Kenneth Vandermark Jr
Hawley,PA
Summary
Currently Employed with Elevance Health (Formerly Anthem) within Carelon Behavioral Health for (19 Years) as a Work From Home Representative. My previous backgrounds include within Medical background; Customer Service, Medical Provider Contacts, Claims Review & Processing, Case Management, Provider P2P Scheduling, with strong analytical, communication, and teamwork skills, with proven ability to new environments.
I also own my own Mobile Disc Jockey/Photobooth business for over 30 years with a successful entertainment business that has received a high number of 5-star ratings on several different platforms to include wedding websites, social media platforms, content marketing, and branding. Utilization of social media to include creating events, marketing posts, creating reels, and utilization of social media analytic tools to track customer engagement-satisfaction.
Overview
19
19
years of professional experience
Work History
Medical Management Specialist II (WAH/REMOTE)
Elevance Health/Carelon Behavioral Health
04.2022 - Current
- Company Overview: Carelon Behavioral Health-Middletown, NY
- Scheduling and assist in multiple markets with Medical/Behavioral Providers
- Gather clinical information regarding cases and determine appropriate areas to refer to or assign (Utilization Management, Med Review)
- Provides information regarding network providers or general information when requested
- Assists with complex cases
- Liaison between Case/Medical Management and/or Operations and Internal departments
- Maintains and updates tracking databases
- Prepare reports and documents for all actions
- Responsibilities include conducting any utilization management review activities requiring clinical information interpretation
Plan to Plan Service Representative II (WAH/REMOTE)
Anthem BCBS/Wellpoint Inc.
01.2017 - 04.2022
- Company Overview: Middletown, NY
- (Work From Home) Telephone Correspondence to include; Blue Cross Plan to Plan Customer Service, Benefit Quotes, Review/Investigation, Adjustments, Advocacy, Training, Claims Processing, Adjustments, Routing Medical Records for Clinical Review, Inventory Timelines for Current and Existing Accounts, Expected Reports, Coordination Of Benefits, and Updates for No Fault/Workman's Compensation
- Middletown, NY
- Successfully maintained Meeting Expectations or Above
- Have many Member/Customer Accreditation
- I was cross trained in systems to complete Claims Processing, Edits, and Adjustments, as well as part of a Selective Inventory Team
Customer Service Rep III (WAH/REMOTE)
EMPIRE BLUE CROSS BLUE SHIELD/ANTHEM
08.2006 - 01.2017
- Company Overview: Middletown, NY
- Telephone Correspondence -Members, Providers, Medical Management, BCBS Plans
- Managed approximately 30 incoming calls, emails and faxes per day from customers/members.'
- Cross Trained Claims/Adjustments
- Worked with Management to resolve higher escalated issues within the Team
- Middletown, NY
Education
High School Diploma -
North Central High School
Spokane, WA06-1988
Skills
- Customer service
- Microsoft Office Suite
- Account management
- Organizational skills
- Attention to detail
- HIPAA compliance
- Insurance verification
- Healthcare management
- Utilization review
- Quality improvement
- Teamwork and collaboration
Timeline
Medical Management Specialist II (WAH/REMOTE)
Elevance Health/Carelon Behavioral Health
04.2022 - Current
Plan to Plan Service Representative II (WAH/REMOTE)
Anthem BCBS/Wellpoint Inc.
01.2017 - 04.2022
Customer Service Rep III (WAH/REMOTE)
EMPIRE BLUE CROSS BLUE SHIELD/ANTHEM
08.2006 - 01.2017
High School Diploma -
North Central High School
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