Care Senior Associate Resume Sample
Heloise Klocko
188 Noel Spur,
Boston,
MA
+1 (555) 220 7676
Work Experience
Care Senior Associate
04/2016
-
PRESENT
Detroit, MI
- Use your own initiative to find new solutions for unusual or problematic situations regarding the customer’s order to ensure the best experience with Dell
- Initiating tasks in order to make improvements to current workflows that parallel with CBH’s mission
- Maintaining a high level of working knowledge about CBH’s customers and products
- Accurately and timely assessment of provider’s contract to determine coverage and benefit availability
- Education based on the participant’s need as well as referrals to external resources including, but not limited to mental health practitioners in the community, client elected benefits, community supports
- Delineate complex service and benefit issues. Ability to judge severity of crisis based on scripted assessment questions and delegate to care manager’s staff when necessary
- Maintains regular and acceptable attendance at such level as is determined at the employer’s sole discretion
- Experience in a managed care environment
- Reviews requests for services that require pre-certification such as: treatment by non-participating providers, review for inpatient criteria, outpatient & diagnostic procedures, surgeries, DMEPOS equipment, outpatient therapy and rehabilitation programs
Customer Care Senior Associate
01/2013
-
03/2016
Detroit, MI
- Reaches out to requesting providers to obtain clinical information if missing & clarification requests of facilities, ICD-10s, CPT, HCPCS coding upon the request of clinical staff
- Maintain compliance with all Policy & Procedures delineated in Medicare
- Contacts physicians as appropriate to obtain information and asks questions when additional detail is necessary to certify medical necessity
- Reviews particular plan coverage to make sure patient is entitled to requested services
- Approve requests that fulfill EOC & Medicare guidelines. Notifies providers and patients (at times) of approval as appropriate
- Forwards potential denials to Medical Director & clinical team for further review
- Answers telephone requests from MD/Members and external providers about pending organization determinations
- Maintains open channels of communication with other company departments. Answers all inquiries in a professional and courteous manner
- Complies with Leon Medical Centers Health Plans’ policies and procedures and maintains confidentiality of member information in accordance with state and federal laws
Pre-certification Care Senior Associate
11/2005
-
08/2012
Philadelphia, PA
- Participates in training and in-service education as required
- Participates in department and clinic meetings as requested
- Create denial letters in accordance with Medicare guidelines and clinical staff instructions
- Manage surgical and referral authorizations lists daily
- Review all request for expedited process, provider information and facility. Separate outliers for specific review
- Creates and maintains the SharePoint database
- Creates and maintains the comprehensive program reports
- Maintains the enrollment and disenrollment logs
- Maintains documentation for the comprehensive programs
Education
The University of Alabama
2000 - 2004
Bachelor's Degree in Mental Health Field
Professional Skills
- Experience working in a contact center and strong customer service skills; Strong ability to build relationships and influence
- Intermediate skills in word processing, data entry of medical information/ terminology and telephone skills
- Demonstrate professionalism when working on the phone and in email. -Advance Written skills
- Two or more years of experience in an office setting, with customer service and computer skills
- Excellent customer services skills both via telephone and during face-to-face encounters
- Demonstrated computer skills and ability to navigate between different programs, utilize dual monitors and input data
- · Strong time management and organizational skills
How to write Care Senior Associate Resume
Care Senior Associate role is responsible for customer, research, medical, telephone, software, insurance, reporting, database, training, health.
