Miriam Young

•Assist patients with navigating Medicare and insurance issues which includes coverage, benefits, summaries, eligibility and getting the most out of their plan

•Serve as internal resource in the clinic on insurance questions for providers and staff

•Assist patients in navigating the healthcare system, help patients resolve medical bills inside and outside of Oak Street health

• Manage the welcome visit and orientation process for new Oak Street health patients
• Educate patients on how to apply for public benefits, such as Public Aid, and Extra Help for prescription drugs
• Support the clinic management team on operational activities as needed, including scheduling and billing
• Provide exceptional customer service
• Foster patients engagement through the design of execution of events, including center tours

• Check patients benefits and eligibility
• Submit prior authorization
• Run test claims
• Coordinate delivery of patients medication

• Healthcare
• Managed member’s Medicare accounts
• This included Medicare Parts A, B, C, and D
• Ensure that the proper benefits are applied to each claim by following appropriate processes and procedures (e.g
• Claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan
• Review and research healthcare claims from members and healthcare providers
• Served as a Case Manager, helping new members navigate through their Medicare insurance selections and the Medicare process
• Answered inbound calls to assist members with questions that included medical and prescription claims
• Initiated prior authorizations for both medical procedures and prescriptions
• Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g
• Claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan

• Respond to and resolve, member’s inquires and issues regarding their benefits, eligibility, claims, financial spending accounts and correspondence
• Help guide and educate customers about the fundamentals and benefits of the UHC Medicare Advantage plan in order to select the best benefit plan options, maximize the value of their health plan benefits and choose quality care providers
• Contact care providers (doctor's offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance
• Assist customers in navigating myuhc.com and other UnitedHealth Group websites and encourage and reassure them to become self-sufficient
• Research complex issues pertaining to the caller's health, status and potential plan options
• Navigate across multiple databases and websites.