Alexandria Moran
Zanesville,OH
Summary
Empathetic Care Worker with sensitive and compassionate approach to cultivating trusting, stimulating and varied lifestyle for members. Offers enhanced care with flexible learning approach for members. Experience in providing guidance and encouragement to patients through emotional support.
Overview
6
6
years of professional experience
Work History
Care Associate Autism Care Team
Aetna
04.2023 - Current
- Process and record receipt of clinical requests
- Facilitate follow up calls for additional information from providers
- Secured necessary results for Clinical staff for provider and community resource searches
- Monitor fax/email boxes and tasking buckets
- Create and Assign cases to clinicians based on state licensure
- Collaborate with staff on administrative process
- Labeled and processed over 25 faxes/cases daily exceeding productivity
- Able to identify autism diagnosis and procedure codes
- Created and approved assessment authorizations submitted by ABA providers
Care Management Associate
Aetna
01.2021 - 04.2023
- Provided members with benefit information and appointment scheduling
- Precept new staff on member engagement, managing cases and identifying health concerns/conditions
- Provided member educational resource information
- Obtained service authorization and approvals
- Located specialists, reviewing medication interactions/changes and eligible incentives
- Built member profiles including diagnosis and CPT codes
- Assigned member to appropriate Case Manager based on location and personal needs
- Developed strong relationships with patients and families to provide compassionate care that meets their unique needs.
- Managed outlook calendars and created PowerPoint presentations.
Precertification Specialist
Aetna
06.2019 - 12.2020
- Educated members on eligibility and affordability options
- Communicated with members from various cultures and backgrounds on application process
- Developed extensive fact-checking and research skills
- Created prior-authorizations for inpatient/outpatient stays, medications/injections
- Appeal filing for denied cases
- Preformed outbound calls to customers providing Case Management engagement.
- Ensured smooth communication between healthcare providers, patients, and insurance companies, resulting in timely approvals and positive experiences.
Health Concierge
Aetna
05.2018 - 06.2019
- Assisted in navigating enrollment process and appropriate Insurance plans
- Provided information on copay and premium details, plan deductibles/allowances, prior-approval for procedures, medications, and hospital stays
- Handled more than 120 daily inbound calls from health plan customers
- Recommended service improvements to minimize recurring patient issues and complaints
- Developed and implemented performance improvement strategies and plans to promote continuous improvement
- Resolved problems related to benefits and eligibility.
- Streamlined appointment scheduling for improved patient experience and reduced wait times.
Education
High School Diploma -
Dublin Coffman High School
Dublin, OH05.2016
Skills
- Flexible and Adaptable
- Training and Development
- Teamwork and Collaboration
- Decision Making
- Cultural Awareness
- Analytical and Critical Thinking
- Self-Motivation and Initiative
Accomplishments
- Recognized for consistently exceeding team metrics as a Care Management Associate.
- Initiated over 300 outbound calls monthly while obtaining appointments.
- Connected members with dedicated Case Managers through the Aetna One Advocacy program.
- Built meaningful connections with members, ensuring they received appropriate assistance.
Top Performer of the Year Award
December 2022 | Christopher Shadle
Timeline
Care Associate Autism Care Team
Aetna
04.2023 - Current
Care Management Associate
Aetna
01.2021 - 04.2023
Precertification Specialist
Aetna
06.2019 - 12.2020
Health Concierge
Aetna
05.2018 - 06.2019
High School Diploma -
Dublin Coffman High School