Data Entry Follow Up
Resume:
Michelle A. Brown
San Antonio, TX *****
*****************@*****.***
PROFESSIONAL EXPERIENCE
Blue Cross Blue Shield of Illinois December 2014 – May 2023
Government Programs
Member Care Coordinator
Completed yearly Individual Service Plans for residents residing in SLF
Conducted Nursing home and Senior Living Facility visits.
Reviewed cases for any HEDIS and gaps in care
Resolved gaps in care and execute cases in compliance.
Assisted residents, family members and staff with DME, Specialist list when needed.
Completed inpatient and discharge procedures monthly
Completed Critical incident forms for COVID-19, Repeat falls and emergency room visits
Assisted Senior Living members, staff family members with Individual Service Plans
Performed Longitudinal Care Management outreach and follow-up attempts regarding LCM and Plan of Care questionnaire to government program members.
Build relationships with members to encourage compliance with care plans and to alert the Case Manager quickly when issues arise.
Served as the primary monitor of progress and status of our high risk chronic, but stable members.
Completed quarterly and annual assessments
Informed and educate members on the Longitudinal Care Management Programs, using supplied scripts. Complete records in system by performing data entry.
Encouraged member usage of our programs, including arranging appointments and additional member services (transportation, dental and vision). Generate appropriate correspondence and send to member manually, electronically, or telephonically.
Maintained production requirements based on established department business needs.
Provided support to the clinical team by performing the non-clinical functions necessary to generate, manage and close a case within the platform.
Received, analyzed, conducted research and respond to telephone or written inquiries. Process information from member or provider to determine needs/wants and ensure customer questions have been addressed. Respond to customer or send to appropriate internal party.
Served as contact for the various groups regarding claims which involves conducting research, obtaining medical records/letters of medical necessity from TMG, reopen or initiate new cases as needed and refer case to clinicians.
Supported and maintain communications with various in-house areas regarding groups concerns.
Complied with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
Maintained effective communication with management regarding development within area of assigned responsibilities
Blue Cross Blue Shield of Illinois January 2014 – December 2014
Government Programs
Health Coordinator
Performed outreach and follow-up attempts regarding Health Risk Assessment questionnaire to government program members.
Contacted members to inform and educate them regarding the government programs
Responded to internal and external requests from members
Received member’s calls regarding quality of care and supporting the clinicians in the Government Programs department.
Maintained Sprint business website for qualified members and their cell phone usage
Received, analyzed, conducted research and respond to telephone and/or written inquiries
Processed information from members or providers to determine needs/wants and ensure customer questions have been addressed
Complied with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies
Maintained effective communication with management regarding development within area of assigned responsibilities
Kelly Services, Glenview, Illinois October 2012 - January 2014
Blue Cross Blue Shield of Illinois
Health Coordinator/Appeals Specialist
Performed outreach and follow-up attempts. Inform and educate PPO members regarding medical management programs
Supported clinicians in the medical management department with their provider and member activities
Performed outreach duties for the high dollar, actuarial dollar and group diagnose spreadsheets
Updated daily workflow on department spreadsheet
Maintained production requirements based on established department business needs
Received, analyzed, conducted research and respond to telephone and/or written inquiries
Processed information from member or provider to determine needs/wants and ensure customer questions have been addressed
Complied with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies
Maintain effective communication with management regarding development within area of assigned responsibilities and perform special projects as required by management
EDUCATION / CERTIFICATION
Ashford University, Clinton, Iowa 2011
Master of Public Administration
Ashford University, Clinton, Iowa 2010
Bachelor of Health Care Administration
South Suburban College, South Holland, Illinois 2004
Certificate program – Medical Coding and Billing
PROFESSIONAL AFFILIATIONS
American Health Information Management Association
Member 2011-2012
REFERENCES
Available upon request
Contact this candidate