Alissa Radford
Sugarloaf,CA
Summary
Dependable Care Manager serving diverse needs of patients through active communication and responsive engagement with healthcare services and policymakers. Skilled at analyzing case files and databases to speed up inquiry response times and guide information through appropriate personnel channels. Maintains highest standards of ethics, professionalism and regulatory compliance to ease common stressors and de-escalate potential conflicts.
Overview
8
8
years of professional experience
Work History
Care Navigator
SCAN Healthcare
11.2023 - Current
- Facilitated care coordination needs of Medicare Advantage members, including creating and managing care plans tailored to unique member needs
- Detailed case management for members with access to care, delay in services, access to medications and complex situations. Claims inquiry, medication inquiry, grievances.
- Consistently maintained confidentiality while handling sensitive patient information in accordance with HIPAA guidelines.
- Reduced hospital readmissions for patients through proactive follow-up and continuous communication.
- Assisted members with social determinants of health and linked to appropriate community resources.
- Participated in interdisciplinary team meetings to discuss complex cases, contributing valuable insights into effective strategies for care navigation.
Member Engagement Specialist/Care Partner
CVS Health/Aetna
02.2022 - 09.2023
- Responsible for provision of work-life consultation and informational services to members and plan sponsors – Walmart, Amazon, & CVS Health; assessed needs, proposed care options, provided resource referrals, and coached individuals on how to use resources to handle various life and work situations
- Administered structured pre-screening based on triggers to assure urgent needs were directed appropriately.
- Enhanced member satisfaction by addressing concerns promptly and providing personalized solutions.
- Improved member retention rates through proactive communication and relationship-building strategies.
- Maintained accurate records of member interactions, using data to inform future engagement efforts.
Member Service Advocate
CVS Health/Aetna
10.2021 - 02.2022
- Made proactive outbound calls to Medicare Advantage members to answer unasked questions, diminish service disruption, and educate members on new plans and plan benefits
- Performed reviews of member claim history and billing
- Created trust and lasting relationships with our members using empathy and compassion.
Office Manager
California Car Company
06.2016 - 04.2020
- Oversaw the daily operations of the office and various departments
- Point person for mailing, supplies, equipment, and bills
- Managed customer accounts – digitally and written
- Handled all disputes and fraud
- Heavy phones, data entry, payroll, shipping and receiving.
- Provided exceptional customer service when addressing client inquiries or concerns via phone calls or email correspondence.
- Handled sensitive information with discretion, maintaining confidentiality of company documents and personnel records.
Education
Certification - Medical Coding And Billing
Penn Foster College
Scottsdale, AZ10.2024
Bachelor of Arts Degree - Industrial & Organizational Psychology
University of Phoenix – Online
01.2015
Associate Degree - Business Management
University of Phoenix – Online
01.2011
Skills
- Customer Service
- Call Center
- Account/Case Management
- Claims
- Billing
- Insurance Verification
- Active Listening
- Tech Savvy
- One Call Resolution
- Research
- Proactive
- Patient confidentiality
- Healthcare Systems Knowledge
Timeline
Care Navigator
SCAN Healthcare
11.2023 - Current
Member Engagement Specialist/Care Partner
CVS Health/Aetna
02.2022 - 09.2023
Member Service Advocate
CVS Health/Aetna
10.2021 - 02.2022
Office Manager
California Car Company
06.2016 - 04.2020
Certification - Medical Coding And Billing
Penn Foster College
Bachelor of Arts Degree - Industrial & Organizational Psychology
University of Phoenix – Online
Associate Degree - Business Management
University of Phoenix – Online
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