Candidate Information | Title | Case Manager Health Systems | Target Location | US-PA-Philadelphia | Email | Available with paid plan | | 20,000+ Fresh Resumes Monthly | |
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| | Click here or scroll down to respond to this candidateIt is time for a career! Dedicated, devoted, focused individual who is ready for the next phase of a career in healthcare. With 20 years of experience in aiding individuals and groups to drive practical solutions to conflicts, most recently, in the military under the healthcare umbrella. Organized and dependable with success in managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. The end goals is always customer satisfaction!Work HistoryStreet Address -11 - CurrentHealthcare Facilitator for Tricare ClaimsWPS Health Systems C/O Proven Process Group, Wisconsin Dells, WIPromoted Tricare products for continuous learning within organization monthly, raging from 10 to 25 participants by sharing best practices and lessons learned from various facilitation experiences regarding Tricare Claims under UB-04's, 1500's and DD2642 forms..Streamlined registration processes for workshops, reducing wait times and improving overall attendee satisfaction.Collected and analyzed participant feedback, consistently implementing suggestions for improvement in subsequent sessions.Collaborated with subject matter experts to develop accurate, relevant content for delivery at industry conferences or professional development events. Assess training needs through surveys, interviews with employees, focus groups, or consultation with managers, instructors, or customer representatives. Design, plan, organize, or direct orientation and training programs for employees or customers. Offer specific training programs to help workers maintain or improve job skills. Present information with variety of instructional techniques or formats, such as role playing, simulations, team exercises, group discussions, videos, or lectures. Obtain, organize, or develop training procedure manuals, guides, or course materials, such as handouts or visual materials.2022-09 - 2023-11Medical On Boarding Case ManagerConcorde Inc, Philadelphia, NYHandles all Cadet medical forms such as DD2808, DD2807-2, Optometrist, and Hearing exams to ensure all fields are filled out resulting in their transition from being one of many cadets who join military after high schoolChasing medical, optometrists when forms are improperly filled out with help of from following databases: DODMET, Basic for case notes, Concentra, if need be, and Outlook for replies via fax or emailTransition of documentation occurs with help of Adobe.Enhanced communication between clients and providers through consistent follow-ups and progress updates.Advocated for client rights when interacting with external agencies or institutions, ensuring fair treatment at all times.Enhanced communication between clients and providers through consistent follow-ups and progress updatesPromoted safe environment for vulnerable populations by reporting suspected abuse or neglect as mandated by law2011-04 - 2022-06Contractor: Tricare and DOD DMDC TrainerInspiriTec, Philadelphia, PAWorked on multiple contracts at this company such as: Susperstorm Sandy: 04/2011 to 08/2011Responsible for intaking victims of New Jersey, information to get grants to restore their homes affectedAffordable Care Act: 09/2011 to 09/2014: Handled all Medicaid applications for state of Pennsylvania using Compass' websiteContractor for DoD re: DMDC 11/2014 to 06/2022: Trained new hires on DEERS database on military benefits for themselves and familiesIncluding Tricare, Medicare, Other Health Insurances, VA database, Express Scripts, etcMeeting with Quality Assurance, retraining reps with low scores through spreadsheets, and monthly enhancement training includedLastly, rewrote training material to meet demand of Governments' request.2014-09 - 2018-12Team LeadPond Lehocky Stern & Giordano LLP, Philadelphia, PADaily intake of 200 calls for registration for Medical Assistance on Compass websiteSummarize information provided and enter information into ACA call tracker dailyReconciliation via spreadsheet with E-signatures from callers while auditing calls for compliance purposes through 4 different excel spreadsheetsMeetings with Department of Public Welfare for ways to better all application processes for callersReading Rights and Responsibilities for customers for accreditation purposes and CHIP sometimesCompliance with Commonwealth of Pennsylvania for auditing purposesTaken over 300 calls daily for victims who wanted to gather information from website: www.sandy help.nj.govWorked with DCA (Department of Community Affairs) with extension of programs for renters, homeowners and businesses in New Jersey CountiesHelped over 300 callers daily identify with grant applications for businesses, homeowners and construction workersTaken courses on OMAP (Medical Assistance applications) and Customer Service courses to assist callers in medical assistance applicationIntake Specialist for Social Security Disability Insurance, Supplementary Security Income, Worker's Compensation, and Referrals Disability Justice: Pond, Lehocky, Stern & Giordano, Daily intake of 300 