SANDALE KEATON
Cigna
Orlando,FL
19
years of professional experience
Ability to coordinate, plan, and direct great delivery of care. With a strong education background in Customer service. Experienced in processing cases, report analysis, and insurance and benefits verification. Results-oriented hard works with ability to work well with others and under pressure within deadline
Work History
Patient Care Advocate
2 Years 11 Months- Collaborated with healthcare providers to resolve patient issues, enhancing overall satisfaction and care continuity.
- Facilitated patient inquiries regarding coverage and benefits, ensuring clear communication of complex information.
- Developed educational materials for patients on plan options, improving understanding and engagement in health management.
- Streamlined processes for claims resolution, reducing turnaround time and increasing efficiency in service delivery.
- Handle high-volume inbound and outbound interactions with members, healthcare providers, and physicians regarding health coverage, benefits, and claims.
- Assist patients in navigating healthcare benefits, pharmacy options, and clinical support programs to resolve complex care or coverage issues.
- Verify insurance eligibility, process medical and pharmacy documentation, and ensure compliance with HIPAA regulations.
- Collaborate with internal operational teams and providers to expedite care delivery, decrease turnaround times, and improve patient health outcomes.
- Maintain precise, detailed electronic documentation of all member inquiries, cases, and resolutions within company systems
Customer Service
2 Years 4 Months- Processed cases to ensure timely resolution and compliance with guidelines
- Outbound calls
- Determined eligibility for coverage plans based on client needs and documentation
- Created excel sheets for data management to streamline information tracking
- Determine eligibility
- Verify Documentation
- Health and Resource Assessment for Coverage Plans
- Conducted retention calls
- Managed contractor relationships
Economics Self- Sufficiency Specialist
3 Years 8 Months- Apply the policies, procedures, and programs governing the agency
- Applied laws, rules, and regulations governing eligibility and grant determination for multiple public assistance programs, ensuring compliance in case administration.
- Plan and organize caseload to ensure work is completed in accordance with regulations relating to eligibility and timeliness.
- Detected and evaluated potential fraud, safeguarding program integrity and resources.
- Detect and evaluate potential fraudulent situations.
- Analyze and interpret written, numerical, and verbal data from various sources.
- Navigated computer screens efficiently to access required information and complete and review basic computer documents and other forms.
- Planned and organized caseload to complete work in accordance with eligibility regulations and timeliness standards.
Acting DA/ Supervisor
3 Years- Conducted hourly rounds to ensure safety and compliance¹
- Coordinated timely breaks for staff to maintain focus and morale
- Separate daily assignment sheets by shifts and by weeks
- S-common all Managers, Css, and P.d as an update throughout the shift
- Supervising eight staff as well as sixty-four residents throughout the night
Direct Support Professional
2 Years 4 Months- Documented patient care and issues to communicate findings with the supervisor
- Recorded patient intake, weight, and behavior to assess health and progress.
- Ensure that patient information is up to date within the system at all times
- Developed solutions for each client’s behavior to effectively resolve issues
Teacher Assist
2 Years 7 Months- Supervised children in classrooms, halls, cafeterias, school yards, and gymnasiums, ensuring safety and positive engagement.
- Presented subject matter to children under direction of teachers, utilizing lectures, discussions, and role-playing to enhance understanding.
- Tutored and assisted children individually or in small groups to master assignments and reinforce learning concepts.
Customer Service Inbound and Outbound
1 Year- Dealt with Health Care Spending Accounts, Dependent Care Accounts, Health Reimbursement Accounts
- Verified client payments and maintained accurate records to ensure compliance
- Performed accurate data entry tasks to maintain up-to-date records.
- Identified issues and communicated solutions to enhance client satisfaction
- Coordinate internal resolution of claims to determine the override
- Researched insurance options for patients to facilitate informed decision-making
Administrator/Coordinator
1 Year- Motivated clients to purchase packages, contributing to fundraising efforts for premature babies
- Managed client paperwork and utilized computer software for data entry tasks
- Maintained front reception area, screened visitors, and coordinated with vendors
- Ordered and delivered packages to ensure timely receipt
Certified Nurse Assist
6 Years 11 Months- Responded to calls for help, monitoring changes in patients' conditions and behaviors
- Observed and reported both physical changes and emotional cues in patients
- Monitored and recorded patients' vital signs in a clinical setting.
- Fed, bathed, dressed patients, served meals, made beds, and kept rooms clean
- Implemented procedures and programs to enhance patient care
Coordinator
7 Months- Called clients to gather required information and scheduled appointments for Medicaid and Medicare services efficiently
- Answered over 200 calls daily on multi-line phone system, directing calls to appropriate departments to ensure timely assistance
- Managed inventory and ordered supplies promptly to maintain operational readiness
Education
Bachelor of Science - Health Services Administration
- Relevant Courses
- Quality Management
- Community Health
- Medical Terminology
- Principles of Healthcare Reimbursement, Insurance, and Managed Care Plans
- GPA: 3.0
Skills
Office proficiency
Organizational skills
Time management
Healthcare knowledge
Multitasking
Patient care
First aid and safety
Problem solving
Interpersonal Skills
Timeline
Patient Care Advocate
Cigna
11.2023 - CurrentRead More
Customer Service
Aerotek
07.2021 - 11.2023Read More
Economics Self- Sufficiency Specialist
Department of Children and Family
10.2017 - 06.2021Read More
Customer Service Inbound and Outbound
Aon
09.2015 - 09.2016Read More
Direct Support Professional
Central Florida Communities
06.2015 - 10.2017Read More
Acting DA/ Supervisor
Central Florida Communities
03.2015 - 03.2018Read More
Teacher Assist
Community Coordinated Care for Children
03.2015 - 10.2017Read More
Administrator/Coordinator
March of Dimes
05.2014 - 05.2015Read More
Coordinator
Shepard Vision
01.2014 - 08.2014Read More
Certified Nurse Assist
Tech Health Care
02.2008 - 01.2015Read More
University of Central Florida
Bachelor of Science from Health Services Administration
Read More