Customer Service Care Coordinator
Resume:
LaSandra Salifu
Las Cruces, NM *8012
********.**@*****.***
Summary:
I currently have 10 years of experience working in the Healthcare Industry. I started as a Customer Service, then moved to Pharmacy Helpdesk, Research Department and last position was in Claims department which also turned into Care Coordinator position. Ability to handle high volume calls with both members and businesses Responding to inquiries from members, and businesses in regard to processes, and status updates on their balances in account and or fees.
Communicating decisions to members, providers, and businesses promptly, including approval notifications, denials for Prior Authorizations or requests for additional information.
Assisted with Accounts Receivables
Demonstrating empathy, professionalism, and effective communication skills in all interactions with members, businesses, and other stakeholders to ensure positive experiences and outcomes.
Proficient in Microsoft Office, Mailing, MS Excel, MS Word and Outlook. Proficient is data entry.
Skills:
Accounting
Data Processing
Claims
Healthcare terminology
Billing
Pharmacy
Verify member eligibility
Processing claims
Contract Negotiation
Provider Enrollment in new accounts
Databases
Microsoft Office - MS Word, MS PowerPoint, MS Excel, MS Windows Professional Experience:
Centene (Medicaid/Medicare Remote)
Project Coordinator/Care Management June 2024- Oct 2024 Responsible for understanding and applying clinical criteria for processing care management
Build and develop skills like communication, attention-to-detail, critical thinking, and teamwork.
Provide support for Clinical Programs to create and maintain guidelines for clinical product offerings for Care Management.
Responsible for making outbound calls/receiving inbound calls, speaking with physicians' offices for additional information or clarifications needed to coordinate benefits. Educate members on preventive care options and wellness programs Adhering to regulatory requirements, privacy laws (like HIPAA), and company policies related to pharmacy operations and customer service. United Health Group Inc (OptumRx)- Phoenix, AZ Oct 2013 - Nov 2023 Customer Service Representative/Prior Authorization Specialist Build and develop skills like communication, attention-to-detail, critical thinking, and teamwork.
Timely and accurate billing sent to clients email or mail Entered and maintained clinical information in multiple health management systems. Performed retrospective reviews as needed for services rendered without authorization. Accurate billing and collection of payments from insurance carriers, agencies and others for equipment and services provided by United Healthcare for Medical Equipment/Home care etc.
Responsible for making outbound calls/receiving inbound calls, speaking with physicians' offices for additional information or clarifications needed to process prior authorization request.
Provide support for Clinical Programs to create and maintain prior authorization guidelines for clinical product offerings.
Fidelity Bank - Atlanta GA 1/2009-4/2013
Bill Pay Specialist
Review and approve customers inquiries for bill pay necessity requests based on established banking guidelines and contract criteria. Provides support for internal and external audits and surveys. Maintain accurate and complete documentation of all inquiries for continuous improvement.
Follow all internal Policies & Procedures to ensure consistency, accuracy, and operational effectiveness.
Supports Fraud, Waste and Abuse program oversight and communicates any suspected fraud discovered.
Follows all state and federal regulations applicable Assisting customers with inquiries about their bills, explaining benefits, helping with claims issues, and resolving billing concerns.
Worked on Nextgen and automated system- Genesis and Bill pay systems Addressing concerns or problems related to billing inquiries and claims processing. Troubleshoot technical issues related to online accounts or customer portals. Communicating decisions to members and businesses promptly, including approval notifications, denials, or requests for additional information. Utilizing various software systems and databases to access customer information, update records, and document interactions accurately.
Worked in Call center high volume
Education:
High School Diploma - Maryvale High School, Phoenix AZ - 1989 College- Grand Canyon University -2011
Real Estate License -Associate Broker- 2023
Tax Preparer Certificate= Intuit Tax
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