Customer Service Case Manager
Resume:
Marva Dightmon
*************@*****.***
Education:
UEI Collage – 2024 Phoenix Az
Diploma Medical Billing and Insurance Coding
West Wood High School - 1988 Mesa, AZ
School Diploma
Professional Work Experience:
Johnson and Johnson
Reimbursement Specialist 05/2024 - 08/2025
Responsible for
●Primary point of contact and case manager for patient support, inquiries and escalations. Coordinates services with internal program operations and Program Management
●Conducting initial welcome calls to patients informing them of available services as well as future targeted outreach to provide ongoing
●Work independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to complete program enrollment, answer inquiries, and coordinate access to therapies
●Processing of patient and prescriber requests to ensure access to therapy in a timely manner
●Use high-level problem-solving skills to research cases independently, using professional judgement to make sound decisions
●Maintain frequent phone contact with internal operational staff to resolve any inquiries or requests from the patient and HCP offices
●Provides exceptional, white glove, customer service to internal and external customers; resolves any customer, client, or physician requests in a timely and accurate manner; escalates appropriately
●Provides support to ensure efficient referral processing from referral intake to triaging of prescription
●Independently and effectively resolves complex issues with creativity and innovation
●Application of defined business rules to qualify patients for manufacturer supported programs
●Ability to coordinate and collaborate with manufacturer representatives, HCP offices and other key personnel on complex cases which require strategic intervention
●Strong compliance mindset, demonstrating clear understanding of patient privacy laws
●Active participation in building and maintaining respectful, collaborative internal/external team relationships, exercising and encouraging positivity.
●Ability to understand payer trends, product access, and reporting reimbursement trends and/or delays (i.e. denials, underpayment, access delays, etc.)
Apria HealthCare 06/2023- 05/2024
Patient Qualification Specialist
●Responsible for supporting hundreds of local branch offices across the country by reviewing new patients’ orders and documentation submitted by referral sources to obtain required documentation and clinical requirements of individual health insurance plans, allowing our patients to maximize their available health plan benefits and to receive the much-needed care as soon as possible.
●Requests health plan authorizations/information as required; either electronically or verbally.
●Demonstrates and ability to develop business relationships within the field leadership through close collaboration, partnership, engagement and communication.
●Performs other duties as required.
●Creating DME Prior Authorizations request for deliveries for patients.
●Making outbound calls to patients verifying address, obtaining Co-payments
●Providing Estimate time of arrival for order’s
Apria HealthCare
Customer Service Specialist – Remote 03/2020- 06/2023
●Responds to telephone, fax, electronic documents and web inquiries and orders from referral sources and homecare patients.
●Receives referral request for home equipment and services.
●Provides information on equipment supplies and services.
●Demonstrates professional etiquette and courtesy when interfacing with customers.
●Resolve patient/customer complaints by identifying problems, troubleshooting of equipment and coordinating appropriate corrective action.
●Assesses patient needs and promotes company products and services.
●Complies with and adheres to all regulatory compliance areas, policies and procedures and best practices.
●Handles Inbound/Outbound phone calls, emails and texts to patients and referrals.
●Follows Apria’s procedures for all transactions.
●Follows Apria’s Quality program to ensure that we give the best service to all customers.
●Performs other duties as required.
McKesson Corporation
Health Services Associate 09/2019 - 01/2020
●Effectively communicates to callers regarding program rules, requirements, and processes.
●Promotes a positive informative customer experience.
●Outbound follow up calls to patient’s DR’s office to obtain information if the patients’ prior authorizations have been received and submitted to the insurance plan.
