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Clinical Enrollment Specialist Resume

3.00/5 (Submit Your Rating)

Tempe, AZ

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SUMMARY

  • Seeking to obtain a position with an organization where I can utilize my experience, education, and interpersonal skills which offers advancement opportunities.

TECHNICAL SKILLS

  • HIPAA Knowledgeable
  • Microsoft Office
  • 10 - Key Proficient
  • Cerner/TrueCare
  • AllScripts
  • Medicare Proficient
  • High Retention Memory
  • CMR/EMR Systems
  • Right Fax
  • CPT & ICD-9
  • TransForum
  • Medical Managed Care

PROFESSIONAL EXPERIENCE

Clinical Enrollment Specialist

Confidential, Tempe, AZ

Responsibilities:

  • Enroll Employer & Health plan members in Health Coaching program
  • Conduct Initial Health Assessment
  • Schedule Health Coach appointments
  • Explain Incentives to Members

Referral Specialist/Temp

Confidential, Tempe, AZ

Responsibilities:

  • Process Individual Provider Request using Cerner/TrueCare EMR System
  • Create request “shells” & forward to Nurse(s) for review on Medicare Managed Members
  • Prior Authorization
  • State and Medicare Managed Care
  • Data Entry
  • Processed Fax Received
  • Answered Claims Inquiries

Eligibility & Qualification

Confidential

Responsibilities:

  • Verify patient insurance eligibility
  • Process orders in accordance with Confidential
  • Processed hospital discharge orders & 911/stat orders via Allscripts EMR System
  • Member Registration
  • Answered Billing Inquiries
  • Processed Fax Received

Manager of Operations

Confidential

Responsibilities:

  • Manage and coordinate the tasks/duties of a team comprised of 20
  • Financial reporting and managing multiple budgets
  • Assist with other administration duties as assigned by company owner
  • Director of customer & client relations

Prior Authorization Specialist

Confidential, Phoenix, AZ

Responsibilities:

  • Assisted members and providers with questions regarding prior authorization requirements
  • Entered relevant data for the review and processing of authorization requests
  • Provided excellent customer service while reaching to all quality and productivity goals

Customer Service Rep-Ops. Specialist/Admin. Coordinator

Confidential, Phoenix, AZ

Responsibilities:

  • Financial reporting and managing of daily processed orders
  • Coordinated assignments with appropriate vendors and agents to meet strict deadlines
  • Provided excellent customer service while reaching to all quality and productivity goals

Tutor/ Teacher Assistant

Confidential, Phoenix, AZ

Responsibilities:

  • Assisted with the administration and preparation of ACE and AIMS testing
  • Mentored and assisted students with classwork as assigned by their teachers

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