Customer Service Administrative Assistant

Janice Lucas

*** ******* ****** · Wentzville, MO 63385 · 636-***-****

**********@*****.***

Accomplished professional with meticulous and successful experience in medical management. Decisive, with extensive experience in Medicare line of business. Superior customer service skills, with excellent success in assisting members and providers with grievances and appeals. CMS guidelines and internal best practices along with HIPPA compliant expert.

Worked remotely from 3-2020 to 4/30/2023 Retired/Bored Looking for Remote/At Home opportunities

Professional Experience

Grievance and Appeals Coordinator in Medicare Department Centene Corporation, Clayton, MO 03/2015 - 04/30/2023 Assisted working Medicare out of network providers appeals. Reviewed documents and requested any missing papers needed. • Processed grievances, Quality of Care (QOC), Quality of Service (QOS) and claim issues according to CMS and Centene guidelines, with successful results, and communicated that outcome to members. • Worked with Medicare and Medicaid MMP, DSNP, ISNP in numerous states, following both CMS and state contracts. • Processed Claim Appeals through AWD to completion. • Effectively utilized many systems: CRM, Amisys, TruCare, Emdeon, Payspan, Omni, Prime Sharepoint, skype, MS Word, Zoom, MS Excel, Outlook, MARx, and Filenet. • Excellent communication skills, which provided departments from all states involved, successful communication to complete findings for closure of grievance. • Excelled in monthly audits, with an average over 95%.

Case Coordinator III

Express Scripts Pharmaceuticals, St. Louis, MO 10/2006-2/2015 Worked effectively on various patient assistance programs: Boehringer Ingelheim Cares Foundation, Novartis Oncology, Novartis Foundation, Novartis Specialty Medication, Novartis Transplant, Lilly Medicare Assistance, RX Outreach and Astra Zeneca. • Medicare/Medicaid (MMP) Specialist. • Processed applications to determine eligibility, appeals, and grievances including mailing applications and processing pre-screens. • Referred patients to Alternate Funding Programs and assisted with the Medicare Prescription Drug costs application. • Excellent customer service, both inbound and outbound phone queues, assisting patients • Communicated between patient and doctor offices, to provide favorable outcome to patient. Materials Coordinator/Assistant Maintenance Manager Truesdale Packing Co., Truesdale, MO 3/2006-10/2006 Tracked and inventoried all packing materials. • Returned damaged products to the vendor. • Organized and maintained all 550 manufacturing, engineering, service and repair documents/books for the control document program. • Published the control documents/books for maintenance and repair department. • Utilized computer system to receive and inventory all parts.

Administrative Assistant

L&L Trucking Wentzville, MO 2001-2006

Processed Payroll oversaw Health & Dental Insurance. • Balanced bank accounts and processed ledgers. • Answered phones and assisted President in all aspects of the trucking industry.

Took Time off to raise adopted nephew after his mother’s murder. Administrative Assistant, CFO

Cathedral Rock Corporation, Chesterfield, MO 2001 - 2001 Assist Legal, payroll and billing department. • Resolve grievance and complaint calls. • Answer phones during receptionist’s lunch. • Liaison between Cathedral Rock, (Merged American Healthcare with Cathedral Rock).

Assistant to the President

American Healthcare, Inc., Chesterfield, MO 1998 - 2001 Assist the President in all daily management operations. • Provided paralegal services in litigation management and other corporate counsel functions. • Assisted payroll department, maintained corporate records, minute, licenses and Operational Policy and Procedures manuals. • Assist Corporate Executive and Facility Staff, collecting census from Facilities.

References available upon request