Referral Management Coordinator II, TRICARE East Region - HUMANA GOVERNMENT BUSINESS - WAH North Carolina
(2018-01)
Processes over 350 referrals a week from the Military Treatment Facilities (MTFs) and civilian providers. Performs varied activities and moderately complex administrative/operational/customer support assignments for beneficiaries in the TRICARE East Region.
- Answers questions or contacts MTFs and/or civilian providers to obtain additional information that may be required to complete provider referral request
- Understands TRICARE benefits/limitations and Humana Military referral processes, MOUs with MTFs, and referral and URAC standards
- Use Medical Management System, assigning an appropriate provider, reviewing benefits for benefits, and/or medical necessity as required to complete referral actions
- Research and resolved complex TRICARE provider issues which may involve certification or credentialing issues, that need to be resolved at higher level
- Works independently on assignments involving complex issues, which requires collaboration with internal and external associates or communicating with provider offices for assistance
Customer Service Support Specialist - XEROS/ACS – Blue Cross Blue Shield - Raleigh, NC
(2013-09 - 2016-01)
Customer Care Support contractor for Commercial Health Insurance Company
- Researched beneficiary/provider complaints, resolved billing issues, and investigated initial cause in order to minimize errors.
- Responded to all inquiries regarding billing issues, benefits, and claim inquiries; educated beneficiaries & providers on self-service tools available on company website/portal.
- Utilized dedicated information system (SharePoint) to track issues/resolution statuses
- Provided Educational Resources to beneficiaries shifting them to use online web portal for routine questions, and answers
- Adhered to beneficiary and company HIPPA, PHI, and PII policy and guidelines in place
- Escalated provider credentialing and/or certification issues to next level supervisor, ensuring warm transfer for provider resolution
Cashier - BOJANGLES
(2004-08 - 2013-09)
Provided Customer Service assignments, greeting customers, handling cash/credit transactions with honesty and integrity, work well with others, and a Team Player
Unit Supply Specialist – E-4 - United States Army - Germany
(2001-02 - 2004-08)
- Received and prepared excess and repairable used parts for reshipment, and general reporting and stock control functions
- Ensured administrative needs were met with daily inventory reports which were presented to senior staff non-commissioned officer in charge
- During 2003 received 100% accountability for third quarter supply inventory inspection valued at $2million in hostile environment
- Reviewed and verified quantities received against contracts, purchase requests, and shipping documents
- Created excel spreadsheets and reports for shortages, deliveries, and equipment request, adhering to US Army Policies and Procedures
Stay at Home Mother
(2016-01 - 2018-01)
Spend 2 years parenting and raising baby boy while using the time to volunteer and pursue other life goals and achievements
