APRIL ORIADE

Provide accurate case documentation in medical records, complete CC referrals, maintain adherence to regulatory timeliness standards for inbound faxes and accurate data entry. Oversee and complete Single Case Agreement log including all updates from UMR. Complete monthly reports per state. Complete special projects as needed. Achieved average Audit score of 100%.

Targeted specific community groups with wellness and disease management information. Helped vulnerable individuals navigate complex healthcare system. Managed enrollment, transportation and paperwork for individuals to take advantage of community resources. Planned, assigned and directed work, as well as evaluated employee performance.

Researched issues and took appropriate action to resolve issues within turnaround time requirements and quality standards. Documented activities and progress in electronic medical record per defined policy and procedures. Assisted in completing and maintaining care management contracts during and after patient's hospitalization. Prepared documents and reports for clinical reviews and discharge plans. Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls. Received, recorded and addressed incoming and outgoing communication via telephone and email. Contact center environment, effectively processing calls from Member, Providers and other areas.

Answered provider inquiries via email, telephone and written correspondence. Contributed to and enhanced audit processes to maximize quality management standards. Researched and resolved disputes, billing discrepancies and claims efficiently to maintain customer satisfaction, boosting satisfaction ratings 97.5%. Interacted with all levels of management to analyze provider claims, directory, file issues. Received high volume call from providers to pre-certify medical services, verify client eligibility and determine authorization requirements for procedures.