Kimberly Hargrave
Philadelphia,PA
Summary
Passionate Healthcare Professional with over 18 years in Customer service and Leadership within the healthcare industry, 7 years in Behavioral Health insurance. Proficient in working in fast-paced environments, working independently, handling complex situations and mentoring team members. Versed in reviewing patient eligibility, benefits, referrals, authorizations and claims to promote efficiency and influence positive outcomes. Proven history of fostering patient focused-results to meet team, individual and management objectives.
Overview
18
18
years of professional experience
Work History
Behavioral Intake Counselor
United Health Group
Philadelphia, Pa
10.2017 - Current
- Identify member and provider needs, providing education on benefit, claims and prior authorization information while maintaining above average performance and quality metrics, handling Medicare, Medicaid, Employer and Health Plan Accounts
- Attained UES survey score of 94% for calendar year
- Analyze claims for behavioral health and initiated calls to members and or providers when needed to correct issues
- Organize and schedule short-term disability appointments while serving as point of contact for members, providers and care advocates to ensure members were serviced within 72 hour window assigned to this project
- Maintained confidentiality and documented conversations to ensure member's chart has accurate information
- Posses knowledge of compliance, fraud and waste within healthcare.
Data Entry Technician/Customer Service
Express Scripts
Trevose, Pa
06.2006 - 05.2017
- Transcribed and entered administering directions for patients, analyzed any notes present on prescription while making necessary updates for retail to mail order conversion
- Complied with Hipaa, federal laws, company policies and procedures and state regulations regarding processing of prescriptions
- Represented department as site level liaison to establish a strategy aiding in problem solving skills
- Mentored and aided team of 20 peer in problem solving complex orders
- Arranged outbound correspondence to patients and providers to obtain required elements absent on prescription
- Outperformed in quality and production rates above peers
- Developed job aids to ensure team is performing above 97% or performance standards.
Education
Master of Arts - Health Administration
University of Phoenix
Phoenix, AZ06.2017
Bachelor of Science - Health Administration
University of Phoenix
Phoenix, AZ08.2015
Skills
- Microsoft programs
- Claims research
- Emotional intelligence
- Cpt and ICD-9 coding
- Adaptable and flexible
- Written and verbal communication
- Willingness to learn
- Leadership and mentoring
- Integrity
- Self-starter
- Positive attitude
- Detail oriented
- Maintain confidentiality
- Time management
- Patient eligibility
- Unet, Facets, Medicare
- Health plan and commercial plans
- Electronic health records
- Microsoft Excel, office, powerpoint
- Citrix
- HIPAA
- Schedule Management
- Crisis Response
Coursework
- FINANCIAL MANAGEMENT IN HEALTHCARE
- HEALTH LAW AND ETHICS
- HEALTHCARE RESEARCH UTILIZATION
Professional Highlights
- Independently coordinated special project scheduling short-term disability appointments for 15 to 20 members, internally and externally tracking communication to see process through to the end.
- Properly risk screen callers for positive risk of self harm.
- Showcased a high level metric of 97.62 % for call quality.
- Mentored 10 plus new hires, supported team chat and supervised throughout on the job training.
Personal Information
Title: Healthcare Administrative Professional
Volunteer Experience
Team Mom, AYF Lawncrest Lions, 06/2017, Present, Coordinate with parents and coaches to ensure snacks, transportation and equipment was in place for 20 to 30 team players., Serve as a point of contact between coaching staff and parents for a team of 20 to 30 children., Managed weekly team meetings to obtain and resolve player and parents issues., Trained other parents to become team moms for different age groups., Organized and distributed registration packages and set deadlines for information to be returned.
Timeline
Behavioral Intake Counselor
United Health Group
10.2017 - Current
Data Entry Technician/Customer Service
Express Scripts
06.2006 - 05.2017
Master of Arts - Health Administration
University of Phoenix
Bachelor of Science - Health Administration
University of Phoenix