Michele L Ellison
Lake Milton,OH
Summary
Proactive, collaborative, Analysis. a leader with dedication to partnering with the team to engaged, in a positive empowering work culture. Innovative and goal-oriented professional and committed to patient advocacy
Overview
14
14
years of professional experience
Work History
Case Manager Onboarding
Home Care Delivered
Remote, VA
09.2021 - Current
- Acted as departmental resource between internal and external departments
- Developed relationships with Care Coordinators and providers offices, provided ongoing support and resolution of patients accounts. Established clear benchmarks for performance and analysed issues and implemented appropriate changes.
- Monitored and maintained progress to hit monthly referral and revenue goals
- Accomplished multiple tasks within established timeframes.
- Developed and implemented comprehensive case management plans to address client needs and goals.
- Coordinated with healthcare providers to ensure clients had access to necessary medical services, enhancing their overall well-being.
- Collaborated with interdisciplinary teams to deliver comprehensive support services for clients.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Analyzed trends and data to inform decision-making and program development.
Supervisor Customer Care Call Center
CVS/CAREMARK MED D
Twinsburg, OH
09.2019 - 09.2021
- Supervise team of direct reports on areas of productivity, metrics, quality, training, coaching and development
- Research complex issues, assist in escalating calls, obtaining prior authorization, interviewing, hiring, training employees, strategizing process improvement and improving performance, overseeing various projects.
- Supervised in providing excellent customer service to callers requiring assistance for pharmacy benefits and prescription issues. Resolved escalated customer issues promptly and professionally to maintain satisfaction.
Supervisor Member Services
BroadPath Healthcare
Remote, AZ
01.2015 - 09.2019
- Leading, coaching and developing team of employees
- Assists operations team of phone representatives on inbound calls for all aspects of coverage determination and appeals process, including workflow and administrative Supervisor duties, guiding Agents on calls according to quality assurance guidelines.
- Answered member questions regarding enrollment, claims, benefits, referrals and pre-authorizations. Responded to customer inquiries regarding health insurance coverage and policies to assist with informed decision-making.
- Reviewed documentation for prior authorization requests and communicated with payers to resolve issues.
Patient Financial Advocate
VALLEY HEALTH CARE SYSTEMS
01.2012 - 01.2015
- Responsible for accurate and prompt entry, authorizations, appeals, grievances and resolution of simple to moderately complex claims in accordance with company and federal guidelines, policies, and procedures
- Educated patients and families on healthcare options and financial support resources. Communicated verification and authorization status updates within department to facilitate decision-making for patient admissions and insurance coverage.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
Education
Certificate - Medical Insurance Billing And Coding
M-TEC
RemoteCertificate - Medical Assisting Certificate
Mahoning County Career And Technical Center
Canfield, OHAssociate of Applied Science - Business Administration And Management
Eastern Gateway Community College
Steubenville, OHSkills
- Team Collaboration
- Intakes and Assessments
- Analysts
- Patient advocacy
- Partnerships
Leadership
- Documentation
- Customer Service
- Benefits Explanations
- Quality Assurance
- Client advocacy
Prior Authorization
Timeline
Case Manager Onboarding
Home Care Delivered
09.2021 - Current
Supervisor Customer Care Call Center
CVS/CAREMARK MED D
09.2019 - 09.2021
Supervisor Member Services
BroadPath Healthcare
01.2015 - 09.2019
Patient Financial Advocate
VALLEY HEALTH CARE SYSTEMS
01.2012 - 01.2015
Certificate - Medical Insurance Billing And Coding
M-TEC
Certificate - Medical Assisting Certificate
Mahoning County Career And Technical Center
Associate of Applied Science - Business Administration And Management
Eastern Gateway Community College