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Click here or scroll down to respond to this candidateCandidate's Name
Saint Petersburg, FL Street Address
EMAIL AVAILABLEPHONE NUMBER AVAILABLEHighly skilled, compassionate, empathic and solution oriented health professional, dedicated toproviding exceptional care and implementing effective treatment plans for children, adolescentsand adults. Expertise in processing and adjudicating claims and working with cross-functionalclaims departments including medical claims review, contracting, and fraud. Effective motivator,communicator and advocate with inherent ability to manage all personalities, diffuse stressfulsituations, proactively resolve issues, meet and achieve challenging goals and objectives. Superiorleadership skills proven in successful staff development and group facilitation. Proven ability to buildpositive relationships with patients, family members, physicians and other medical professionals.Proficient in all documentation/record maintenance/paperwork to ensure accuracy and patientconfidentiality. Thorough physical assessment skills, with in-depth knowledge of patient registration process Remain calm under pressure; and strengths in making swift, correct decisions in emergencysituations. Able to work a variety of hours, including nights, weekends, and holidays Effective leadership, communication, management and organizational skills Remarkable experience in reviewing and making determinations regarding insurance claims Ability to analyze claims, set reserves, determine compensability and settle claims Ability to maintain records, prepare reports and conduct correspondence related to the work Dmntrtd lid nltil, dignti, needs-assessment, riritiztin, diin-mking, ndmultitasking skills. Professional team player with strong work ethic, communication skills, and attention to detail. Experience with multitasking and meeting deadlines in timely manner.CORE COMPENCIES Case Management Health outreach Clinical Judgment Medication Administration Parent/ Patient Family Education Data Entry/Administration Crisis Intervention Client Assessment/Evaluation Admissions Medical charting Triage phone calls Customer Service Billing and Collection Patient care management Inventory Management Injection Administration Trials pain management. Insurance Evaluation Claims Administration Reports and Record AnalysisWilling to relocate: AnywhereAuthorized to work in the US for any employerWork ExperienceSenior Customer Service SpecialistCapital One - Tampa, FLMarch 2016 to May 2019Responsible for primarily fielding inbound calls, answering questions, providing an unmatchedcustomer experience, and handling customer concerns through one call resolution. Associates will alsoutilize a variety of systems and tools to efficiently service the needs of the customer and will informand educate customers to help them make well-informed decisions essential to utilizing their creditcard in this ever growing digital world. In addition, listening skills are critical such that effective use ofinformation that is heard is fully leveraged.Patient Care CoordinatorSpeak easy - Tampa, FLMay 2012 to 2016Speak Easy translation and transportation Provide oral and written interpretation of legal documents or proceedings. Verify information from original text in order to ensure appropriate interpreting Ensure that all written translations conform to the original text in terms of technicality andterminology Submit translations for acceptance by any court or government agency in the United States orabroad. Ensure that both content and style of statements in communicated effectivelyPatient Care CoordinatorPMSI HOLDINGS2012 to 2015Processed/fulfilled product therapies and services to Injured Workers within the Critical Care division. Assisted physical therapists as needed and maintained cleanliness of facility Utilized a windows based operating system to generate purchase orders, provisioned by PMSINetwork of Contracted and non-Contracted Providers. Follow up on all orders, price quotes, special authorizations, Letters of Medical Necessity andother DME referral workflow to PMSI Clients which include Adjusters, Nurse Case Managers, Patients,Physicians, Vendor Providers and other referral sources. Collaborate with Supervisor and others to manage queues to meet appropriate weekly and monthlyorder completion volume, order aging and authorization metrics. Communicated with other doctor offices, imaging offices, and all other organizations as neededMedicare / Medicaid Operations SpecialistHUMANA2006 to 2009Served as primary resource to 3,800 individual and corporate member accounts on various benefitissues including individual health plans and state and federal laws/mandates Provided client-specific advice, counseling and representation on matters involving insurance issues,public/private benefits and other legal issues to Medicare beneficiaries and/or their caregivers Assisted potentially eligible Medicare beneficiaries and/or their caregivers to apply for entitlementprograms and ensured that benefits were understood by applicants Handled billing, enrollment, claims, and authorizations Maintained and established indispensable relationships with sales professionals to enroll newmembers and maintain existing memberships. Addressed and resolved customer issues, ensuring total member satisfaction. Coordinated monthly team meetings and served as the primary contact person and leader forspecial team-building events and activitiesAchievements Implemented new Web Enrollment Department within Humana and provided backup support toother departments. Received numerous service awards and monetary bonuses for quality and outstanding performance Recognized as a trustworthy and dependable employee; received many perfect attendance awardsCustomer Service RepresentativeVerizon and GEMB2000 to 2006Greeted customers in person and over the telephone Inquired into customers' purpose of visit or call Listened intently to understand query or problem Provided customers with information on products and services provided by the company Demonstrated product features and answer questions regarding price, features and aftersalesservices Took customers' orders and provide them with delivery options Assisted customers through the payment procedures and ensure proper packing of purchasedproducts Take and record customers' contact information in company database Provide customers with information on aftersales services and warrantees Handle product recalls, returns and replacements Increased company revenues by maximizing opportunities to sell additional products and services.LICENCE Florida 240 Health Insurance License Voluntarily received 240 License on personal time to better serve Humana and generate additionalsalesEducationSome collegeSkills Microsoft office suite (10+ years) Call center (10+ years) Billing Data Entry Microsoft Excel Microsoft Word Organizational Skills Outlook Receptionist Scheduling Microsoft Office training CPR Microsoft Office Epic |
