Sunshine Health - Program Coordinator I Resume Example

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Penelope Perry
XXXX XXXXX XXXX XXX XXXXXXX XXXX, Pembroke Pines, FL 33025
Ph: XXXXXXXXXXXXX
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Professional Summary
Demonstrate sense of urgency in a busy call center environments in both retail and telecommunication industries. Possess exceptional ability to build productive relationships, resolve complex issues, and win customer loyalty. Excellent interpersonal skills, ability to work well with others, in both supervisory or support staff roles.
Skills
  • Knowledge of Medicaid statutes and making regulations 
  • Promotes positive behavior
  • Highly Motivated
  • Accomplished leader 
  • Supervisory training
  • Independent judgment and decision 
Experience
Program Coordinator I Jun 2014Present Sunshine Health Sunrise, Fl
  • Initiate authorization requests for output or input services in keeping with the prior authorization list.  
  • Research claims inquiry specific to the department and responsibility. 
  • Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results.  
  • Screen for eligibility and benefits.  Identify members without a PCP and refer to Member Services. Screen members by priority for case management (CM) assessment.  
  • Perform transition of care duties to include but not limited to, contact the member's attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.
  • Data enter assessments and authorizations into the system.
  • Assist with special projects as needed.
Medicaid/Medicare Service Representative Oct 2010Jun 2014 Molina Healthcare of Florida Doral, Fl
  • Meeting all department standards by 95% or higher.Explain plan's procedures, protocols, benefits, services and information to members and providers as required.
  • Ensure that all assigned provider issues are resolved and communicated to the provider within appropriate timeframes and report resolutions that are unfavorable to the appropriate Provider Relations Representative.
  • Assist providers with escalated inquiries including but not limited to; verifying proper medical coding, claim status, explanation of benefits, negative balance requests, claim payments and denials, appeal procedures and appeal status.
  • Document all inquires and complaints completely and thoroughly, Adhere to all HIPAA, State and Federal requirements, and regulations at all times in existing and future lines of business.
Sales Associate (Lead Representative) Feb 2009Mar 2011 At&t Miami, Fl
  • Exceeded monthly sales quotas 100% of the time. 
  • Trained and supported team members to assist with closing sales. 
  • Able to successfully up sale customer's on additional AT&T products.Answered nearly 100 inbound calls daily to assist customers with various products, services and billing inquires. 
  • Consulted with customers to recommend and sell a variety of AT&T products and services to meet the customers' needs.
  • Provided AT&T customers with a positive sales and service experience. 
  • Interacted with multiple online systems while speaking with customers. 
  • Assisted customer with billing inquires as well as assisted customers in making payments to their AT&T account.
Provider Service Advocate V (Lead Representative) Feb 2007Dec 2009 Blue Cross and Blue Shield of Florida Doral , Fl
  • Resolved issues on escalated calls from providers in regards to claim issues.
  • Supported team members in claim inquiries both telephone and written.
  • Exceeded claims processing daily quotas 100% of the time.
  • Answered nearly 60 inbound calls daily to assist providers with claims, benefits, and contracting inquires.
  • Always meeting expectations in quality, adherence and production scores while gaining a deep understanding and foundation on health insurance functions on many levels.
  • Assisted providers with written and phone inquires regarding claims, benefits, contracts, and fees schedules.
  • Provided resolutions to providers via letter and documenting all issues.
  • Built working relationships with healthcare providers in order to insure excellent customer.
Education
High School Diploma : Vocational Studies Jun 1996 Miami Norland Senior High School Miami Gardens, Fl

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About this resume

Program Coordinator I FROM Pembroke Pines , Florida RESUME

This is a resume for a Program Coordinator I in Pembroke Pines, Florida with experience working for such companies as Sunshine Health and Molina Healthcare of Florida. The grade for this resume is 0 and is one of hundreds of Program Coordinator I resumes available on our site for free. Use these resumes as templates to get help creating the best Program Coordinator I resume.

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School Attended
Miami Norland Senior High School