Data Entry Medical Assistant
Resume:
*Adriana E. Mejia
El Paso, Texas 79930
adsvxm@r.postjobfree.com
Objective:
To provide the best customer service and record keeping and management skills this company, also to be able to demonstrate my capacity of workmanship to my employer as well as to my co- workers.
Experience:
09/26/2016-Presesnt: Amerigoup/Elevance Health
Medical Management Specialist
My current duties and responsibilities are as follow but not limited to:
Providing non-clinical support to the Medical Management and/or Operations area.
I also gather clinical information regarding case and determines appropriate area to refer and assign a case (utilization department, case management, QI. Med Review.
Provide information regarding network providers or general program information.
I also assist in come cases, maintain and update tracking database. This includes queueing and processing faxes into correct member files for requested services and updates.
Prepare reports and documents all actions to include preparing and processing approvals for Long Term Services and faxing those documents to appropriate servicing providers.
Outreach Care Specialist
My duties as a OCS at Amerigroup were as follow; assist member’s and providers in checking eligibility for members under Medicaid programs such as Star Plus, Star Kids, as well as answering inquiries as to which benefits are covered under specific member plans. I also do assists in communicating with Service Coordination when members are in need or requesting specific covered services, as well as assist in submitting requesting Long term Services for members. Other duties I am responsible for are assist providers following up on pre-certifications for services for health plan members. The systems I experience working with at Amerigroup in Case Management Department are MACES-major fax file database, FACETS which contains members data and Care Compass which is use to document to keep track of handled members accounts.
05/23/2016- 09/19/2016 TriWest
PSR: Person Service Representative: Veterans Choice Program
Assist veterans checking on authorization send in by VA for health services. Review consult (authorization) make sure medical documentation is in place. Once all medical documentation is in place I arrange appointment for veteran with community providers. It any documentation is not in place, or if consult is a duplicate, I return to the VA through a work portal that is affiliated with TriWest. I also would cancel and reschedule appointment for veterans and with providers. If so, at times will create authorization with ICD-10 codes in order for veterans to get the health service they needed.
03/01/2003-05/20/2016 Telerx: Merck Business Unit: Account Rep 2
Promotional Contact Center: DTC/Diabetes Program/Patient Assistance Program
I started with this company in the Merck Patient Assistance Program, which entailed assisting patient checking status of their medication assistance application status and refill orders. Contact health care providers in order to complete the applications by collecting data on applications submitted by patients and health care providers. Issue out proper forms for patient who need exceptions in order to qualify for the assistance program. Then I transition to becoming Program Administrator for Journey For Control Program. My role as administrator for this program my duties were assemble marketing materials and coordinate shipment to Merck Field sales representatives to meet service level turnaround time of 24 hours. Manage RSVP inbound and outbound calls in response to multiple education programs within multiple regions. I also would create administrative reports for client of diabetes programs. Schedule patients for diabetes class and assist doctors in scheduling patients and setting up classes. I also act as liaison between the patients and Merck field representatives as it relates to communicating program scheduling. I also managed sending of multiple bi-weekly emails to field sales representatives to inform them of RSVP counts for their respective programs. Meet service level metric of providing updated RSVP counts tow times a week up to one week prior to the program. I also did transition into the Promotional Contact Center Department which I assist consumers with information on certain Merck manufactured products, as well as take down report of consumers having Adverse Experience with Merck medications. I also assist health care providers in granting them access to various Merck websites as well as unlocking account is, resetting their passwords and helping them request samples from pharmaceutical company. Checking DEA numbers and NPI numbers making sure they match providers calling, as well as providing them directions on trainings for products offered by MERCK.
Education:
Certificate of Career Technology Medical Assistant January 2004
AAS Child Development Teaching May 2000
Certificate of Completion in Computer Information Systems-Data Entry Aug 1998
Yearly certification on HIPAA regulations.
Skills:
Have experience in patient triage and clerical skills
I Read, Write and Speak English and Spanish
I have 19 years of excellent customer service experience.
I have excellent computer skills and with programs such as Excel, Word XP. Cloud.
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