Hi, I’m
DORA RAIDEN CAMPBELL
Gig Harbor,WA
Summary
Clerical Professional with 10+ years of experience in Customer Service. Proficient in Data Entry and Microsoft Office Applications. Possesses natural ability to nurture and grow client relationships. Seeking a position that leverages my strong interpersonal skills in order to provide a true Customer Service approach.
Overview
10
years of professional experience
Work History
Molina Healthcare of WABothell , WA
Appeals & Grievances Coordinator
12.2019 - Current
Job overview
- Process over 50 appeals per week regarding denied health services such as imaging/radiology, medications, therapies, inpatient services, member reimbursement requests for services rendered by out of-network providers, etc.
- Act as liaison between external health care providers and medical directors when processing appeals
- Make outreach to members and providers to inform on status of their appeal request(s) and advise on any questions/concerns
- Input data entry utilizing multiple internal healthcare systems
- Ensure all appeal requests are processed and completed within turnaround time to meet WA state criteria and patient care needs
Molina Healthcare of WABothell, WA
Care Review Processor
11.2016 - 12.2019
Job overview
- Provided telephone, clerical, and data entry support for Care Review team (Prior Authorizations/Utilization Management Dept.)
- Assisted with provider inquiries such as eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges, and assistance with providing information on CPT/HCPCS codes, and ICD 10 diagnosis codes
- Worked with multiple provider offices and pharmacies to inquire on necessary prior authorization requests
- Contacted physician offices to request missing information pertaining to authorization requests and request additional information as needed by company’s Medical Director to make determination on authorizing services
- Ensured prior authorization requests were completed within turnaround time to meet WA state regulations and guidelines
Molina Healthcare of WABothell, WA
Member Services Rep/ Billing Claims Rep
05.2013 - 10.2016
Job overview
- Responded to over 50 incoming calls from members and healthcare providers as required to meet departmental goals daily
- Provided benefits and eligibility information for both providers and members
- Accurately/thoroughly documented incoming and outbound calls
- Cooperated with other departments as needed to reconcile certain issues with member accounts
- Completed primary care physician changes (PCP) and demographic changes to keep all members files current and up to date
- Assisted with complaint calls and de-escalated volatile situations
- Examined claims billing issues and sent back claims for reprocessing/adjustment when appropriate
Allstate Financial GroupBothell , WA
Customer Service Rep/Data Entry Processor
04.2012 - 04.2013
Job overview
- Handled billing inquiries for hundreds of gyms nationwide
- Assisted clients via phone and email
- Helped member with their accounts such as update billing info and cancel memberships upon request
- Educated on general info/details of their gym terms and agreements
- Made outbound calls to inform on any past due balance and processed payments accordingly
- Entered numerical data into databases with speed and accuracy using 10-key pad.
- Managed documents by organizing forms, making photocopies, filing records, preparing correspondence and creating reports.
- Scanned documents and saved in database to keep records of essential organizational information.
Education
Cascade High SchoolEverett, WA
High School Diploma
06.2008
Skills
Well-versed in Microsoft programs and other system applications such as:
MS Word, Excel, OneNote, Outlook, Teams, PowerPoint
Nitro Pro Software, Cisco Jabber, Cisco Webex, Citrix, Skype and Zoom
NOTABLE TRAITS:
- Customer-service oriented
- Typing speed of 60 wpm
- Outstanding attendance and punctuality
- Self-motivated
- Flexible and adaptable
- Excellent interpersonal and communication skills
- Strong written and oral skills
- Commendable work ethic
- Independent worker who takes initiative
- Ability to multi-task
- Process and detail oriented
- Dependable
Timeline
Appeals & Grievances Coordinator
Molina Healthcare of WA
12.2019 - Current
Care Review Processor
Molina Healthcare of WA
11.2016 - 12.2019
Member Services Rep/ Billing Claims Rep
Molina Healthcare of WA
05.2013 - 10.2016
Customer Service Rep/Data Entry Processor
Allstate Financial Group
04.2012 - 04.2013
Cascade High School
High School Diploma
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