Patient Care Coordinator
Resume:
EDUCATION
Strayer University
July ****-September 2023
BBA in Healthcare
Strayer University
July 2021-July 2023
ABA in Healthcare
ISMAIL F. LANE
Healthcare Administrator
PROFILE
Results oriented professional with a robust
healthcare administration education and proven
success implementing policies and procedures.
Able to manage multiple tasks and prioritize
time sensitive situations with high attention to
detail. Excellent verbal and written
communication with internal and external
stakeholders. Combines technical and
analytical aptitudes with problem solving skills
to produce timely and cost-efficient results.
CONTACT
PHONE:
EMAIL:
*******************@*****.***
WORK EXPERIENCE
VDH Virgina Department of Health
Education Coordinator I
October 2024-Present
Supervised sustainable pilot program for Chronic Care Management to provide CHW-specific services for patients with chronic disease. Implemented blood pressure self-monitoring programs and healthy heart lifestyle change programs as a Healthy Heart Ambassador. Facilitated meetings with community members and interprofessional partners around a community health issue(s). Interacted with patients experiencing chronic disease; and collected and documented outcome data while following all data security protocol.
Cigna
Sr. Benefit Analyst
February 2022-September 2024
Ensured all compliance requirements were satisfied in addition to all practices and procedures. Implemented, updated, and maintained automated direct connection ensuring manual eligibility data. Processed simple and complexed claims for payment and reconsideration. Connected members with additional administrative and clinical resources as needed. Facilitated cross functional resolution of medical and pharmaceutical coverage issues and proactively addressed, researched and resolved issues revenue optimization. United Healthcare
Patient Care Coordinator
July 2019-March 2021
Prioritized effectively to meet member service goals. Collaborated with colleagues to deliver a world class experience for our customers with honesty and integrity. Reviewed and adjudicated complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Applied medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. SKILLS
• Problem Solving
• Patient Care
• Quality Management
• Regulatory Compliance
• Critical Thinking
• Teamwork
• Communication Skills
• Adaptability
• Relationship Building
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