Provider - Member service Resume Brooklyn,NY - Hire IT People

SUMMARY:

To work in a positive and rewarding position with ability to maintain balance, professionalism and mindfulness .

SKILLS:

Analytical, Accurate, Resourceful, Determined, Positive, Flexible,loyal

EXPERIENCE:

Confidential, Brooklyn,NY

Provider - Member service

Responsibilities:

Sales
Assist providers with claims, authorizations benefits and eligibility.
Help members with benefits, eligibility, pharmacy concerns, and scheduling transportation. liaison between member and providers office.
During AEP enroll prospects in Medicare advantage plans, dual eligible and managed long-term care plan.

Systems: Epaces, Marx, Payor, Market prominence, care to care, altruista, Guiding Care,Embeon

Confidential, Brookpark, OH

Member Services Rep

Responsibilities:

Provide information and support for members of cip.
Read insurance claims and translate to member
Call providers offices to update claim information or schedule appointments
Pharmacy services
Helping member understand medication costs and coverage calling pharmacies and ass isting with processing member medication correctly
Medium for insurance company, member and provider
Coverage determinations for medication
Org anization determinations for member ben efits
Assist with prior authorization
Compliance champion -100% compliance

Confidential, Knoxville, Tennessee

Collections Specialist

Responsibilities:

Collect on credit card accounts 30-120 days past due for 2nd chance credit cards
Team lead second talk position / take the call when previous rep cannot get payment it then comes to me to attempt