calls in 50 states for legal representation for Workman's Compensation, Social Security Disability Insurance, and SSI claims-in Needles and Litify databasesCollaborate with Legal Analysts, and Lead Review team, who review intakes to see if thereare cases such as SSDI, SSI and Worker's Compensation, or thrid party- referrals.Assist Case Managers and Asst Case Managers in any help pertaining to pre-hearing questions for clientsDaily intakes for Cessation, Request for Hearing, and Reconsideration cases throughout 50 states as wellLook for Mancini cases and Union employees (i.eCarpenters, Electricians, PECO, SEPTA, and PGW), who may want to pursue cases against their employees to maintain monthly quotaRefers clients to Medicaid and rules of applying for it in state of Pennsylvania Continuous education on Medicare for clients once awarded Social Security DisabilitySometimes updated intakes are needed to be done for clients who rejected first time aroundSometimes call claimants back to make sure they fax either: DLI (Date Last Insured), AL Decisions (Favorable or Unfavorable Decisions), medications, treating doctors, or paystubsAssist with Packet Team in sending out retainers, or IA Team (Initial Application Team) in making sure client's information is accurate on their application on www.ss.govFor Exeter, Learning Tree, Hub, Boys Latin Charter School and ECFMGTrained team on all aspects of operating procedures and company servicesMonitored network performance and provided network performance statistical reports for both realtime and historical measurementsBuilt application platform foundation to support migration from client-server product lines to enterprise architectures and servicesReviewed daily requirements and forecasts and delegated work for optimal coverageDelivered superior training and leadership to teams to boost performance and help team members achieve performance targets.Education2018-01 - 2019-05M.D. in Health Management and SustainabilityUniversity of Phoenix - Philadelphia, PA2009-10 - 2012-05Bachelor's degree in Healthcare ManagementUniversity of Phoenix-Online Campus - Philadelphia, PAAdditional InformationSecret Security Clearance, PII Training, Cyber Awareness Training, Rapids Training, DEERS database savvy, Medicare, Tricare, VA.Gov, IRIS, DIMS, SharePoint, IRRUJohn ButlerHealthcare Management And SustainabilityContactAddressPhiladelphia, PA 19135PhonePHONE NUMBER AVAILABLEE-mailEMAIL AVAILABLEWWWhttps://bold.pro/my/dejuan-peters/694SkillsCall center Team LeadCharts and Graphs via excelConference room set upsCustomer ServiceDatabases for Trcare, Medicaid, SSD and SSIRepresentative experienceEmergency service callsFollowing directionsMastery of customer serviceService-orientedStudent government representativeSocial services knowledgeWeb technologies and servicesTechnical direction and product strategiesCustomer service professionalService focusedScheduling servicesCustomer service backgroundClient service and supportPersonalized customer serviceCustomer service and engagementInformation servicesService navigationService referralsCase service plansExecutive taxi servicesService team supportDirecting callersCustomer service standardsSocial servicesCustomer service understandingTeam directionCustomer directingService quality optimizationService schedulingCustomer service managementCustomer serviceAnalysis SkillsAuditingBusiness ConsultingDocument ManagementRecords ManagementWorkers' CompensationBusiness ManagementDEERS Database (3 years)ExcelPowerpointBusiness DevelopmentComputer NetworkingStatisticsChange ManagementPortfolio ManagementProcess ImprovementStrategic PlanningMicrosoft ExcelAdministrative experienceMicrosoft PowerpointPhone etiquetteBusiness AnalysisProject ManagementMicrosoft SharePointManagementIVRProduct developmentFinancial acumenRelationship managementDocumentation reviewPresentation skillsFMLABenefits administrationOSHAADPResearchHuman resourcesSupervising experienceManaged careHIPAALeadershipData collectionTypingPatient monitoringBehavioral healthCase managementMedical terminologyPivot tablesMobile devicesProgram designQuality managementQuality controlDischarge planningMedical office experienceManagementEpicWorkdayQuality assuranceContinuous improvementProofreadingMicrosoft AccessRoot cause analysisFinancial servicesEMR systemsMicrosoft OfficeICD-9ICD-10MilitaryAdobe AcrobatSurvey designPeopleSoftHRISEmployee orientationEmployee relationsData collectionPractice managementOracle EBSOracleKronosDatabase managementIDSAdult educationLMSCalendar managementEmployment & labor lawDevelopmental disabilities experiencePublic relationsCompliance managementSalesforceProgram managementComputer literacyComputer skillsCustomer supportResearch & developmentInformation managementGoogle SuiteMeeting facilitationMotivational interviewingWindowsHealthcare managementSoftware troubleshootingTeam ManagementTechnical SupportAnalyticsMeeting ManagementTask DelegationData AnalysisContract ManagementOperations ManagementBusiness AdministrationFeedback DeliveryAssertivenessIcebreakersInterpersonal SkillsDecision-MakingSoftwareEchosHumana 360 LaunchpadTricare.milMainframeOnbaseTrifectaSharepointOne noteFloatOutlookAdobeLMSExcelPowerpointHIPAA and Cyber Awareness continuous TrainingsOlli. |