Laprisha Cody
McDonough,USA
Summary
Motivated Member Service Specialist with experience successfully managing and monitoring eligibility information for members and groups. Highly skilled at facilitating program approval or denial through qualifications assessment, policy and record keeping. Confident and committed to promoting positive customer outcomes through dynamic communication and exemplary engagement skills.
Overview
13
13
years of professional experience
Work History
Member Service Specialist 3
DCH/State Health Benefit Plan
01.2023 - Current
- Performs research to provide information or respond to SHBP member concerns/or inquiries.
- Resolves complicated customer service issues, specific escalated complaints, constituent services issues, or direct customer to appropriate entity.
- Advises members and/or officials regarding regulations, policies and procedures to process appeals.
- Reviews and processes weekly reports regarding Medicare Advantage members enrollment.
- Performs job responsibilities with minimal supervision.
- Serves as subject matter expert or organization resource in assigned areas.
- Assisted members with correcting account, service, and system issues by educating on required forms and technical processes
- Assesses member eligibility and identifying their needs.
- Followed-through on all critical inter-departmental escalations.
- Cross-trained and backed up other member service specialists
- Documents all inquiries and maintaining accurate member records.
- Works with internal and external partner such as ADP, TRS, ERS.
- Work remotely and in office
- Processed refunds to members in compliance with accounting
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email, and in-person interactions.
- Observed strict procedures to maintain data and plan participant confidentiality.
- Conducted Retiree conferences to promote understanding of coverage and options before open enrollment period.
Clinical Administrative Coordinator/ Patient Navigator
Optum/United Health Care
05.2021 - 01.2023
- Responsible for ensuring healthy outcomes for patients by acting on possible barriers.
- Serve as liaison between hospital, client staff and patient throughout the life cycle of the program.
- Conduct inpatient or telephonic visits in the acute and subacute setting.
- Preparing patient case status summaries.
- Accurately populate, maintain, and update PILOT database per episode.
- Attend weekly collaboration meetings and company meetings.
- Utilize Strongly working knowledge of Medical Terminology.
- Maintain strict confidentiality of all records and data.
- Conducting research to assist with discharge care planning.
- Remote
Economic Support Specialist
Georgia Department of Human Services/RSM
11.2019 - 05.2021
- Utilized GAMMIS to manage and confirm patient data, such as insurance, demographic, and medical history information.
- Managed monthly renewals and daily applications received for other Medicaid Classes of Assistance.
- Maintained accuracy, completeness and security for medical records and health information.
- Collected, reviewed, and analyzed data from Gateway Dashboard.
- Processed Medicaid Applications for Breast/Cervical Cancer Coverage. Managed load of 360 Women's Health cases.
- Documented data and completed accurate updates to case records.
- Interviewed applicants and explained scope of different available benefits.
- Collaborated closely with physicians and nursing staff to improve quality of patient records documentation during renewal period.
- Use of VPN to work remotely.
- Remote
Economic Support Specialist
Georgia Department of Community Health/ RSM
01.2016 - 11.2019
- Seated at Children's Hospital; Collected and analyzed personal and financial information to make appropriate determinations.
- Communicated with people from various cultures and backgrounds on application process.
- Inputted all gathered information and researched data on applicants into computer system using Ga Gateway.
- Assessed information gleaned from interviews, medical records, consultation with other professionals and diagnostic evaluations to identify clients' abilities, needs and eligibility for services.
- Conducted 8 Community Outreach per year to promote Medicaid programs and educate public on available resources.
Economic Support Specialist
Department Family Children Services
11.2012 - 01.2016
- Scheduled appointments with applicants to gather information and explain benefits processes.
- Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
- Interviewed applicants and explained scope of different available benefits.
- Researched and interpreted program regulations and applicable laws.
- Trained in Ga. SNAP/Medicaid Policy and HIPPA policy.
- Looked for signs of fraud and reported cases to fraud coordinator and investigators.
Education
B.S. - Health Information Management
University of Arizona GC
Master of Public Health - Public Health
University of Arizona GC
Chandler, AZSkills
- Case Management
- HIPAA Compliant
- Verbal and written communication
- MS Office Teams Share Point
- Medical Records Management
- Documentation Review
- Medical terminology knowledge
- ICD-10 / CPT
- Data Imaging Systems
- Analytical Skills
- State Medicaid Policy
- Client support systems
- CMS Policy Knowledge
- Critical thinking
- Quality assurance
- Employee benefits coordination
- Benefits analysis
Timeline
Member Service Specialist 3
DCH/State Health Benefit Plan
01.2023 - Current
Clinical Administrative Coordinator/ Patient Navigator
Optum/United Health Care
05.2021 - 01.2023
Economic Support Specialist
Georgia Department of Human Services/RSM
11.2019 - 05.2021
Economic Support Specialist
Georgia Department of Community Health/ RSM
01.2016 - 11.2019
Economic Support Specialist
Department Family Children Services
11.2012 - 01.2016
B.S. - Health Information Management
University of Arizona GC
Master of Public Health - Public Health
University of Arizona GC