Nicole Feins
Spring Hill,USA
Summary
Candidate has a passion for helping others Excellent communication skills Ability to follow direction Responsibilities motivated by challenge and rewarded through the seamless implementation of critical initiatives that aid profitability, productivity, and quality. Commended for the ability to learn quickly, deliver projects on time, and work under strict deadlines while maintaining diligence and managing sensitive and or classified information, quality improvement principles, standards, and practices.
Overview
13
13
years of professional experience
Work History
A Brighter Future Daycare
12.2024 - Current
- Responsible for supervising and caring for toddlers
- Create a safe and engaging environment that promotes learning and growth
- Planning and organizing activities that cater to the needs of our young clients is crucial
- Maintaining cleanliness and providing meals according to our high standards is also essential
- (PRN)
LTC Care Coordinator
MetLife
04.2022 - 04.2023
- Directly Reports to Associate Manager
- LTC Claims Ops II- Evelyn Tocco
- Manages assigned caseload with limited supervision.
- Provides timely, balanced, and accurate claims reviews, documentation, and recommended decisions in a time-sensitive and fast-paced environment.
- Compiles file documentation requiring extensive policy and factual detail.
- Identifies information and resources needed to make benefit eligibility determinations.
- Communicates decisions to policyholders and or their representatives in both verbal and written form.
- Clarifies and reconciles inconsistencies.
- Conducts in-depth, detailed information-gathering phone calls that obtain medical condition details and other information.
Care Coordinator
Centene, Sunshine Health Plans
10.2021 - 04.2022
- Directly reporting to the Manager of Utilization Management
- Initiate authorization requests for output or input services per the prior authorization list. Research for home health agencies when a member wants to change providers.
- Perform tasks necessary to promote member compliance, such as new member satisfaction callbacks.
- Coordinate services with case managers/home health agencies/ durable medical suppliers/ nursing homes, HDM.
- Makes process improvement recommendations to upper management.
- Performs special projects as necessary.
- Expert for escalated authorization and escalated issues that require additional research and resolution regarding the members.
- (Company bought out by Centene)
Care Coordinator
WellCare, Staywell Health Plans
06.2020 - 09.2021
- Directly reporting to the Manager of Utilization Management
- Provide counseling/corrective action procedures when required to Program coordinators.
- Conducts training for new associates and re-training based on changing policy and procedure.
- Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness, and other skills as identified.
- Evaluate members for case management services and determines the appropriate level of care coordination/ management services for member.
- Manage an active caseload based on state-mandated ratios according to residential setting, case intensity, and understanding.
- Adapt to changes in policies, procedures, new techniques, and additional responsibilities.
- Received assigned cases due to their complexities and/or resolution of AHCA complaints.
- Eve Rexach -Godoy Evelitza.RexachGodoy@wellcare.com-
Authorization Specialist
Black Stone Medical Services
08.2019 - 06.2020
- Assured that all requirements necessary are present per insurance verification.
- Initiated the pre-authorizations/pre-determinations for insurance to get verified and processed correctly.
- Faxed and emailed LOMN (letter of medical necessity) with clinical notes to the provider for authorizations.
- Ensuring that all insurance information needed for billing and collection processes is appropriately obtained and recorded in the computer system.
- Answer and respond to calls regarding insurance-related issues in a courteous, professional manner.
- Repeatedly calls insurance companies to follow up.
- Familiarity with ICD-9 and CPT coding, Medical Terminology.
- Supervisor -Shanice Francis
- PH (813)-239-4616 Ext 328
Provider Service Advocate
United Health Care Group
05.2017 - 08.2019
- Answer incoming calls from providers from facilities, physicians' offices, and ancillary providers.
- Effectively guide providers through all stages of their journey, ensuring their needs are met and issues resolved end-to-end. Interpret and translate clinical/medical terminology into simple-to-understand terms for providers.
- Respond to and resolve the first call customer service inquiries and issues by identifying the topic and type of assistance the caller needs, such as benefits, eligibility and claims, appeals, correspondence, etc.
- Navigate through multiple platforms and databases to retrieve information regarding medical plans, claims submissions, appeals, demographics, credentialing, etc.
- Must remain current on all communicated changes in process and policies/guidelines. Adapt to all process changes quickly and maintain knowledge of changes at site and entity levels by utilizing all available resources.
- Eric W.-Team Supervisor
- PH :( 813)818-3310
Companion
Family and Friends Healthcare LLC
08.2012 - Current
- Assisted patients with activities of daily living such as eating, bathing, dressing, grooming, and toileting.
- Displayed solid clinical skills in assessing vital signs and patient monitoring. Also, comply with HIPAA standards in all patient documentation and interactions.
- Ensured the accurate, timely flow of information by maintaining thorough patient records and updating the healthcare team on patient status.
- Provided developmental suggestions to the organization about its clients on long-term and private care to improve the organization's efficiency.
- Worked with a wide variety of patients to understand and adapt to the individual needs of each patient, thus leading to higher levels of patient and family satisfaction.
- (PRN)
- Michelle -Office Manager
- PH :( 352) 835-7195
Education
Associate in Arts -
Pasco Hernando State College
01.2017
Licensed Massage Therapist - undefined
Bene's Beauty Career Academy
01.2024
Skills
- Microsoft Word
- Microsoft Outlook
- Excel
- PowerPoint
- Internet Explorer
- Chrome
- Care Central
- Business Skype
- Microsoft Teams
- SailPoint
- PEGA
- TruCare
Timeline
A Brighter Future Daycare
12.2024 - Current
LTC Care Coordinator
MetLife
04.2022 - 04.2023
Care Coordinator
Centene, Sunshine Health Plans
10.2021 - 04.2022
Care Coordinator
WellCare, Staywell Health Plans
06.2020 - 09.2021
Authorization Specialist
Black Stone Medical Services
08.2019 - 06.2020
Provider Service Advocate
United Health Care Group
05.2017 - 08.2019
Companion
Family and Friends Healthcare LLC
08.2012 - Current
Licensed Massage Therapist - undefined
Bene's Beauty Career Academy
Associate in Arts -
Pasco Hernando State College
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