Ashley Keeton

Case Management.

Maintain and process case information.

Review court documents for conformity with local rules.

Ensure that all necessary court documents and orders are entered.

Prioritize work assignments to meet statutory deadlines.

Schedule hearings, prepare notices of hearings, and maintain court calendars.

Assist the public by providing information regarding court procedures; answer inquiries, and explain legal filing processes; explain fees, and assist individuals in locating material and information.

Assess appropriate amounts due, and process payments and receipts.

Read, interpret, and process a wide variety of complex legal documents, such as court orders, judgments, petitions, calendars, proofs of service, motions, temporary restraining orders, and other legal papers.

Perform difficult and complex duties assigned to the work unit, including receiving, examining, and filing a variety of court documents.

Review work for accuracy and completeness, and assure that deadlines were met.

Answer telephones, directed calls, and took messages.

Communicated with customers, employees and vendors to answer questions and address complaints.

Coordinated review by internal teams of submitted appeals or grievances.

Collaborated with other departments within the organization to identify potential solutions for resolving customer disputes.

Provided guidance and support for staff members on how to respond appropriately during difficult customer interactions.

Interpreted external regulations governing the handling of appeals and grievances.

Assessed customer complaints to determine eligibility for appeal or grievance filing.

Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.

Collaborated closely with team members to achieve project objectives and meet deadlines.

Managed time effectively to ensure tasks were completed on schedule and deadlines were met.

Identified needs of customers promptly and efficiently.

Completed day-to-day duties accurately and efficiently.

Updated and maintained databases with current information.

Conducted comprehensive research and data analysis to support strategic planning and informed decision-making.

Manage large amounts of incoming phone calls.

Assist with grievance and appeals concerns.

­­­­Provide prompt, accurate and courteous responses to written and telephonic inquiries. These inquiries encompass numerous contacts and originate from subscribers, members, physician offices, and health plans, and typically involve a variety of issues, including benefits, pricing, claim rejections, authorizations, and claim status.

Research and accurately resolve problematic claim situations.

De-escalate situations involving dissatisfied customers, offering patient assistance, and support.

Provide full customer service, where I could accept inbound calls or outbound calls to follow up on concerns.

Maintain customer accounts and information.

Respond to customer inquiries with compassion, active listening, and support the best solution in an efficient manner.

Model professional work standards and behaviors to maintain and strengthen a professional working atmosphere, and the strictest confidentiality within the department, as well as with other internal and external customers and work partners.

Perform other than normally assigned duties, as directed and required, within and outside of the department to support the overall business needs, goals, and objectives.

Adheres to all HIPAA and confidentiality requirements.

Working knowledge of Medi-Cal and Medicare.

Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.

Maintained accurate records of services provided during each call or procedure.

Addressed patient inquiries and concerns, resolving issues in a timely and empathetic manner.

Coordinated review by internal teams of submitted appeals or grievances.

Collaborated with other departments within the organization to identify potential solutions for resolving customer disputes.

Provided guidance and support for staff members on how to respond appropriately during difficult customer interactions.

Collaborated with other departments within the organization to identify potential solutions for resolving customer disputes.

Assessed customer complaints to determine eligibility for appeal or grievance filing.

Compiled data on an ongoing basis concerning trends in appeals or grievances filed.

Monitored progress made towards resolving appealed or grieved matters.

Review cases to determine if they need further review by a clinician.

Use sound, fact-based decision-making skills to render a decision for non-clinical complaints.

Use appropriate templates to complete the necessary documentation for final appeals or grievance determinations.

Relay appeal or grievance information to members, providers, and internal/external parties within the appropriate timeframe.

Maintain grievance and appeals case files in the database. Effectively communicate with members and providers, verbally and in writing.

Prepare summaries and write resolution letters for members, which include summarizing member complaints and the steps taken to resolve complaints.

Attend and present cases at the bi-weekly Staff Grievance and Appeals Committee.

Prepared files for appeals to regulatory agencies.

Working knowledge of Medi-Cal and Medicaid.