Carla Oliver
O'Fallon,IL
Summary
Career Summary Exceptionally sensitive and dedicated individual with a strong record of health care service and client satisfaction. Adept at handling a variety of client issues and problems with kindness and professionalism.
Overview
20
20
years of professional experience
Work History
Utilization Management Representative II
Blue Cross Blue Shield/Elevance
St Louis, MO
04.2022 - Current
- Responsible for non-clinical tasks including performing 30 inbound calls to members/providers to connect them with Care Managers to complete clinicals and Pre- Authorization, Performed duties such as working faxes, calling facilities to request clinical., verifying HIPPA, research diagnosis codes, multitasking, handle Crisis Calls
- Developed and implemented performance improvement strategies and plans to promote continuous improvement
- Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting
- Actively listened to customers' requests, confirming full understanding before addressing concerns
Customer Service Representative
Lumeris Healthcare
St Louis, MO
09.2020 - 03.2021
- Performed calls accurately and professionally including correct grammar
- Resolved customer service inquiries for 1-2 communities which could include: benefit and eligibility information; billing and payment issues; customer material requests; physician assignments; authorization for treatment; Explanation of Benefits (EOB); Provider claim disputes, answer claim questions, look up procedure codes for Providers to determine coverage,
- Handled escalated situations and act urgently when necessary
- Make outbound calls as needed including but not limited to members, providers, pharmacies, hospitals
- Resolved issues, called Pharmacy to get medication overrides
- Offer ICAG, create referrals, explain Coverage GAPS
- Investigate and respond to general and complex inquiries and document as appropriate
- Interact with other departments including Enrollment and Medical Management to resolve issues
- Adhere to compliance requirements and CMS standards
- Willing and able to work flexible hours including weekends and overtime as needed
- Answered customer telephone calls promptly to avoid on-hold wait times
- Used company troubleshooting resolution tree to evaluate technical problems and find appropriate solutions
- Offered advice and assistance to customers, paying attention to special needs or wants
Health Program Representative
Anthem Blue Cross/Blue Shield
St Louis, MO
03.2017 - 11.2018
- Knowledge of principles and processes for providing customer and personal services
- This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction
- Input data into HRS Systems while using Codi System guide
- Encourage members to participate in program by providing information and features of program
- Observing, receiving, and otherwise obtaining information from all relevant sources
- Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
- Devoted special emphasis to punctuality and worked to maintain outstanding attendance record
- Used critical thinking to break down problems, evaluate solutions and make decisions
- Created plans and communicated deadlines to complete projects on time
Administrator
Enhanced Quality Of Life Adult Day Program
St. Louis, MO
01.2011 - 03.2018
- Participate in audit activities, including collecting, preparing, reviewing, tracking, submission, and recordkeeping of requested information, data, and documents
- Experience in Medicaid, DMH regulated environments in a role that requires interpreting, understanding, implementing, monitoring, or auditing compliance with regulations
- Generated reports to suggest corrective actions and process improvements.
- Studied processes, implemented cost reductions and developed reporting procedures to maintain administrative workflow.
- Networked with industry professionals to exchange best practice knowledge and stay abreast of latest developments.
- Maintained personnel records and updated internal databases to support document management.
- Targeted new customers to grow geographic reach and increase revenue.
- Troubleshot employee concerns and recommended corrective actions to resolve issues.
- Screened and transferred incoming calls, took down messages and transmitted information and documents to internal personnel.
- Collected, validated and distributed information to employees.
- Completed forms and reports to facilitate admission, transfer or discharge.
- Oversaw successful planning and execution of staff meetings, parties and events.
- Managed payroll, transactions, invoicing and budgeting to decrease financial inconsistencies.
Program Owner/Director
Enhanced Quality Of Life Adult Program
St Louis, MO
01.2011 - 03.2018
- Managed day-to-day business operations.
- Consulted with customers to assess needs and propose optimal solutions.
- Trained 10 employees and motivated employees to perform daily business functions.
- Enhanced operational efficiency and productivity by managing budgets, accounts and costs, increasing finances for company.
- Collaborated with management and fellow supervisors to organize operations and achieve demanding schedule targets.
- Evaluated company documentation to verify alignment with regulatory requirements.
- Established departmental performance goals and provided feedback for underperforming areas.
Orthopedic Technician
Cardinal Glennon Hospital
St Louis, MO
11.2007 - 03.2011
- Scheduled appointments for multiple physicians using Epic systems; Refill prescriptions at request of patients or pharmacy
- Referred patients out to appropriate facilities as directed for imaging; Monitor new and returning patient contacts; acting as general liaison between provider and patient
- Set up orthopedic fracture tables for casting procedures and applied variety of plaster and fiberglass casting, splints, braces, soft goods and skin and skeletal traction.
- Assessed patient comfort related to cast and splints and assisted with comfort measures.
- Decontaminated all equipment, instruments and supplies and cleaned and stocked carts, rooms and changed linen, as required.
- Measured and fit crutches and canes and instructed patients on proper crutch and cane walking.
- Worked with vendors to source diverse materials and items for use during device fabrication processes.
- Handled tools and machinery with caution and precision to avoid costly mistakes and safety accidents.
- Fitted appliances onto patients and made necessary adjustments.
Education
BS - Healthcare Management
Lindenwood University
2018
Associates - Health Information Technology
Missouri College
St Louis, MO2007
Diploma - Medical Assistant
Sanford Brown College
St Louis, MO2003
Skills
- Obtaining Authorizations
- Nursing Consultation
- Patient Condition Monitoring
- Detailed Oriented
- Leadership Skills
- Self Management Skills
Timeline
Utilization Management Representative II
Blue Cross Blue Shield/Elevance
04.2022 - Current
Customer Service Representative
Lumeris Healthcare
09.2020 - 03.2021
Health Program Representative
Anthem Blue Cross/Blue Shield
03.2017 - 11.2018
Administrator
Enhanced Quality Of Life Adult Day Program
01.2011 - 03.2018
Program Owner/Director
Enhanced Quality Of Life Adult Program
01.2011 - 03.2018
Orthopedic Technician
Cardinal Glennon Hospital
11.2007 - 03.2011
BS - Healthcare Management
Lindenwood University
Associates - Health Information Technology
Missouri College
Diploma - Medical Assistant
Sanford Brown College