Karishia Glenn

Centene Corporation (WellCare converted over to Absolute

Total Care), Columbia SC.

Maintain HIPPA standards and ensure the confidentiality of

protocol health information.

The assigned caseload for the outreach the confidentiality of

the Care Coordinator II.

Assist, complete, and submit special projects, reports, or assignments to meet department needs and objectives.

Screen for eligibility and benefits.

Identify members without PCP refer them to Member Services.

Calling members to confirm appointments .

Calling physician's office to confirm follow/up and schedule member appointments for adults, teenagers, and minors with parental consent.

Making outgoing and receiving calls from members and providers.

Keying notes in TruCare, creating tasks, updating members demographics page.

TOC (Transition of Care) loading members current medications, home location and facility location in TruCare.

CMPR Report of calling members to offer case management

of needing assistance of getting help.

Credentialing of providers and hospitals.

Checking to make sure the providers/hospitals license to participate in Medicare & Medicaid are active.

Scrubbing medical contracts.

Keying Medicaid contracts into Omniflow.

Root cause analysis of operational and health services issues.

Acts as liaison between internal departments on data gathering and problem solving while investigating problems of an unusual nature in the area of responsibility.

Assist with special projects as assigned or directed.

Support the Provider Relations Field Reps to resolve claims and payment issues.

Review and process incoming and outgoing paperwork, including directory updates, and provider credentialing application.

Contract maintenance forms and other related forms.

Assist in education of Providers as it relates to credentialing issues, contracting, claims, and membership assignment.

Check patients in and out, schedule patients, confirm appointments, and answer multi-lines phone system.

Assist with general administration.

Obtain referral, authorizations from different insurance companies, and government/ non-government entities.

Responsible for billing and collections.

Receive and post payments and in general manage the day to day activities of the front office.

Train and supervise new personnel.

Externship

Work experience placement for Medical Office Administration Program.

Medical Billing Specialist

Medical Collection Specialist

Medical Billing Specialist

Medical Billing Specialist

• Assisted nursing staff with patient care, ensuring timely completion of tasks and improved patient satisfaction.
• Answered telephone calls to offer office information, answer questions, and direct calls to staff.
• Managed incoming calls and directed to appropriate department.
• Maintained a clean, organized work environment for optimal efficiency in the delivery of patient care services.

• Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
• Maintained confidentiality of sensitive information by adhering to strict privacy policies and implementing secure filing systems.
• Delivered excellent customer service through prompt responses to client inquiries, addressing concerns effectively, and building strong relationships.
• Ensured accurate record-keeping with diligent data entry and database management for vital company information.