Michelle Harden
Orlando,FL
Summary
Detail oriented healthcare professional with experience in patient coordination, member support, and accurate clinical documentation. Skilled in communicating with patients, providers, and multidisciplinary teams to resolve issues and support continuity of care. Brings strong problem-solving, multitasking, and healthcare software proficiency in fast-paced, regulated environments. Seeking to contribute as a Case Manager Assistant in a hospital setting.
Overview
4
4
years of professional experience
Work History
Medicare and Market Place Agent
Pitch Perfect Solutions
Orlando , FL
09.2024 - Current
- Advised members on Medicare and Marketplace coverage options to ensure optimal benefits and coverage understanding.
- Proactively resolved provider and medication issues by coordinating with healthcare offices and pharmacies.
- Maintained a high standard of member advocacy and service quality.
Case Manger/Customer Service
Alignment Health Plan
Tampa, USA
06.2023 - 03.2024
- Managed intake for Medicaid members assisting with resolution of complex member cases, ensuring timely follow-up, accurate data entry, and compliance with CMS requirements.
- Communicated with members and CMS to obtain documentation, provide case updates, and resolve coverage or eligibility issues.
- Coordinated with pharmacies and primary care providers to ensure medications were filled and appointments were scheduled without delay.
- Delivered concierge-level support to members by proactively addressing barriers to care in a fast-paced, remote environment.
Member Advocate Specialist
Alta Resources: Blue Cross-Blue Shield
Fort Myers, USA
12.2021 - 07.2023
- Assisted members with health insurance inquiries related to benefits, claims, billing, prior authorizations, and coverage via phone, chat, and email.
- Researched policy details and claims information to resolve issues accurately while navigating complex insurance systems.
- Updated member accounts and processed claims in accordance with plan guidelines and compliance standards.
- Collaborated with internal teams to resolve escalated issues and ensure timely access to quality care.
- Advocated for members by providing clear explanations of coverage and supporting informed healthcare decisions support remotely.
Education
Some College (No Degree) - Education
Florida Southwestern State College
Fort Myers, FL01-2020
High school or equivalent -
Lennard High School
Ruskin, FL05.2019
Skills
- Patient Coordination & Member Support
- Documentation & Data Entry Accuracy
- Communication & Interpersonal Skills
- Problem Solving & Multitasking
- Team Collaboration
- Healthcare Software Proficiency
- HIPAA
Timeline
Medicare and Market Place Agent
Pitch Perfect Solutions
09.2024 - Current
Case Manger/Customer Service
Alignment Health Plan
06.2023 - 03.2024
Member Advocate Specialist
Alta Resources: Blue Cross-Blue Shield
12.2021 - 07.2023
Some College (No Degree) - Education
Florida Southwestern State College
High school or equivalent -
Lennard High School