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Click here or scroll down to respond to this candidateCandidate's Name
Street Address PHONE NUMBER AVAILABLE EMAIL AVAILABLESUMMARY OF QUALIFICATIONSResults-driven professional with over 20 years combined experience in serving in a wide range of health care administration rolesStrong focus on creating business process improvement programs for fast-paced customer service organizationsKnowledge of health care management for Medicare plans, process innovation and implementationAbility to establish call handling standards and service level criteria, and issues management by creating performance monitoring systems to meet customer expectations.Outstanding health care insurance expertise with strong customer service skillsProficient in handling complex tasks while being highly trustworthy, discreet, and ethicalStrong analytical skills coupled with a commitment to excellence and the ability to drive efficiency performance improvementExcellent ability to clearly and effectively communicate with diverse populations in written, verbal, and presentation formatsAble to manage large caseloads including assessing, counseling, mentoring, advocating and referring clients and members to community resources.Proficient in Microsoft Office (Word, Excel, PowerPoint), Epic, Spreadsheets/Databases, and Microsoft WindowsEDUCATIONCapella University, Minneapolis, MN, 2018Master of Science Degree in Human BehaviorConcordia University, Portland, OR 2012Bachelor of Arts Degree in Health AdministrationEXPERIENCEKaiser Permanente, Portland, ORHealth Plan Member representative 2005 2022Applies and regularly leverages expert knowledge of Federal, State, Medicare policies/regulations, and mandates pertinent to Health Maintenance Organizations, delivery of medical care, and insurance coverageEducates members about health plan products and available services and advises members on enrollment and eligibilityDetermines members eligibility for services and resolves enrollment discrepanciesEstablish policies and procedures to enable the company to operate efficiently within defined business processesFacilitates resolutions to gaps that may result from new or revised program benefits, policies, and procedures for enrollment due to legislative changes affecting Medicare and/or Medicaid beneficiariesPrepares written responses to technical inquiries on various aspects of the law, regulations and proceduresResearches and compiles issues in MACESS to generate reports used by management to identify patterns of member feedback.Documents, resolves, appropriately triages member complaints, concerns, and compliments according to departmental and Medical Office policies and proceduresUpdates Kaiser Permanente systems to reflect corrections/changes to PCP and other demographic informationInitiate communication between Membership Service and medical/dental operations to ensure information that may affect members is clearly transmittedActively communicates changes in Medical Office policy and procedures to Membership Service in order to update knowledge information systemsInteracts with multiple KP departments (e.g., Claims, Patient Billing Services, Sales and Marketing, Member Relations, Membership Administration, medical/dental operations, etc.)Assess member needs, respond accordingly in potentially volatile situations and act appropriately to resolve issuesCandidate's Name Resume, Page 2Transition Projects Inc., Portland, OREmployment Center Coordinator 2003 2005Developed and nurtured partnerships with local businesses to create employment opportunities for Jean's Place residents.Created individualized employment case plan for residentsAdvised residents through employment process including writing resumes and developing interviewing skills.Managed caseload of 55 womenAccurately updated monthly reports and case management paperworkSupervised and trained employment center volunteersConsulted with hiring managers to determine current and future recruitment needsProcessed paper work, created reports, and scheduled team meetingsPrepared program budget with executive director and fiscal officerMonitored program expenses to maintain and control spendingUtilized all available funding and verified that all expenses are appropriateChangePoint Inc, Portland, ORAdmission Specialist 2000 2003Maintained clients data files and scheduled clients intakeNetworked with agencies in the community to provide clients with additional resourcesObtained information from clients via phone, mail, and in personCoordinated with team to ensure smooth planning for clients with mental and physical disabilities.Volunteers of America Common Bond, Portland, ORParent Educator 1997 2000Provided case management, tracking, and follow-up for 35 teen parentsScheduled and facilitated daily home visitsIdentified client strengths and needs to create goals and long term developmental plansProvided referrals and information to community resourcesImplemented and taught culturally sensitive parenting and life skills classes.Performed detailed assessment for the urgent need of families and developed appropriate service plan to increase and strengthen the family situation based on social, mental, and physical family needs. |
