MARK KANG
Fair Oaks,USA
Summary
Experienced call center professional trained in insurance policies, plans and coverage limitations. Remains calm and level-headed in fast-paced environments. Solves problems independently and teaches providers to use electronic systems. High-performing and systematic with excellent organizational and analytical abilities with focus on promoting loyalty.
Overview
11
11
years of professional experience
Work History
Customer Service Associate
Magellan Health
09.2021 - Current
- Listens and probes callers in a professionally and timely manner to determine purpose of the calls
- Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality
- Resolves customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction
Case Manager
Kaiser Permanente
02.2021 - 09.2021
- Investigates all issues, including collection of appropriate data, preparation, and presentation of documents to decision makers
- Collaborates with internal staff, other MS Departments, managers, and physicians to seek resolution on issues and cases affecting member while ensuring compliance, documentation and enhancing members' experience
- Meets time frames for performance while balancing the need to produce high quality work related to complex and sensitive member issues
Provider Administration
VSP Vision Care
09.2020 - 02.2021
- Monitor and maintain critical provider information in various VSP systems
- Ensure requested information is delivered within the specified time frame and completed accurately
- Create and maintain files for credentialing applications and renewals
- Process and track new applications and renewal applications for all medical providers
Appeals and Grievances Coordinator
Blue Shield of CA
10.2019 - 03.2020
- Gather necessary documents (from internal and external resources) related to an appeal, grievance, or complaint to develop a complete file
- Required to communicate in writing with customers, members, providers, or designated representative, using the regulatory compliant format on all issues both for acknowledgment and resolution
- Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review
Eligibility Specialist
BRMS
04.2017 - 02.2018
- Reviewed documentation for compliance with requirements and accuracy of information
- Contributed to and enhanced audit processes to maximize quality management standards
- Developed and deepened relationships with providers and partners to maintain expertise and address problems
Credentialing Specialist
Aetna
12.2013 - 02.2017
- Obtained NPI numbers for providers and facilities and updated existing profiles
- Conducted primary source verifications such as background checks and board certifications
- Received and evaluated applications to look for missing and inaccurate information
- Completed enrollments into Medicaid, Medicare and private insurance plans
Education
Some College (No Degree) - Early Childhood Education
American River College
Sacramento, CA06.1999
Skills
- Inbound and Outbound Calling
- Customer Support
- MS Office proficiency
- Quality Assurance
- Software troubleshooting
- Problem-solving abilities
- Call Center Operations
- Customer relations
- Claims investigation and research
- Medicare and Medicaid eligibility
- Quality assurance
- File and records management
- Provider enrollment
- Accreditation information management
- Insurance credentialing processes
- Teaching, tutoring and counseling
- Differentiated learning techniques
- Tutoring and after school help
- Behavioral/cognitive skills development
- Reporting and documentation
- Classroom management
- Innovative lesson planning
- Curriculum development
- Special needs students
- Performance assessments
- Creative lesson plan development
- ICD-9 forms
- Clinical judgment
- Medicaid statutes and regulations
- Policy and program development
- Confidential case documentation
- HIPAA and confidentiality
- Medical billing and collections
Timeline
Customer Service Associate
Magellan Health
09.2021 - Current
Case Manager
Kaiser Permanente
02.2021 - 09.2021
Provider Administration
VSP Vision Care
09.2020 - 02.2021
Appeals and Grievances Coordinator
Blue Shield of CA
10.2019 - 03.2020
Eligibility Specialist
BRMS
04.2017 - 02.2018
Credentialing Specialist
Aetna
12.2013 - 02.2017
Some College (No Degree) - Early Childhood Education
American River College
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