Carmen Arellano
Summary
Highly motivated, dedicated individual with strong problem solving, customer service, organizational, and multi-tasking skills. Results-oriented and flexible team player who works effectively to achieve personal/business objectives.
Overview
16
16
years of professional experience
Work History
Authorization Specialist
Blue Shield Promise Health plan
08.2007 - 11.2023
- Consistently provides beneficiaries, providers, and internal staff with exceptional customer service by answering inbound and outbound calls.
- Verifies medi-cal eligibility on AEVS and Facets
- Process LOAs when needed
- Meeting daily goal of processing 40+ authorization requests
- Assist with special projects and other duties assigned by management
- Support the clinical (outpatient) department in all administrative duties
- Processes time sensitive authorizations and pre-certification requests to meet department timeframes.
- Knowledge of Medi-cal and Medicare line of business pertaining to UM process
- Process authorizations for Long Term facilities
- Responsible for completing a health risk assessment questionnaire
Disease Management Coordinator
Blue Shield Promise Health Plan
- Interactions with members, providers and provider groups as needed to support disease management
- Prepare all correspondences to members and providers
- Member telephonic contact at the direction of the case managers
- Make all member welcome/introductory calls
- Conduct non-clinical assessment, and member satisfaction surveys
- Scheduling appointments and reminder calls for case managers
- Management functions, at the direction of the DM case manager
- Assists with system letters, requests for information and data entry
- Provides administrative/clerical support to medical.
Education
LVN Nursing school
08.2013
Diploma -
Nogales high school
06.1997
Skills
- HIPAA trained
- Medical terminology knowledge
- Proficiency in MHC system
- CPT and HCPCS coding
- Risk Assessment
- Authorizations Knowledge
- Strong work ethic
- Good written communication
- Rapid and Adaptive
- Solutions oriented professional
Timeline
Authorization Specialist
Blue Shield Promise Health plan
08.2007 - 11.2023
Disease Management Coordinator
Blue Shield Promise Health Plan
LVN Nursing school
Diploma -
Nogales high school
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