Jermaine Elliott-Blount

Managed client denials by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or further request is warranted and then delivered final determination based on trained skillsets and/or partnerships with clinical and other Humana parties.

Executed advanced administrative/operational/customer support duties that required independent initiative and judgment. [also included intermediate mathematical skills]

Routinely assisted members, via phone or face to face, further/support quality related goals.

Investigated and resolved member and practitioner issues. Decisions typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.

• Conducted investigational reviews of customer grievances and appeals involving provision of service and benefit coverage issues.
• Triaged clinical and non-clinical inquiries, grievances and appeals, prepared case files for member grievance committees/hearings.
• Generated written correspondence to customers providing most up-to-date information for members, providers and regulatory agencies.

• Contributes to departmental business plans and priorities by applying company policies and procedures to resolve a variety of issues for clients of Ernst & Young.
• Supports Ernst & Young with Learning Compliance, CPE Compliance, course publishing/design using system tools: LMS, LAS, LCMS, LCDR, sNOW platform, etc.
• Developing knowledge and experience in own discipline and acquiring higher level knowledge and skills to reach departmental goals and objectives.