Summary
Overview
Work History
Education
Skills
Timeline
Generic
Dana Lawrence

Dana Lawrence

Tucson,AZ

Summary

I have achieve a bachelors degree

Overview

13
13
years of professional experience

Work History

Sr. Service Advocate OPS ~ Health Survey Specialist

Aetna, a CVS Health company
08.2022 - Current
  • Outreaches to DSNP members via phone to complete the Health Risk Assessment.
  • Uses motivational interviewing and other consultative techniques to gather comprehensive information about a member’s medical health needs.
  • Documents each call in the member’s electronic record, thoroughly completing required actions with a high level of detail to ensure we meet our compliance requirements.
  • Protects the confidentiality of member information and adheres to company policies regarding privacy/ HIPAA.
  • Demonstrates an outgoing, enthusiastic, and caring presence over the telephone.

Coordinator & Appeal Analyst

Aetna, a CVS Health company
03.2020 - 08.2022
  • Responded to calls and ensure timely, customer focused response to appeals, and update appeals cases for decisioning.
  • Reviewed claims for appeals cases using ASD, HRP, GPS and other systems.
  • Researched and reviewed claims to determine if claim was paid.
  • Researched claim processing logic to verify accuracy of claim payment, member eligibility data, billing/payment status, prior to initiation of appeal process.
  • Processed appeals cases for dismissals along with basic experience in Microsoft Applications.
  • Responsible for coordination of all components of appeals, including final communication to member/provider for final resolution and closure.

Transaction Processing Associate IV-Hearings & Appeals

Conduent
11.2012 - 08.2019
  • Responded to customer inquiries in a call center environment using a computerized system.
  • Responded to telephone inquiries and complaints using standard scripts and procedures. Gathers information, researched/resolves inquiries, and logged customer calls.
  • Communicated appropriate options for resolution in a timely manner. Informs customers about services available and assesses customer needs.
  • Completed pre-hearing conference interviews with appellants who are appealing their eligibility decisions for SNAP, TANF, Medicaid, HIP, & post eligible for ACA.
  • Researched, analyze, and manage caseloads of cases under appeal to ensure that case information was gathered and processed in a complete and accurate manner in accordance with state policy with quality assurance.
  • Prepared and presents hearing exhibit packets for fair hearings as a preventative of state of Indiana and run reports daily for task production.
  • Provided solutions that best meet requirements of hearings & appeals in a performance driven environment using the Workflow Management System WFMS.

Education

Bachelor of Science - Public Affairs, Public Administration

Indiana University Northwest
01.2002

Skills

  • Excellent verbal and written communication skills
  • Exhibits heart-at-work behaviors
  • Meeting all scorecard objectives for a rolling 12 months
  • Strong analytical and research skills
  • Typing
  • Microsoft Office
  • Microsoft Word
  • Case Management

Timeline

Sr. Service Advocate OPS ~ Health Survey Specialist

Aetna, a CVS Health company
08.2022 - Current

Coordinator & Appeal Analyst

Aetna, a CVS Health company
03.2020 - 08.2022

Transaction Processing Associate IV-Hearings & Appeals

Conduent
11.2012 - 08.2019

Bachelor of Science - Public Affairs, Public Administration

Indiana University Northwest