ISIS CAULEY
Cleveland,OH
Summary
Detail-oriented individual with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives.
Overview
7
7
years of professional experience
Work History
Medicaid Eligibility Specialist
Centauri Health Solutions
05.2024 - Current
- Maintained electronic medical records (EMR) system, accurately documenting patient information and updating records as necessary
- Responded to patient inquiries via phone, email, and in-person, providing exceptional customer service and resolving issues promptly
- Managed patient check-in and check-out process, ensuring accuracy of demographic information and insurance verification
- Verified patient insurance coverage and eligibility, obtaining necessary authorizations for medical procedures
- Processed and submitted insurance claims for reimbursement, ensuring accuracy and adherence to billing guidelines
- Maintained detailed records of all billing activities, including claim submissions, payments received, and adjustments made
Senior Client Service Analyst
OPTUM SERVICES, INC.
09.2021 - 08.2023
- Implemented quality assurance procedures to ensure customer satisfaction levels are consistently met
- Developed strong organizational skills through managing multiple client accounts simultaneously
- Successfully managed projects from conception to completion while meeting deadlines
- Collaborated with other departments to resolve complex customer issues
- Prepared detailed reports on customer interactions using business intelligence software tools
- Served as a liaison between the company, clients, vendors and other departments
Team Supervisor
United HealthCare
02.2020 - 09.2021
- Delegated tasks to team members according to project requirements and employee strengths
- Assisted in the recruitment and onboarding of new team members
- Communicated work goals and deadlines to employees to increase productivity and meet project benchmarks
- Successfully led team of 10 members to deliver projects on time and within budget
- Cultivated an environment of trust, respect, collaboration, and accountability among the team members
- Developed a system for tracking progress, measuring performance, and providing feedback to the team
- Motivated team to achieve optimal results through effective communication and interpersonal skills
Health Care Coordinator Supervisor
CVS HealthCare
08.2017 - 05.2019
- Monitored patient satisfaction surveys to identify areas where improvements can be made within the department's processes
- Assessed potential risks associated with new business opportunities related to managed care contracts
- Developed process improvement initiatives designed to streamline workflow within the department
- Trained new staff on managed care operations and processes
- Assisted in the development of provider contracts, including fee schedules and network participation agreements
- Developed a comprehensive understanding of managed care industry regulations, policies and procedures
Education
Associate of Applied Science Degree - MRI Imaging
GMC Global
Remote08.2026
Skills
- System Documentation
- Talent Development
- Interpersonal And Written Communication
- Document Management
- Call Monitoring
- Handling Escalations
- Team Supervision
- Call Center Operations
- Leadership Skills
- Windows
- Documentation review
- Supervising experience
- Application processing
- Eligibility determination
- Policy interpretation
- Medicaid
- Teamwork
Timeline
Medicaid Eligibility Specialist
Centauri Health Solutions
05.2024 - Current
Senior Client Service Analyst
OPTUM SERVICES, INC.
09.2021 - 08.2023
Team Supervisor
United HealthCare
02.2020 - 09.2021
Health Care Coordinator Supervisor
CVS HealthCare
08.2017 - 05.2019
Associate of Applied Science Degree - MRI Imaging
GMC Global
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