Latoya Lewis

• Manage 40-50 cases per day.
• Scheduled appointments and meetings for Case Care Managers.
• Maintained and verified accuracy of records and generated miscellaneous reports.
• Worked with other departmental staff to answer questions and resolve problems.
• Performed general administrative duties by mailing and shipping materials, maintaining legal postings, and creating and publishing employee communications.
• Assisting members with Prior Authorizations for Medical Durable Equipment, Behavioral Health Facilities, and Home Health Aide Facilities.
• Standardized office structures and processes to promote collaboration and increased performance.
• Helped patients receive appropriate, high-quality care with reasonable results.
• Educated patients and loved ones about different treatment options and outside care approaches to reduce the burden on hospital resources.
• Facilitated clear communication between patients, families, and medical staff through concise documentation and timely updates on care progress.
• Coordinated appointment scheduling for optimal time management while accommodating urgent or emergency cases as needed.
• Assisted in coordinating and scheduling appointments for follow-up visits.
• Built strong relationships with patients and families for optimized care satisfaction.

• Answering average of 50 calls per day.
• Assist Medicaid and Personal Wellness members with their eligibility and renewals, assist member with changing their Primary Care Providers,and Providing Primary Care Provider Information.
• Assist Medicaid and Personal Wellness members with Medical Management concerns; such as Prior Authorizations status and request.
• Explanation of Plan Benefits.
• Assisting Medicaid and Personal Wellness with Explanation Of Benefits and Coordination of Benefits.
• Direct members to appropriate lines of business
• Explain paid or denied medical claims based upon established claims processing criteria.
• Maintained a learned knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
• Explained procedures to patients to reduce anxieties and increase patient cooperation.
• Oriented and trained new staff on proper procedures and policies.
• Followed-through on all critical inter-departmental escalations to increase customer retention rates.
• Increased efficiency and performance by monitoring team member productivity and providing feedback.

• Ensured superior customer experience by addressing customer concerns, demonstrating empathy and resolving problems in timely manner.

• Ensuring members understand their benefits.

• Answered an average of 120 calls per day by addressing customer inquiries, solving problems and providing new product information.

• Assisting members and Providers with Prior Authorizations request.

• Assessed caller accounts to determine Pharmacy benefits, identify service needs and resolve issues.
• Met all customer call guidelines including service levels, handle time and productivity.
• Educated customers about billing, payment processing and support policies and procedures.

• Receive 60-70 incoming calls, emails, and faxes per day from customers.'
• Worked closely with Pharmacy Care Representatives (PCRs) in providing excellent patient care.
• Saved patients money and increased pharmacy profit margins with therapeutically equivalent and more cost-effective generic drugs.
• Assisted members with Medicare Part D benefits
• Assisted members with Specialty medications and copay information
• Ensuring claims are processed correctly
• Scheduling medication
• Working with Providers to process Prior Authorizations
• Assisting with mail order and retail pharmacy claims explanation of rejected claims.
• Monitored progress and documented patient health status changes to keep care team updated.
• Developed rapport to create safe and trusting environment for care.