To write great resume for care senior associate job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Care Senior Associate Resume
The section contact information is important in your care senior associate resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Care Senior Associate Resume
The section work experience is an essential part of your care senior associate resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous care senior associate responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular care senior associate position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Care Senior Associate resume experience can include:
- Good ownership and time management skills to manage projects and ensure success of projects
- Experience in a home health care setting with experience in scheduling required
- Prior experience working in request of payments via hospitals, billing etc would be advantageous
- · Ability to meet deadlines and manage effectively and ability to adapt and respond to fast paced, rapidly growing environments
- Effectively guide and coach peers
- Effectively handle escalated customer issues
Education on a Care Senior Associate Resume
Make sure to make education a priority on your care senior associate resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your care senior associate experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Care Senior Associate Resume
When listing skills on your care senior associate resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical care senior associate skills:
- Good problem solving skills and ability to deal with ambiguity
- Good language skills (English)
- Excellent telephone and communication skills -English Language
- Excellent organizational, written/oral communication skills and attention to detail
- Strong time management, organizational, research, analytical, and customer service skills
- Works well in a team approach and strong interpersonal skills
List of Typical Experience For a Care Senior Associate Resume
1
Experience For Customer Care Senior Associate Resume
- At least one year of experience in customer service role/operation
- Multi-task, process and handle multiple task at one time, set priorities and develop action items independently
- Handle multiple tasks, set priorities and develop action items. Detail oriented
- Medicare/Medicaid/Commercial Healthcare experience
- Responsible for incoming fax management or other portal entries
- Determine the course of action for each request based on existing workflows
2
Experience For Pre-certification Care Senior Associate Resume
- Support and assist with training of new personnel
- Identify the outstanding claims with payers through the reports from clients
- Review outstanding claims for collection efforts
- Tracks outcomes for the comprehensive programs
- Maintains documentation for regulatory review
- Creates referrals to other departments
- Uploads documentation/files into SharePoint
3
Experience For Floor Care Senior Associate Resume
- Reviews and edits written material
- Responsible for data collection and / or data entry into computer system
- Responsible for collaborating with healthcare providers and members to optimize member benefits and to promote effective use of resources; obtain additional information needed to completed cases
- Willingness to learn new information and take on additional assignments as requested
- Provide non-clinical support to department Managers, Supervisors and field base behavioral health case management team
- Accurately create and document assessments, notes and reviews in the case management system
- Provide accurate information, education and assistance to behavioral health vendors, providers and members that call in to the queue helpline as it relates to plan benefits and Cigna-HealthSpring policies and procedures
- Facilitate the request for prior authorization of inpatient and outpatient services, ensuring timely and accurate responses in compliance with state and federal guidelines
- Assist field base case management team with member and provider calls, assessing the needs and providing timely follow up
4
Experience For Care Senior Associate Resume
- Maintain documentation for regulatory review
- Access the various Cigna systems to obtain requested information such as eligibility, benefits, demographic information, discharge and clinical information, available customer programs, Case Management status and CAC alignment
- Provide accurate information to the ECCs based on an understanding of customer and service requirements
- Review eligibility, liability, and coverage information on cases and on regularly scheduled follow-up; provide communication of benefit plans for cases on an as-needed basis
- Review request for guarantee of payments (international form of pre-authorization)
- Research and analyze insurance and claim issues as needed
5
Experience For Customer Care Senior Associate Resume
- Review and direct claim payment for cases that have a treatment plan in place that are being managed by a utilization nurse, provide benefit information for utilization management benefit reviews
- Attains established production standards and operational objectives
- Attains established quality assurance standards
- Participate on special projects/customer demonstrations
- Answers inquires, gathers information, resolves routine matters, and responds to minor complaints or problems
6
Experience For Pre-certification Care Senior Associate Resume
- Provide initial customer contact for incoming calls to the health services queue line, providing accurate information to callers based on an understanding of customer’s request
- Performs outbound post discharge calls to members
- Monitors daily productivity to ensure all work is completed timely and accurately
- Adheres to call center procedures and ensures adequate coverage of phone queue
- Maintain confidentiality and adheres to all HIPAA and PHI regulations
7
Experience For Floor Care Senior Associate Resume
- Completes all assigned and required trainings
- Adheres to all Policies and Procedures to ensure compliance
- Processes all organization determination authorization requests within required time frames and ensures compliant documentation of each request
- Processes all assigned calls within required time frames and ensures compliant documentation of each call processed
- Attends staff meetings and one on one meetings with leadership as scheduled
- Product/process resource for Associates
8
Experience For Care Senior Associate Resume
- Flexible work staff for increased volumes
- Identifies opportunities for business improvement
- Assists draft review as needed
- Cross train team to increase efficiency
- Collaborate across groups
- Proficient knowledge of departmental policies and procedures; knowledge of Medicaid, CFC, MMP, HIPAA
- Perform outbound calls to Member to schedule face to face assessment with services coordinator
9
Experience For Customer Care Senior Associate Resume
- Distribute schedules within deadlines and work with field staff and members as reschedules are requested in a timely manner
- Follow up with case managers to ensure appointments are kept
- Promptly reschedule and ensure member’s visits are done in the event the scheduled case manager is unable to make their appointment
- Make sure all schedule changes are made and all staff (office and field) are notified of staff changes
- Run daily, weekly and as needed reports and follow up with field staff to make sure all visits are addressed, accepted, scheduled and verified
- Run reports weekly for supervisors and contact all field staff who service patients
- Respond professionally to employer and patient needs
10
Experience For Pre-certification Care Senior Associate Resume
- Communicate to field staff and the manager all hospitalizations, on-holds, and if the patient is not available
- Report to the manager any variations or foreseeable variations outside the established time lines
- Work on own initiative within clearly defined parameters
- Maintain the trust of the staff and address issues in confidence with
- ASK RECRUITER ABOUT HIRING INCENTIVES!
