KELLY WARREN

After working for Anthem BCBS for over 14 years, i was laid off due to Reduction in Force, but quickly landed another job working at Yale Medicine, part of Yale New Haven Hospital. I left the workplace to care for an ill parent and i am now returning. During this period i also relocated over 1,500 miles. Ready and eager to get back to work and invest more years into serving future employer and clients.

• Provides assistance or directs caller to appropriate person, contacting physician/nurse directly for urgent needs
• Notifies patients of changes/cancellations and prioritizes urgency of appointments for rescheduling
• Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
• Weighed patient need, provider availability and insurance coverage to determine optimal scheduling.
• Entered medical data using EPIC to document referrals and results.

• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
• Refers cases requiring clinical review to Nurse reviewer
• Responds to telephone and written inquiries from clients, providers, and in-house departments
• Checks benefits for facility-based treatment
• Submitted cases for criteria failures and helped facilitate resolutions and approvals.
• Served as subject matter resource, providing information related to Behavioral Health and Substance Abuse situations.

• Worked multiple lines of business including Medicaid and Medicare as well as Individual and group health plans
• Able to multi-task multiple systems and screens for use with different programs (MCW, Fisc, Check Inquiry, OCL, APM, On Demand, Ultera, Ultera West, ESI, AIM)
• Helped support other teams to bring down their average handle times by taking HMS/DSS calls daily to quote Member Eligibility and Benefits.
• Lobby duty- Meeting and greeting members in person to assist with any questions or concerns and collecting premium payments
• Mentor to new employees – assisting with any questions or problems that may arise.
• Part of Build a Better Wellpoint- Coming up with ways to simplify everyday duties so that we may better assist members.
• Collaborated with staff members to enhance customer service experience and exceed team goals through effective client satisfaction rates.
• Educated customers about billing, payment processing and support policies and procedures.
• Handled over 50+ calls per shift, retrieving customer data, and answering any relevant benefit or claims information.