Customer Service Representative/Case Specialist

TONYA DUKES

**** **** **., ******, ** *****

PHONE # 908-***-****

Objective: To obtain part time employment.

PROFESSIONAL EXPERIENCE:

AMERIGROUP 399 THORNALL ST. EDISON, NJ - 800-***-****

**/**/03 - Present

Case Specialist: Responsible for coordinating care and services to members. Working in conjunction with Case Managers/RN’s to coordinate health care services by facilitating, scheduling, and arranging a variety of treatment and health care plans.

PRIMARY RESPONSIBILITIES:

1. Coordination, authorization, fulfillment, monitoring and tracking of health care services.

2. Initiates and maintains contact with assigned individuals/significant others and providers to determine members response to services.

3. Coordinate home visits for Case Managers.

4. Identifies cases in consultation w/ Case Manager that would benefit from alternative care.

5. Coordinates assignments for Case Managers to facilitate timely member evaluation.

6. Arranges for services as identified by the case manager such as home health resources, alternative long-term care placements etc.

7. Identifies potential liability issues for services provided.

8. Utilizes knowledge of community resources.

9. Ensures that health care services are received as authorized by the provider.

10.Collect clinical data.

CARE ADVANTAGE,485 Rte. 1 SOUTH ISELIN, NJ - 800-***-****

Medical Review Specialist: 11/00 - 12/02

HORIZON BC/BS OF NJ,3 PENN PLAZA

NEWARK, NJ 07103 - 800-***-****

Client Service Consultant: 06/99 - 11/00

NEWARK BETH ISRAEL MEDICAL CENTER

201 LYONS AVENUE

NEWARK, NJ 07112 - 973-***-****

Sr.Secretary/Registrar: Oncology Dept. 06/88 - 05/99

EDUCATION:

Best Care Training Institute – 68 South Harrison Street, East Orange, NJ 07018 973-***-****

Certified Nurse Aide – Nursing Skills, Anatomy, Nutrition and infection Control as well as clinical activities at South Mountain Nursing Home in Union New Jersey - 08/28/07 – 10/14/07

ESSEX COUNTY COLLEGE

Certification in medical billing Courses included: Medical Terminology, Computer training, CPT4 and ICD9 Coding, and Medical billing.

09/98 - 05/99

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