ALEXIS MURRAY
Pittsburgh,Pennsylvania
Summary
Experienced healthcare professional with over 5 years of experience seeking to advance career in healthcare administration, medical billing, and coding. Background and education provide a strong foundation for success in these areas. Committed to going above and beyond to complete tasks, hardworking, well-educated, and eager to contribute skills. Known for strong time management abilities, reliability, and a highly accurate and efficient work style.
Overview
10
10
years of professional experience
Work History
Care Management Coordinator
Highmark Health
03.2024 - Current
- Proactively inform designated individuals of the status of work assignments to assure decision time-frames and notification requirements are met.
- Communicate effectively with Utilization Management Staff, providers, other internal and external customers and management.
- Route cases based on established guidelines.
- Provide accurate and timely routing of service request to the nurse reviewer to assure that the decision and notification notification time frames are in compliance with regulatory guidelines.
- Process service request meeting, established guidelines and document and routes request that are not permitted.
- Request additional information verbally, and in writing when the information provided is not adequate to make a medical necessity determination.
- Escalate appropriate cases to leadership that require a clinical review and or other intervention.
- Assist with reporting as directed.
- Participate in precepting of new employees as assigned.
- Maintain or exceeded department call center standards.
- Adhere to line of business phone standards to assure regulatory requirements are met.
- Utilize phone functions to monitor the number of calls and queue and wait time.
- Utilize daily phone standard reports to assess opportunities for self improvement.
- Meet or exceeded standards for other production and quality measures.
- Other duties as assigned or request requested.
Commercial Member Appeals Analyst
Highmark Corporate Headquarters
05.2016 - 03.2024
- Used Microsoft Word, Excel, Beacon, Insinq, and EPIC to accurately enter all patient and insurance information into the company's computer system
- Maintained a strong understanding of basic medical terminology to better understand services and procedures
- Reviewed numerous patient cases and double-checked insurance coverage information every week
- Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away
- Researched topics and completed due diligence to resolve issues in a timely manner
Patient Access Coordinator
UPMC Passavant - McCandless
04.2015 - 09.2015
- Helped visitors check in on time by greeting them and establishing the purpose of their visit
- Double-checked important patient data like name, date of birth, social security number, before entering it into the patient management system
- Continually improved my knowledge, skills, and performance based on feedback and self-identified professional development needs
- Consistently upheld and enhanced the company's positive image and reputation in the markets I served
- Checked documents for compliance with requirements and information accuracy
- Collected copayments and kept track of my finances on a daily basis
- Aided patients in completing check-in and payment forms
Education
Associate of Science - Medical Office Administration
Pittsburgh Technical College
Oakdale, PA01.2020
High School - undefined
Taylor Allderdice High School
Pittsburgh, PA01.2014
Skills
- Team management
- Time management
- Communications
- MS Office
- MS Office Suite
- Data entry
- Strong communication skills
- Superior attention to detail
- ICD-10, CPT (CPT-4), and HCPCS Knowledge
- Medical Terminology
- Appeals
- Insurance Verification
Timeline
Care Management Coordinator
Highmark Health
03.2024 - Current
Commercial Member Appeals Analyst
Highmark Corporate Headquarters
05.2016 - 03.2024
Patient Access Coordinator
UPMC Passavant - McCandless
04.2015 - 09.2015
Associate of Science - Medical Office Administration
Pittsburgh Technical College
High School - undefined
Taylor Allderdice High School
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