Alexis Evans
Wesley Chapel,FL
Summary
Analytical specialist in application processing and eligibility determination with expertise in policy interpretation and case collaboration. Ensures compliance with program regulations while effectively resolving inquiries and enhancing customer experiences. Knowledgeable in health services and documentation review, delivering solutions that drive positive outcomes.
Overview
9
9
years of professional experience
Work History
Eligibility Specialist
Centene
Tampa, Florida
09.2023 - Current
- Reviewed and processed eligibility applications for health services efficiently.
- Clarified documentation and requirements through effective communication with applicants.
- Collaborated with case managers to address and resolve eligibility-related inquiries.
- Maintained comprehensive knowledge of program regulations, policies, and procedures.
Claims Representative
Centene
Tampa, Florida
10.2018 - 09.2023
- Reviewed claim submissions for accuracy and compliance with company policies.
- Communicated with healthcare providers to clarify details and resolve issues.
- Educated members on claims processes and benefits coverage through direct interaction.
- Filed appeals for customers after claim denials due to insufficient evidence.
Appointment Scheduler
Health Net
Tampa, Florida
11.2017 - 10.2018
- Scheduled patient appointments utilizing electronic health record systems.
- Conducted follow-up calls to confirm scheduled appointments, enhancing patient attendance.
- Resolved scheduling conflicts by adjusting appointments and promptly notifying affected patients.
- Assisted front desk staff with patient check-in and insurance verification to streamline workflow.
- Collaborated with team members to achieve departmental objectives.
Education
High School Diploma -
Freedom High School
Tampa, FL06-2015
Some College (No Degree) - Computer and Information Sciences
Hillsborough Community College
Tampa, FLSkills
- Eligibility determination
- Application processing
- Policy interpretation
- Documentation review
- Case collaboration
- Customer service
- Attention to detail
- Problem solving
- Time management
- Team collaboration
- Effective communication
Timeline
Eligibility Specialist
Centene
09.2023 - Current
Claims Representative
Centene
10.2018 - 09.2023
Appointment Scheduler
Health Net
11.2017 - 10.2018
High School Diploma -
Freedom High School
Some College (No Degree) - Computer and Information Sciences
Hillsborough Community College