Summary
Overview
Work History
Education
Skills
References
Timeline
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Charvonia R. Mayhue

Tampa

Summary

To secure a position that will lay foundation for personal and professional growth, in an organization where employees embody the promises made to customers. PROFILE Passion to learn; ability to efficiently apply newly acquired skills and knowledge. Consistent, dedicated, and open-minded team player, who is task and detailed oriented. Professional and respectful; eager to partner with diverse others to achieve common goals or objectives.

Overview

10
10
years of professional experience

Work History

Member Service Representative

WellDyneRx
09.2023 - Current
  • Respond in a prompt, professional and courteous manner to member questions regarding placement of an order and/or the status of an order
  • Provide basic level of customer support; referring complex issues or questions to appropriate support staff
  • Handle difficult people and problems professionally
  • Trained in processing, orders and inquires for general or specific queues
  • Other tasks as assigned

Utilization Review Specialist

Jacobson Group, Health First Health Plan
05.2021 - 08.2023
  • Worked with patients to ascertain issues and make referrals to appropriate specialists.
  • Facilitated communication between patients and various departments and staff.
  • Applied administrative knowledge and courtesy to explain procedures and services to patients.
  • Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.

Appeals & Grievances Coordinator

WellCare
01.2020 - 03.2021
  • Processed and finalized appeals and grievances within agreed-upon turnaround time.
  • Submitted verbal and written notification to members and providers.
  • Organized and detail-oriented with a strong work ethic.
  • Coordinated with contracting department to resolve payer issues.

Claims Associate I

Cognizant
04.2018 - 12.2019
  • Updated claims system to track claim status and provide relevant information to other department.
  • Analyzed and addressed escalated claims to resolve issues quickly.
  • Worked productively in fast-moving work environment to process large volumes of claims.
  • Researched and analyzed complex claims to determine next steps and possible outcomes.

Medical Claims Representative

General Dynamics IT
05.2017 - 04.2018
  • Call center taking calls from beneficiaries assisting with applying for health coverage through
  • Medicare for beneficiaries 65 and older,
  • Assisting customers with Medicare claims
  • Follows established claim policies and practices to resolve claims and issues
  • Provide claim status updates including approvals, denials, closure and appeal decisions
  • Help beneficiaries compare different prescription drug plans and enroll Medicare beneficiaries in prescription drug plan
  • Answer any questions and concerns beneficiaries had about their Medicare policy
  • Provide beneficiaries with accurate information from the Government, Social Security and
  • Medicaid regarding their Medicare policy
  • Disenroll beneficiaries from Medicare policy if they no longer wanted Medicare

Healthcare Support Worker

HealthPlan Services
08.2015 - 01.2017
  • Handled customer service inquiries in person, via telephone and through email.
  • Gathered information, assessed and fulfilled callers' needs and educated on important policies and procedures.
  • Entered patient demographic and insurance data into electronic medical record system.
  • Resolved billing inquiries and disputes in timely fashion.

Education

High School Diploma -

Hillsborough High School
Tampa, FL

Skills

  • Verbal Communication Skills
  • Call Center Experience
  • Plan of Care Support
  • Managing Referrals
  • Benefits Guidelines
  • Outpatient Treatment
  • CPT Coding
  • Information Updates
  • Medicare Part B
  • Payment Collection
  • Clinical Data Entry
  • Customer Service Excellence
  • Appointment Scheduling
  • Patient Engagement
  • Customer Experience
  • Prior Authorization Processing
  • Insurance Plan Verification
  • Preparing Claims
  • Documentation Research
  • Health Insurance Industry Knowledge
  • Client Rapport-Building
  • Cold Calling
  • Claims Preparation

References

Available Upon Request 

Timeline

Member Service Representative

WellDyneRx
09.2023 - Current

Utilization Review Specialist

Jacobson Group, Health First Health Plan
05.2021 - 08.2023

Appeals & Grievances Coordinator

WellCare
01.2020 - 03.2021

Claims Associate I

Cognizant
04.2018 - 12.2019

Medical Claims Representative

General Dynamics IT
05.2017 - 04.2018

Healthcare Support Worker

HealthPlan Services
08.2015 - 01.2017

High School Diploma -

Hillsborough High School

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