Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Prince Poh

CA,NJ

Summary

Healthcare professional with expertise in Medicare Grievance and Appeals, medical coding, and case coordination. Skilled in managing grievance and appeals processes, ensuring regulatory compliance, and enhancing healthcare quality with a commitment to exceptional service and high standards in documentation.

Overview

11
11
years of professional experience
1
1
Certification

Work History

Medicare Grievance and Appeals Case Manager

Actalent
06.2019 - Current
  • Company Overview: NJ Sharing Network
  • Prepared acknowledgment and resolution letters to address each issue/request and notified the member or provider of the plan decision
  • Investigated, resolved, and communicated complaints and grievances filed by members
  • Ensured that complaints and grievances, including those under Medicare, were processed in accordance
  • Ensured compliance with all applicable laws, regulations, and industry standards
  • High-quality work related to complex and sensitive member issues, with meeting performance timeframes
  • Managed existing/open cases, including those under Medicare grievance and appeal processes
  • Support pay-for-performance programs through data entry, tracking, and organizing information
  • Assist with data entry, provider calls, and claims research
  • Data enter assessments, authorizations, and other necessary information into the system accurately and efficiently
  • Initiate authorization requests for services following the prior authorization list
  • Perform tasks to promote member compliance, such as verifying appointments and obtaining lab results
  • Assess and monitor inpatient census, screen for eligibility and benefits, and identify members without a Primary Care Physician (PCP) for referral to Member Services
  • Perform transitions of care, including communication with the member's attending physician, medical power of attorney, and other providers regarding special needs
  • NJ Sharing Network

Case Manager

SafeGuard Biosystems
10.2015 - 02.2019
  • Conducted interviews and assessments to identify areas of need and developed appropriate interventions
  • Ensured compliance with regulations related to Mental Health Case Management services
  • Coordinated referrals to external agencies or specialists as needed
  • Coded diagnoses and procedures from patient medical records using ICD-10-CM and CPT-4 codes
  • Maintained up-to-date knowledge of CPT and ICD-10 coding principles, government regulations, protocols, and third-party billing requirements
  • Addressed coding discrepancies and denials to maximize reimbursement
  • Interpreted medical reports to apply appropriate ICD-9, CPT-4, and HCPCS codes

Phlebotomist Technician

Aculabs
12.2013 - 08.2015
  • Company Overview: NJ
  • Perform venipunctures of patients at Clinics and Facilities for medical testing and transport broad specimen
  • Collect urine and stool specimen to the laboratory for testing
  • Document detailed patient’s information on requisitions
  • NJ

Education

Master of Science - Biomedical Sciences

10.2024

Bachelor of Science - Biology, Computer Science

Montclair State University
Montclair, New Jersey
01.2019

Skills

  • HIPAA Compliance
  • Medical Billing
  • Payment Posting
  • Insurance Verification
  • Utilization Review
  • Healthcare Claim Coding
  • Patient Registration
  • Anatomy and Physiology
  • Patient Data Identification
  • Data Verification
  • EMR System Knowledge
  • Health Information Systems
  • Database Management

Certification

  • CPR
  • BLS
  • BACHELORS OF SCIENCE IN BIOLOGY
  • US ARMY (11B) Infantry Training

Timeline

Medicare Grievance and Appeals Case Manager

Actalent
06.2019 - Current

Case Manager

SafeGuard Biosystems
10.2015 - 02.2019

Phlebotomist Technician

Aculabs
12.2013 - 08.2015

Bachelor of Science - Biology, Computer Science

Montclair State University

Master of Science - Biomedical Sciences

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Prince Poh