Caren Gulledge
Summary
Detail-oriented and results-driven professional with a strong background in medical services coordination, seeking a challenging position to contribute skills in intake, screening, and utilization of Medical Services Programs.
Dedicated with a proven track record in telephonic outreach, member enrollment, and fostering positive connections with health plan members. Bringing a dynamic blend of sales expertise, healthcare navigation skills, and exceptional customer support to drive engagement and ensure seamless enrollment processes.
Overview
4
4
years of professional experience
Work History
Medical Service Coordinator
Humana
04.2022 - 12.2023
- Supported comprehensive coordination of medical services for Medical Services Programs.
- Facilitated insurance authorizations for medical procedures, reducing delays in treatment and minimizing patient frustration.
- Promoted and supported the quality and effectiveness of Healthcare Services.
- Conducted intake of calls from members or providers regarding services via telephone, fax, and EDI.
- Utilized MedCompass/ATV and other systems to build, research, and enter member information.
- Screened requests for appropriate referral to medical services staff.
- Approved services that did not require a medical review in accordance with the benefit plan.
- Performed non-medical research, including eligibility verification, COB, and benefits verification.
- Maintained accurate and complete documentation of required information meeting risk management, regulatory, and accreditation requirements.
- Promoted communication internally and externally to enhance the effectiveness of medical management services.
- Ensured confidentiality of member information and adhered to company policies regarding confidentiality.
- Communicated with Case Managers when processing transactions for members active in the Program.
- Supported the administration of the precertification process in compliance with various laws and regulations, URAQ, and/or NCQA standards.
- Conducted sedentary work involving significant periods of sitting, talking, hearing, and keying.
- Demonstrated visual acuity to perform close inspection of written and computer-generated documents as well as a PC monitor.
- Worked in a typical office environment.
Engagement Specialist
Carenet Health
03.2021 - 04.2022
- Conduct telephonic outreach to eligible members to educate and enroll them in health plans.
- Demonstrate a highly energetic and empathetic approach, serving as a knowledgeable salesperson, healthcare navigator, and customer support representative.
- Utilize effective communication skills to convey complex healthcare information in an understandable manner, ensuring members are informed and engaged in the enrollment process.
- Facilitate case assignments and ensure timely and accurate documentation of member information.
- Connect identified members to care managers immediately through warm transfers, fostering a smooth transition into ongoing care relationships.
- Collaborate with cross-functional teams to address member needs, resolve issues, and optimize the overall member experience.
- Meet and exceed enrollment targets through proactive outreach and relationship-building.
- Provided exceptional customer support for health plan members, addressing inquiries, resolving issues, and ensuring a positive customer experience.
- Demonstrated expertise in navigating healthcare systems and plans, assisting members in understanding their benefits and coverage.
- Collaborated with internal departments to streamline processes and enhance the efficiency of customer support operations.
- Contributed to the development of training materials for new customer support representatives, ensuring a consistent and knowledgeable team.
Customer Support Representative
United Healthcare Group
02.2020 - 02.2021
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Streamlined support processes for increased efficiency and reduced response times.
- Collaborated with team members to identify areas of improvement in customer service protocols.
- Boosted customer retention rates by building strong rapport and delivering exceptional service.
- Resolved technical issues for customers with clear explanations and step-by-step guidance.
- Maintained comprehensive knowledge of products and services, ensuring accurate information was provided to customers.
- Exceeded performance metrics by consistently providing high-quality support to clients.
- Managed escalated calls with professionalism, ultimately resolving complex issues to the satisfaction of both the client and company.
- Balanced multiple priorities while maintaining a focus on excellent communication skills and attention to detail.
Medical Aide
BroadPath Healthcare
07.2019 - 01.2020
- Improved patient comfort by providing compassionate care and addressing individual needs.
- Assisted medical staff with diagnostic procedures for accurate results and timely treatment.
- Enhanced patient satisfaction by maintaining a clean, organized, and safe environment for all patients.
- Contributed to efficient workflow by promptly completing assigned tasks and assisting in daily operations.
- Facilitated communication between patients and medical professionals, ensuring clear understanding of treatment plans.
- Promoted patient safety through adherence to infection control protocols and proper use of equipment.
- Supported healthcare team in managing appointments, coordinating schedules, and processing paperwork for optimal organization and time management.
Education
Bachelor of Arts - Accounting And Business Management
Ultimate Medical Academy - Clearwater
Clearwater, FL06.2023
High School Diploma -
A. Philip Randolph Academies
Philadelphia, PA06.2019
Skills
- Intake and Screening
- Utilization of Different Systems (MedCompass/ATV)
- Provider Relations
- Patient Scheduling
- Collections
- Documentation
- Benefits Verification
- Documentation and Record-Keeping
- Communication (Internal and External)
- Confidentiality Adherence
- Precertification Process Administration
- Compliance with Laws and Regulations
Timeline
Medical Service Coordinator
Humana
04.2022 - 12.2023
Engagement Specialist
Carenet Health
03.2021 - 04.2022
Customer Support Representative
United Healthcare Group
02.2020 - 02.2021
Medical Aide
BroadPath Healthcare
07.2019 - 01.2020
Bachelor of Arts - Accounting And Business Management
Ultimate Medical Academy - Clearwater
High School Diploma -
A. Philip Randolph Academies
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