●Outbound calls to pharmacies to have patients’ prescriptions to be ran for possible rejection errors of still needing a prior authorization
Cigna 05/2017 - 7/2019
Pharmacy Services Associate
●Respond to phone fax and online inquiries from health care professionals to assist them through the medication prior authorization process
●Collected clinical data for prior authorizations and non-formulary exception request following guideline provided for or online prior authorization tools and or corresponding forms
●Performed initial screening of request based on guidance given by online prior authorization tools approves prior authorization request if the data collected meets the approval specification
●Prior authorization request that do not meet approval specification a pharmacist for clinical review
●Researched and responded to inquiries and interprets policy to determine the most effective response using established departmental procedures, HIPPA regulations and corporate policies
LogistiCare 9/2016 - 1/2017
Customer Service Representative
●Provide superior customer service to clients, efficient and accurate entering of all customer service requests into LogistiCare's data management system
●Perform all functions related to trip authorization, documenting and resolving complaints and issues
●Friendly, helpful, and polite with the ability to take care of the customer's needs while following company procedures.
●Work closely with transportation providers and health care facilities to resolve problems
●Assists with providing support to office staff in pursuit of excellent customer service
Mutual of Omaha 6/2016 - 8/2016
Data Entry
●Provided data entry keying check information such as amount, check numbers, account numbers along with routing numbers
●Balanced 4 Bank branches end of day accounts submission by reviewing all prior information keyed in system from check information
●Reviewed each account and amounts balanced account by either correcting numbers or placing credit and debits in the correct order
●IOT tickets for bank branches to make corrections for the accounts to be balanced
●Scanned copies of IOT’s into the system to wash the account out for submission
TriWest 4/2016 - 6/2016
●Provided non-clinical support for the Medical Management and Operations Departments
●Make routing decisions regarding incoming correspondence based on defined processes.
●Collects and keys-enters data into the TriWest medical management system based on defined processes
●Parses and triages incoming faxes to the appropriate task lists
●Made outbound calls to facilities or providers
Asurion 10/2015 - 4/2016
Tech Support
●Took inbound calls from customers to solve their technical issues with their phones
●Used software to log into customer cell phone to fix their phone issues
●Implemented protect plus app for backing up phone contacts photos and videos
●Explained details of app for finding their device in the event of it being lost or stolen
●Made outbound calls to customers to fix technical issues
Rev MD 02/2015 – 07/2015
Claims Processor
●Rural Metro Ambulance claims into multiple systems for payments to be received from patients who required ambulance transportation
●Processed up to 210 claims daily, meeting all companywide metrics - production quota and accuracy
●Extremely knowledgeable with ICD9/CPT codes and behavioral health coding
●Reviewed all claims for what type of transportation was required for the correct billing
●Reviewed all authorizations for processing
●Completed manual ads by taking a new claim and creating the account with the correct and updated insurance information
●Made outbound calls to complete insurance verification
●Utilized dual monitor system working proficiently with up to 10 programs simultaneously
●HIPPA Certified
Xerox LLC
Customer Care Support -State of AZ AHCCCS 08/2013 - 9/2014
●Processed up to 90 claims daily verifying all patient information and codes
●Strong working knowledge of behavioral health codes
●Assisted clients in obtaining information about their benefits, and checking case status for applications
●Utilized multiple systems to provide accurate information and complete applications by phone for assistance
●Helped clients navigate through the website, reset passwords, and directed clients to appropriate resources
Century Link Business Clients 01/2011 - 06/2012
Customer Care Specialist
●Assisted Century Link Business customers with billing issues, adding services, and providing company products and services to customers looking to obtain new accounts
●Created tickets for customers with issues, helped customers with contract agreements, and kept track of all calls by notating in the system
●Completed outbound calls to customers if needed, to ensure exceptional customer service
Chase Bank 06/2007 - 02/2010
Customer Care Specialist / Private Loan Processor
●Provided phone support to borrowers providing guidance regarding private student loans for the consolidation programs
●Ensured borrower status updates on multiple systems to ensure timely processing
●Identify and interpret loan denied issues and assign denial disputes to appropriate team members. Assist borrowers with questions on applications and verify that all required documents are on file. Prepared files for underwriting department to review for approval or denied
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