Administrative Assistant Customer Service
Resume:
JENNIFER F. TROWER
Gwynn Oak, Maryland 21207
adzze3@r.postjobfree.com
SUMMARY OF QUALIFICATIONS
Highly skilled professional with over 12+ years of experience in the healthcare industry with a concentration in the Medicaid arena. Proven track record to be results-driven with little to no supervision and 100% satisfaction rate with no errors. Provides superior customer service to in-person/via telephone educating consumers on products/services available to them. Remains abreast and very knowledgeable of principles/processes based on consumer need assessment, to meet quality standards for services, and ensure customer satisfaction.
EDUCATION
High School Diploma, New York State
SKILLS AND SOFTWARE
Alchemy Software
Medical Insurance Processing
Medical Billing
Trizetto QNXT Software
PROFESSIONAL WORK EXPERIENCE
2017- PRESENT, CENTENE CORPORATION (Maryland Physicians Care)
Program Coordinator I
Serve as the contact point, advocate, and informational resource for members, care team, family/caregiver(s), payers, providers and community resources
Cultivate and support primary care and provider co-management with timely communication, inquiry, follow-up, and integration of information into the care plan regarding transitions of care and referrals
Direct health assessments to assist health management teams and assess intervention actions
Member Connections Representative I (2017-2018)
Educate members on and assist with health care benefits through home visits and outreach
Coordinate and implement community events for member outreach initiatives
Schedule/complete home visits for noncompliance, benefits information, ED and readmission diversion and other high risk issues
Conduct targeted phone calls for compliance, HEIDS initiatives and health risk assessments
Assist in locating and connecting members to community resources
2005 – 2017, AETNA (Maryland Physicians Care)
HEDIS Outreach Specialist (2008-2017)
Coordinate outreach and enrollment programs designed to identify under-served population segments and provides assistance for access to care
Collect/track data to ensure compliance of Health Resources and Services Administration (HRSA) guidelines
Observe/track member and provider outreach activity through Healthcare Effectiveness Data and Information Set (HEDIS) incentive programs
Coordinate care services, schedule appointments, and secure transportation services for members
Assist with referring members when appropriate for substance abuse treatment, special needs coordination and other case management related services
Case Management Care Coordinator (2006-2008)
Serve as the contact point, advocate, and informational resource for members, the care team, family/caregiver(s), payers, providers, and community resources
Coordinate and assist members with services to ensure arrival to all medical appointments and little to no gaps in access to care
Direct health care assessments to support health management teams and assess intervention actions
Prior Authorization Representative (2006)
Educate providers by responding to inquiries regarding plan benefits
Follow appropriate call tracking and entered data at 100% error free rate
Triage approximately 200-400 inbound prior authorization requests monthly for approval
Medical Management Assistant (2005-2006)
Assist with the processing of daily, weekly, and monthly utilization management (UM) reports
Contact hospitals to obtain discharge status and updated authorizations for members
Enter data containing ICD-9 and CPT coding accurately and timely
Generate member and provider denial letters within mandatory Maryland state guidelines
Manage daily in-patient census, long term care, and stop-loss referrals under strict deadlines
Triage and manage incoming department claims, reconsiderations, and/or authorization faxes
2003 – 2005, A.I.D.S. ADMINISTRATION
Administrative Assistant
Answer calls, create spreadsheets, and presentations accordingly
Assist with workflow as requested from Executive staff
Enter medical assessments received from hospital facilities
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