LESANN WATSON
Columbus
Summary
Customer-focused professional with a background in customer service roles. Known for providing top-notch client support while maintaining high levels of customer satisfaction and loyalty. Strengths include exceptional communication, problem-solving skills, and ability to handle multiple tasks simultaneously. Proven track record of consistently improving operational processes to enhance the overall customer experience.
Overview
14
14
years of professional experience
Work History
Clinical Administrative Coordinator
United HealthCare Community and State
Westerville
03.2014 - 08.2016
- Assisting our nurse case managers, by managing their work queues and delegating member assignment to each case manager
- Ensuring members are assigned expeditiously to a nurse care manager so that the nurse may intervene to help with health concerns our members are currently facing
- Onboarding new employees, that is including field staff nurse case managers, as well as clinical coordinators, managers, etc.
- Manage our Unison health home, and ensure records are submitted daily to the state as well as the health home to reflect if a member has went to the ER or if they may need additional assistance such as lodging, or drug abuse counseling, or pregnancy issues, etc.
- I train new staff on our processes and procedures as well as our systems
- I manage the expenses for my manager that I support using a system called Concur, and ensure everything is reconciled within the allotted timeframe
- Configure laptops and tablets for our new employees as well as phones, initiating broadband requests, etc.
- Answer phone calls from our nurse case managers, as well as Area agencies on aging to ensure our waiver/passport/ assisted living members needs our met
- Assist with the processing of claims adjudication
- Assist with routing authorizations to our intake department so that patient are able to have services approved
- Assist with provider billing questions
- Assign cases to our nurses based on the severity level of the member (120-150 assigned per day)
- Creating reports/spreadsheets daily to compile case loads, as well as member demographic information.
- Arranging travel for new employees such as hotel, car, air, etc.
Customer Service Agent
Aetna Health Insurance
02.2003 - 02.2014
- Providing excellent review of complex/specialized claims to give most accurate information.
- Demonstrate knowledge of Rumba windows and ASD applications.
- Knowledge of CPT and ICD9 codes for complete benefit information.
- Part of the Electronic Correspondence Handling System (ECHS) Team/ Flex Team.
- ECHS/Flex Team provides review of written inquiries and resolution to the inquiries; as well as routing correspondence to the correct unit for resolution -- example: appeals, CCR review or to appropriate unit.
- Assist providers with referral documentation needs.
- Make outbound calls to follow up with provider inquiries.
- Enjoy the opportunity to educate providers on self service options -- example AVA and Navinet.
- Document and track all provider calls and outcomes.
- Superior average handle time, quality and attendance.
- An employee who enjoys the fast pace work setting.
- Assist prior team leads with supervisor/escalated call backs.
- Enjoy working as a team member to achieve accurate results.
- Superior customer service skills.
- Selected to work and participate in many Aetna activities.
- Excellent verbal and written communication skills.
- Knowledge of HMO platforms.
- Participant in lifestyle program 3 years running - providing motivation and tracking of healthy lifestyle points.
- Selected as WAH employee 2007.
- Assist with desk side training while in office.
- Selected to assist in phone lab for new hire training 2008.
- Assist teammates on correct routing procedures in ECHS.
- Efficient in Outbound Correspondence System (OBC).
- Product Knowledge: Traditional platforms, HMO platforms, Rumba - SCM, MSW, SCI, ACAS, MEA, PRICER, EPDB, CLI, TARGET, AST, AUTO CODER, CLREMI, ECHS, ETUMS, OBC, EPOLICY, AEPPAYS, SFE, ASD, Microsoft Word, Office, Excel, PowerPoint, Some college, Microsoft Word (10+ years), Microsoft Office, Scheduling, Administrative Assistant, Outlook, Serving Experience, Data Entry, Training, Medical Terminology, Case Management.
Education
Some college -
Skills
- Expense Management
- ICD-9
- Insurance Verification
- ICD-10
- Case Management & Social Work - Highly Proficient
- Customer Focus & Orientation - Highly Proficient
- Effective communication
- Team collaboration
- Case management
- Clerical assistance
- Administrative assistance
Assessments
- Case Management & Social Work, Highly Proficient, 12/19
- Customer Focus & Orientation, Highly Proficient, 10/19
Personal Information
- Willing To Relocate: Anywhere
- Authorized To Work: US for any employer
Timeline
Clinical Administrative Coordinator
United HealthCare Community and State
03.2014 - 08.2016
Customer Service Agent
Aetna Health Insurance
02.2003 - 02.2014