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Administrative Assistant Customer Service

Location:
Halethorpe, MD
Salary:
I'm flexible
Posted:
September 26, 2023

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Resume:

JENNIFER F. TROWER

* ******* ** #*

Gwynn Oak, Maryland 21207

443-***-****

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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