Summary
Overview
Work History
Education
Skills
Timeline
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Miya Autery

Tampa,FL

Summary

Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.

Overview

13
13
years of professional experience

Work History

Pediatrics Care Coordinator

Centene
Tampa, FL
06.2020 - Current
  • Outreaches unable to reach members on a quarterly basis
  • Outreaches opt out members on a quarterly basis.
  • Engages case managers to complete clinical assessments and reassignment.
  • Collaborates with members family members case managers community-based organizations and other care coordination support members to assist with non-clinical resource needs.
  • Check in on the member quarterly to monitor and document process.
  • Help care manager to manage the member’s care.

Appeals Intake Specialist

Well Care Health
Tampa, FL
01.2020 - 04.2020
  • Contract work
  • Efficiently and accurately conducted the intake of appeals and related requests resulting from scanned mail, customer service calls and faxes.
  • Determined appropriate classification of each request, performed accurate data entry and conducted initial processing and assignment of appeals request.

Health Concierge

Aetna
New Albany, OH
06.2017 - 01.2020
  • Handled inbound calls from providers and members
  • I performed review of member claim history to ensure accurate tracking of benefit maximums
  • I used applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries
  • Reviewed and adjudicated routine claims in accordance with claim processing guidelines
  • I responded to providers and members via written correspondence, and the internet
  • Utilized all applicable system functions available ensuring accurate and time claim processing service
  • Applied and approved routing claims that could not be adjudicated.

Accounts Receivable Representative

Laser Spine Institute
Tampa, FL
03.2015 - 05.2017
  • Filed Appeals when necessary
  • Print Medical Records
  • Complete refund requests
  • Contact insurance groups for claim status
  • Make outbound calls to patients.

Appeals Specialist

United Health Group
Oldsmar, FL
05.2011 - 02.2015
  • Reviewing and investigating case documentation
  • Correctly triaging cases for clinical review
  • Identifying and working with other departments when necessary
  • Resolving standard grievances
  • Making determinations on non-clinical appeals and coverage determinations (as appropriate)
  • Drafting responses to members
  • Attaching case documentation in image repository system
  • Identifying accurate root cause reasons.

Education

High school diploma - General Studies

Central Hower High
06.1993

Skills

  • Proactive, able to identify problems and find solutions; face challenges head on
  • Quick and eager to learn; conscientious and detail-oriented
  • Trustworthy and dependable with access to confidential information
  • Outgoing and personable, able to satisfy customers while meeting company objectives
  • Experience with personal computer
  • Microsoft Word
  • Excel
  • Power Point
  • Internet
  • Accounts Receivable
  • Guest Services
  • Medical Billing
  • Medical Records
  • Cold Calling
  • Insurance Verification
  • Medical Scheduling
  • Medical Terminology

Timeline

Pediatrics Care Coordinator

Centene
06.2020 - Current

Appeals Intake Specialist

Well Care Health
01.2020 - 04.2020

Health Concierge

Aetna
06.2017 - 01.2020

Accounts Receivable Representative

Laser Spine Institute
03.2015 - 05.2017

Appeals Specialist

United Health Group
05.2011 - 02.2015

High school diploma - General Studies

Central Hower High

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Miya Autery