Dominique Davis

• Obtained patient vital signs and reported results to staff nurse or physician, noting changes from prior measurements
• Answered patient assistance calls, assessed needs, and offered qualified support
• Monitored, tracked, and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery
• Supported needs of 14+ residents under long-term care

● Completing correspondence requests as, well as documenting customer feedback while utilizing multiple complex system software, including but not limited to in-coming calls, emails, chat and electronic document transmissions
● Manage administrative intake of members; including but not limited to working with hospitals, clinics, facilities and clinical team to manage requests for services from members or providers
● Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles
● Assist clinical staff with setting up documents and triage cases for Clinical Coverage Review

● Provided accurate and concise policy and procedure information to members regarding claims and benefits in timely manner
● Mastered Medicaid reimbursement procedures: with ability to disseminate information to members and utilize medical coding knowledge
● Assisted fellow advocates with solving complex problems, and diffusing complicated member conflicts using effective soft skills
● Successfully met and exceeded productivity metrics consistently, while excelling at multi-tasking to ensure optimal productivity

● Assisted with development of processes and procedures to identify gaps in medical care plans for optimal care of residents

● Trained entry-level caregivers on medical guidelines for residential care within medical based facility, as well as conduct and manage daily audits of procedures to ensure maximum productivity and safety of residents

● Acted as mediator between patients and caregivers to address care needs. Resolve disputes while documenting and completing incident reporting

● Provide and document resident medication provisions alongside medical staff utilizing standard medical coding and terminology

● Provided direct care to patients including bathing, moving, taking patient's vital signs, providing basic hygiene, and maintaining a clean environment

● Assist RN with providing great patient care

● Transport patients as needed

● Provide and document resident medication provisions alongside medical staff utilizing technology

● Assisted members in explication of benefits, enrollment options and providing requested information accurately, in professional manner

● Effectively use medical knowledge to accurately document member files, as well as track customer activity, and service requests

● Provide ongoing assistance to fellow CSR team members to engage and improve efficacy and productivity through coaching sessions, trainings and process implementation

● Provide grievance referrals for member concerns to appropriate departments while accurately documenting customer needs for resolution