List of Typical Skills For a Care Senior Associate Resume
1
Skills For Customer Care Senior Associate Resume
- Good time management, organization, written, and oral communication skills
- · Prior experience in customer service role/operation
- Communicate effectively with health care staff: nurses, physicians, and other health workers
- Working/internship experience in consulting or the related field is encouraged
- Excellent with MS Office products including Excel, Word, and working within Windows environment-transferring and saving files and creating folders
- Hospital or clinic experience, & training in medical terminology is mandatory
- Good knowledge of Microsoft Office tools including Excel
- Strong knowledge of Microsoft Office products including Excel, PowerPoint, Word, and Access, and SharePoint
- 2+years’ working experience in a managed care environment
2
Skills For Pre-certification Care Senior Associate Resume
- Effective communication with our client's customers by phone and in writing
- Intermediate hands on experience with Microsoft Office including SharePoint, Outlook, PowerPoint, Excel and Word
- Experience in a managed care environment
- Work experience; position is suitable for fresh graduates
- Two years’ experience in utilization management, behavioral health direct care or behavioral health case management
3
Skills For Floor Care Senior Associate Resume
- At least two years experience in health services, customer service, claims, or managed care environment
- At least three years’ experience in health services, call center and/or managed care environment
- · 1+ years’ experience in a managed care environment
- Experience in health services, call center and/or managed care environment
- Experience in a managed care environment
- Effective communication with internal colleagues
- De-escalation knowledge and effectiveness
4
Skills For Care Senior Associate Resume
- Servicing and supporting Spanish, English or French speaking customers in emerging markets
- Working knowledge of Microsoft Office including SharePoint, Outlook, PowerPoint, Excel and Word
- Meeting or exceeding all expectations in monthly evaluations
- Calling US based insurances to get the status of the claims
- Getting the status through websites
5
Skills For Customer Care Senior Associate Resume
- Ensuring accurate and timely completion of transactions to meet or exceed client SLAs
- Managing day to day workload and call volume efficiently
- Navigating several different systems simultaneously; eg Enrollment
- Meeting with your manager to discuss trends on the team
- Supports in coming pre-service fax boxes by labeling, shelling the authorization and attaching clinical documentation into CCMS documentation program
- Back up for answering phones including screening and directing call to appropriate staff
- Identify issues attributing to account delinquency, aging and escalate it for resolution
- Creative, self-disciplined and capable of identifying and completing critical tasks
- Use computer application including databases (Access), spreadsheets (Excel) and Word processing
6
Skills For Pre-certification Care Senior Associate Resume
- Attends assigned Complete Health Team meeting acting as scribe for required documentation components as specified
- Provide feedback to manager for coaching Associates, when appropriate provides coaching themselves
- Carry out designated tasks including reporting outcome of actions taken
- Processes denials including correspondence sent to families, customers, facilities, and applicable contracted providers
- Bi lingual Spanish speaking requirement
- 6+ weeks of paid training onsite
7
Skills For Floor Care Senior Associate Resume
- Position includes up to 9 weeks of paid training
- · Intermediate knowledge of Microsoft office including Outlook, PowerPoint, Excel, and Word
- Provide training to new members
- Participates in education of member / providers regarding plan benefits
- Updates Job Aids ensuring compliance
- Supports and assists with training for employees
8
Skills For Care Senior Associate Resume
- Shifts covering 1st and 2nd Shift available
- Responsible for authorization data collection and/or data entry into computer system from incoming calls or faxes
- Work evening, weekend and holiday shifts to support the Expedited Organization Determinations
- Track record of delivering exceptional customer service
- Handles certain complex cases, including escalated issues
- Liaison with Specialists for accurate routing
- Schedule all evaluations within 24-48 hours of event working with the case manager when the member cannot be reached
- Communicate all scheduling issues to the Manager
9
Skills For Customer Care Senior Associate Resume
- Send case manager and department managers the clinical staff productivity for preceding week
