Alicia Boyd
Laplace,LA
Summary
Experienced Medical Management Specialist II with proficiency in Medicaid systems and managed care. Demonstrated expertise in utilizing Epic for referrals, authorizations, and claims processing. Committed to collaborating with healthcare professionals to ensure high-quality, patient-centered care. Known for excellent communication and proactive problem-solving.
Overview
15
15
years of professional experience
Work History
Medical Management Specialist II
Elevance Health
Indianapolis, IN
05.2022 - 06.2024
- Determined members' case management program requirements by making outbound and inbound calls, assisting members with community resources, and managing referrals for case management and behavioral health.
- Verified Medicaid eligibility and sent unable-to-reach letters using systems such as HIP, Macess, Live chat , Epic, Facets, Amazon Connect, and CPUSI.
- Drive collaborative efforts within teams, and bolster the Anthem Indiana Medicaid Case Management Department's efficiency.
- Oversaw the strategic distribution of educational resources, enhancing patient knowledge and engagement.
- Coordinated insurance eligibility verification, prior authorizations, referrals, and claims processing.
- Provided guidance on utilization management processes to ensure quality care while controlling costs.
- Developed and implemented medical management policies and procedures.
- Schedule meetings via Zoom, in person, and Teams.
- Researched customer account information to respond to inquiries and resolve disputes.
- Generated detailed reports on billing and quality activity for management review.
- Contacted the state Health Department, physician offices, and/or parents and guardians for children who have been diagnosed with elevated lead levels. Follow up regarding lead rechecks until levels are low.
Medical Management Specialist II
Anthem Health Services
Indianapolis, IN
08.2015 - 05.2022
- Provided administrative support to the Central Medicare Team, utilizing systems such as AMUI/ACMP, Macess, and Facets.
- Triaged phones, voicemails, faxes, and email requests.
- Inputted data into Excel spreadsheets for tracking purposes.
- Assisted with generating and analyzing reports on benefit enrollments.
- Scheduled meetings, ordering equipment, and appointments for the department.
- Assisted the payroll team with leave of absences and benefits processes. Workday reports in the absence of the manager.
- Provided support to management in administering HR services and benefits.
- Responded to inquiries and provided guidance on benefits and policies.
- Assisted with annual benefit enrollment processes.
- Approved and processed maternity notifications, collected birth outcomes, and managed hospital admission and discharge notifications.
- Collaborated with hospitals and clinical teams to ensure compliance with data requirements, and managed census and bed-day variances.
- Handled authorizations for acute and post-acute admissions, processed referrals, and supported providers through Epic user services.
- Managed calls in inpatient/outpatient, DME, and case management queues, coordinating System of Care referrals for youth with behavioral challenges.
- Scheduled peer-to-peer (P2P) reviews for denied cases, and researched claim denials for approvals.
- Triaged care coordination notifications and referred cases for non-clinical assessments.
- Designed customized reports based on requirements from different departments within the organization.
- Conducted medical research.
- Managed management and providers' calendars to ensure meetings and all deadlines are met.
Clerical Assistant
Peoples Health Insurance
Metairie, LA
04.2009 - 08.2015
- Determined benefit eligibility and authorized inpatient admissions, outpatient precertifications, and hospital discharges.
- Arranged home health services and durable medical equipment (DME) for smooth care transitions across settings.
- Served as a liaison for the New Orleans team, assigning case referrals to social workers, and case managers.
- Generated reports using database software programs.
- Provided clerical and administrative support to clinical staff and managers for special projects and reports.
- Triage phones, emails, online requests, and fax requests to determine needs.
- Inputted data into spreadsheets for tracking purposes.
- Scheduled meetings and appointments for the department.
- Assisted in training for staff and new hires.
- Maintained accurate records of employee information, such as wages, performance reviews, benefits, and leaves of absence, as requested by the Regional Manager.
- Conducted medical research.
- Prepared summaries of daily work completed for review by supervisors.
- I worked in the EPIC system.
- Assisted the claims department in getting the appeals request initiated.
- Scanned physical documents into electronic format for storage in a secure database system.
- Corresponded daily with clients, insurance adjusters, and doctors.
- Managed management and providers' calendars, ensuring all deadlines are met accurately.
- Facilitated peer-to-peer requests between admitting, attending, and the payer physician.
- Reports problems, errors, and denials to management.
- Assist customers with billing problems and issue findings and resolutions.
Education
High School Diploma -
John McDonogh Sr High
New Orleans, LA05-2000
Associate of Science - Healthcare Administration
American InterContinental University
Schaumburg, ILSkills
- Utilization Management
- Customer Service
- Self-Directed
- Excellent Communication
- Medical Billing
- Insurance Verification
- HIPAA Compliance
- Medical Management
- Attention to Detail
- Epic Systems
- Multitasking
- Teamwork and collaboration
- Time management abilities
- Strong attention to detail
- Project management skills
- Problem-solving abilities
- Professionalism
- Reliability
- Adaptability
- Microsoft Excel
- Appointment scheduling
- Calendar management
- Research skills
- Data entry proficiency
- Good Telephone Etiquette
- Clerical support
Timeline
Medical Management Specialist II
Elevance Health
05.2022 - 06.2024
Medical Management Specialist II
Anthem Health Services
08.2015 - 05.2022
Clerical Assistant
Peoples Health Insurance
04.2009 - 08.2015
High School Diploma -
John McDonogh Sr High
Associate of Science - Healthcare Administration
American InterContinental University