Residential Aide
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To apply the knowledge acquired through a decade of Medical Office Management and five consecutive years at a (MCO) managed care organization while seeking a challenging position to assist the public, where I can utilize my medical skills to ensure excellent teamwork to support other staff or independent projects.
Residential Aide - Ken Crest Services - Philadelphia, PA
(2025-10)
Expectation of Job Description: Assisting residents with their daily personal tasks. Ensuring that residents are cared for following their hygiene, meals, sleep, and medication routines.
Residential Counselor - Merakey Inc - Philadelphia, PA
(2022-05 - 2022-02)
Expectation of Job Description: Assisting residents with their daily personal tasks. Ensuring that residents abide by the rules and policies. Organizing and facilitating group activities.
Provider Enrollment Services; PDM (PROVIDER DATA MANAGEMENT) & IPQ (INVALID PROVIDER QUEUE: CLAIMS) - AmeriHealth Caritas - Philadelphia, PA
(2022-05)
Expectation of Job Description: Verifying the health provider's qualifications and experience through data collection, primary source verification and committee review. Data Accuracy, Data cleansing, Data policies and compliance, and provider data maintenance. Also, creating and developing data management strategies; as well as eliminating inefficiencies in provider data management. Ensuring all business rules are adhered to and ensuring a glitch-free reimbursement process.
Provider Service Helpline Agent for Member Relations Department - Health Partners Plans - Philadelphia, PA
(2017-09 - 2022-04)
Expectation of Job Description: Provide accurate and complete information in response to providers' inquiries, complaints and/or problems. Collaborate with internal departments to facilitate resolutions to provider issues and concerns Respond to provider related calls in a courteous, professional & efficient manner providing timely follow-up to requests for information and service. Respond to provider inquiries regarding member eligibility, Third Party Liability (TPL) and benefits Document all calls in accordance with departmental requirements Review claims in the core processing system and provide high level claim status to provider inquiries Provide member authorization statuses upon request Confirm which services require prior authorization upon request Educate providers on Provider Portal capabilities (i.e. reset passwords and duplicate EOP request) Reference and review the providers contract and provide basic information to contractual inquires Operate telephone systems effectively and efficiently, following established protocols for security, transfer and information exchange with the Utilization Management, Pharmacy and Claims Services departments.
High School Equivalency - TEMPLE UNIVERSITY (2005)
Diploma - Medical Office Management - THOMPSON INSTITUTE (2007-02 - 2008-04)
Health Care Studies - COMMUNITY COLLEGE (2023-10)