- Compassionate and caring attitude and the ability to deal with people from a wide range of backgrounds, ages and temperament
- Use discretion concerning sensitive information and adhere to HIPAA
- Work flexible schedules, including weekends, and overtime as needed
- Compliance with HIPAA regulations and Cigna Healthsping guidelines
10
Skills For Pre-certification Care Senior Associate Resume
- Assist Health Service clinical staff processing paperwork and documentation
- Collect and enter benefit information: Issue Guarantee of Benefits to Healthcare Providers
- Interact with multiple members of the healthcare team
- Use of multiple systems and applications
- Handle multiple products and benefit plans
List of Typical Responsibilities For a Care Senior Associate Resume
1
Responsibilities For Customer Care Senior Associate Resume
- Proficient knowledge of departmental policies and procedures; knowledge of Medicare, and HIPPA Professional demeanor and the ability to work effectively within a team or independently
- Receive request for authorization from hospitals, providers, members and vendors; Meet service level goals (e.g., PPAL adherence, Grade of Service, Average Handle Time, Average Speed to Answer, abandonment rate)
- Proficient knowledge of departmental policies and procedures; knowledge of Medicare, HIPAA and NCQA
- English AND German OR Greek OR Portuguese OR Swedish OR language
- English AND Italian OR French OR Turkish OR Swedish OR Russian language
2
Responsibilities For Floor Care Senior Associate Resume
- Work a dual model computer screen
- Able to work an 8-hour workday and schedules are determined based on Cigna’s hours of operations
- Knowledge of Health Benefit policies would be advantageous
- Clearly communicate information
- Knowledge of managed care and/or medical management and medical terminology
- In a managed care environment
- Working experience in a managed care or health services related environment with a focus on process management and communication with customers/members/patients
- Identify problem areas and address them appropriately
- Analyze data to identify significant trends and opportunities for improvement
3
Responsibilities For Care Senior Associate Resume
- Perform outbound calls to facilities to obtain additional information needed to respond to the ECC’s inquiries
- Knowlege of healh care systems and applicaitons
- Understand the needs of the clients and respond to any queries immediately
- Create Appeals and send to insurances
- Identify trends in denials and rejections and fix them
- Create reports for Customers
- Create work flow based on the requirements
4
Responsibilities For Customer Care Senior Associate Resume
- Audit the samples and share feedback
- Fluency in French or/and English
- ASK YOUR RECRUITER ABOUT HIRING INCENTIVES!
- Assisting with design, implementation, execution, control and completion of key strategic projects, ensuring consistency with company’s strategy, brand and business aim
- Co-facilitate the planning, implementations and monitoring of projects; including resource allocation, stakeholder syndication, managing project timelines, advise and assist the team with the projects they are responsible for
- Successfully receive and execute tasks assigned by Project Managers and deliver with tangible results
5
Responsibilities For Pre-certification Care Senior Associate Resume
- Regularly monitor, review and report on the progress of projects
- Ensure timely completion of projects with successful implementations considering all stakeholders with early identification and mitigation of potential risks and issues
- Closely collaborate and share knowledge within the team and peers
- Work under direction of supervisor/manager
- Triage queries that require clinical review with appropriate follow up
6
Responsibilities For Floor Care Senior Associate Resume
- Receive request for authorizations from hospitals, providers, customers, and vendors; meet service level goals
- Determine authorization requests and make determinations on correct authorization process (i.e., auto approve, refer to appropriate care team member, or Medical Director)
- Maintain benchmark standards for TAT (turn-around time) as established by the organization
- Provide determinations on authorization requests to customers and/or providers based on benchmark standards for authorization decisions. Process extensions of authorizations as appropriate
- Notifies responsible parties prior to initiation of denial letter and ensures that customer and responsible party understand details of the letter and the appeals process to follow
7
Responsibilities For Care Senior Associate Resume
- Completes review of non - authorized medical claims
- Proficient knowledge of departmental processes and procedures; knowledge of Medicare, HIPPA, and NCQA
- Possible holidays required
- 2-3 holidays required
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