Customer Service Health Insurance

DESIMARIE WRIGHT

917-***-****. ***********@***.*** . Brooklyn, NY 11203

PROMGRAMS

• Jump Cloud

• Community Outreach

• Integrate Clinical User Experiences

• Program Evaluation

• MS Office-Word

• PowerPoint

• Explanation Of Benefits

• Collaboration Of Benefits

• Smart data Solutions Claims Control Panel

• Health Savings Accounts

• Health Reimbursement Accounts

• Flexible Spending Accounts

• Cobra

• Reimbursement policies

• Health Insurance Portability and Accountability Act UNITED HEALTH GROUP Remote Location

Customer Service and Coding Representative Sr.

January 2024-April 2025

• Ensure claims are accurate and in compliance with applicable laws

• Prepare and submit reports to management

• Provide advice on reimbursement policies and procedures

• Utilize appropriate knowledge resources to drive resolution of applicable questions/issues (e.g., websites, CRM tools, Onyx, Siebel, knowledge bases, product manuals, SharePoint)

• Make outbound calls to resolve caller questions/issues (e.g., to callers, providers, brokers, pharmacies)

• Ensure proper documentation of caller questions/issues (e.g., research conducted, steps required, final resolution)

• Offer additional options to provide solutions/positive outcomes for callers (e.g., online access to relevant information, additional plan benefits, workarounds for prescription delays)

• Develop and maintain productive relationships/interactions with callers

• Knowledge of applicable health care terminology (e.g., medical, dental, behavioral, vision)

• Knowledge of applicable products/services (e.g., HIPPA, state/regional requirements)

• Demonstrate knowledge of applicable products/services (e.g., benefit plans, disability, COBRA, FSA, HRA)

OPTUM SERVE/MILITARY/VETERAN AFFAIRS Remote Location Medical Coordinator II

June 22, 2022 –January 2024

• Provide advice on reimbursement policies and procedures

• Consistently exhibits behavior and communication skills that demonstrate our company’s commitment to superior customer service, including quality, care, and concern with every internal and external customer

• Documents members’ service benefits by contacting the appropriate health plans as needed

• Processes appropriate authorizations for HMO/PPO clients as specified in the Optum procedures

• Prints and mails authorizations to providers, patients, HMOs, and facilities as needed

• Assists and monitors in the processing of referrals. Enters, updates, and closes referrals daily while assuring that appropriate internal/external referral providers are utilized, members are eligible and have benefits coverage, correct CPT/ICD-9 codes have been entered, accurate records of all dates and other required fields are entered, supporting clinical data for the referrals is entered, and all urgent referrals are processed within the designated time limit

• Coordinates, identifies and routes referrals that require review to licensed Care Management staff who arranges outside physician medical review as appropriate

• Assists with answering telephones and maintaining files, logs, or other reports,

• Uses, protects, and discloses patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards NEW YORK CITY HEALTH AND HOSPITAL CENTRAL (NYCHHC) New York, NY Public Health Advisor Level II

June 2020-April 2022

• Work in collaboration with the Case Investigator from the Local Health Department (LHD) and call contacts of newly diagnosed cases.

• Communicate with contacts in a professional and empathetic manner maintaining emotional and cultural awareness.

• Collect and record information on symptoms and needs into Customer Relationship Management (CRM) with accuracy.

• Provide contacts with approved information about NYS isolation and quarantine procedures, and if appropriate, refer them to testing according to protocol and/or to a COVID-19 Community Support Specialist for social resources.

• Follow a set script to inform contacts about the importance of isolation or quarantine and what to do if COVID-19 symptoms are present or develop.

• Maintain daily contact with Team Supervisor and teammates to report on work completed. BROOKLYN CENTER FOR INDEPENDENCE OF THE DISABLED (BCID), Brooklyn, NY Compliance Specialist/Housing (Criminal Background Investigator) May 2017 – May 2022

• Assess barriers to the housing of individuals and families experiencing homelessness to determine housing and service needs and support them in obtaining and maintaining housing.

• Develop a housing procurement, financial, and self-sufficiency case management plan with clients, including an intake interview to determine the client’s needs, goals, and eligibility.

• Provide mediation and advocacy with landlords, and property management companies, on the client’s behalf to develop a workable plan to obtain and or maintain housing.

• Research Criminal and Sexual Offender background researcher.

• Maintain up-to-date knowledge about the different housing programs, NYCHA, Section 8, City Feps, LINC l, ll, lll, and others.

• Meet with the clients, family members, and Social Workers to review if the client can be approved for the program. I collect all the paperwork and review the client's background by calling the Department of Correction and the United States Department of Justice Sex Offender Public Website, called the New York State Division of Criminal Justice Services, to double-check the background. When all paperwork is collected and reviewed, reach out to the client and landlord for rent verification, to see how they are doing and if the apartment needs repairs or if there is a conflict between the client and landlord.

• Participates as a mental health team member

• In some cases, the client will need assistance to adjust to moving back into the community or dealing with serious mental illness. I will connect the participants to community resources and support groups. Check on them more than once a month to make sure they are okay.

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