD in Education

Mc Arthur High - Pembroke Pines, FL

1998 to 2002

Certificate

Institute of Business & Entrepreneurship

2002

Skills

• PowerPoint, Word, Excel, Qcare, Maxmc

• Case Management

• Social Work

• Technical Support

• Medical Billing

Additional Information

• Experienced in handling confidential paperwork

• Exceptional customer-relations background

• Detail Oriented

Contact this candidate