Virginia Bennett
Temple Terrace,Florida
Summary
Highly motivated and experienced professional seeking a challenging role in Utilization Management. I aim to leverage my extensive knowledge of healthcare operations, medical coding, and regulatory compliance to optimize resource allocation and ensure the delivery of high-quality patient care. With a keen eye for detail and a strong commitment to efficiency, I strive to contribute to the success of the organization by implementing effective utilization strategies, reducing costs, and enhancing overall healthcare outcomes.
Overview
10
10
years of professional experience
Work History
Vice President of Marketing -PRN
OhmyNailz
07.2020 - Current
- Used Canva and Postermywall.com to create flyers/QR codes.
- Built a network of potential customers using Twitter, Google, Facebook, Yelp, YouTube, and Instagram.
- Created content including videos, articles, professional photos and business resources.
- Created original content daily to meet article requirements and goals
- Attained a client retention rate of 65%.
- Worked with clients to discuss their needs and provide services.
Licensed Sales Agent
Rate Quote Direct
03.2023 - 07.2023
- Assisted ACA recipients by providing them with solutions to general healthcare, dental, and vision needs
- Interviewed prospective clients to learn about their needs, discuss any existing coverage, then present and clearly explain insurance policy options based on those stated needs
- Built and maintained a book of business through effective use of inbound and outbound leads, and consistent client follow up
- Managed multiple CRMs and research tools simultaneously through effective organization and multitasking.
Sales Associate-Contractor
Publishing Concepts Inc
01.2023 - 03.2023
- Worked from home generating sales from 40-50 inbound and outbound calls daily
- Pitched products and created value propositions to clients
- Updated client's contact records for their school or organization’s directory
- Collected stories and conduct interviews for Oral History Projects.
- Sold directories, Oral History Projects, and alumni products (such as hats, travel bags, and apparel).
Licensed Sales Agent -Contractor
GetHealthe
06.2022 - 12.2022
- Assisted Medicare recipients by providing them solutions to their medical, dental, vision, pharmaceutical, and general healthcare needs
- Interviewed prospective clients to learn about their needs, discussed any existing coverage.
- Presented and clearly explained insurance policy options based client's needs.
- Built and maintained a book of business through effective use of inbound and outbound leads, and consistent client follow-up.
Licensed Health Insurance Sales Agent -Contractor
CVS/ Aetna-Rose International
07.2021 - 05.2022
- Assisted Medicare recipients by providing them solutions to their medical, dental, vision, pharmaceutical, and general healthcare needs
- Interviewed prospective clients to learn about their needs, discuss any existing coverage, then present and clearly explain insurance policy options based on those stated needs
- Built and maintained a book of business through effective use of inbound and outbound leads, and consistent client follow up
- Managed multiple CRM's and research tools simultaneously through effective organization and multitasking
- Achieved elevated levels of enrollments through extensive product knowledge, thorough
Claims Representative
Anthem, Apple One Staffing
01.2020 - 05.2020
- Researched rates for specific healthcare procedures, doctor visits, prescriptions, and immunizations
- Ensured timely delivery of payments to clients and medical providers
- Flagged claims that may be eligible for third-party recovery
- Worked with other professionals such as lawyers, physicians, and other Anthem employees on claims that require more research or attention
- Investigated insurance claims or assist with coordinating an investigation
Licensed Health Insurance Sales Agent-Contractor
Wipro Ltd
10.2019 - 12.2019
- Answered 50-60 incoming phone calls from prospective members
- Identified needs analysis and information identify customer needs
- Completed all necessary paperwork, documentation
- Performed Follow-up in accordance with Case Management Services
- Screened applicant eligibility and reviewed applications.
Senior Process Executive
Cognizant Technologies
01.2017 - 09.2019
- Answered 50-90 inbound calls through call center queue daily
- Enforced HIPAA/ and compliance on all calls
- Verified information on applications for policy reinstatement and approval eligibility
- Reviewed, researched, investigated, and escalated claims.
- Collaborated with peers to measure ongoing process performance, enacting changes based on historical data
- Supervised meetings to maintain interdisciplinary communication of process weaknesses and performance
- Oversaw change management duties during new business process onboarding, reducing productivity interruptions
- Provided strategic and operational recommendations for improvement across departments
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Performed admission reviews based for medical necessity based upon specification.
- Evaluated patient histories, complaints, and current symptoms.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
- Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
- Conveyed treatment options, diagnosis information and home care techniques to patients and caregivers to continue care consistency.
- Participated in all steps of utilization management.
Workers Compensation Coordinator (Contractor)
Health Integrated
01.2016 - 01.2017
- Worked within a claims team, using the latest technology
- Managed an assigned caseload of routine to moderately complex claims
- Helped making decisions about liability/compensability, evaluating losses, and negotiating settlements
- Interacted with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claims management process.
Call Operations Generalist –Contractor
Frontier Communications, Collabera Staffing Agency
03.2016 - 12.2016
- Answered 50-90 incoming calls through call center queue
- Assisted in the development and implementation of consistent workflows and procedures
- Improved customer satisfaction by identifying trends, problems, and barriers
- Provided insight and made recommendations for resolution
- Created work orders for contractors, scheduling work with customers, sending customer letters.
Licensed Sales Producer- Contractor
Humana
07.2015 - 11.2015
- Assisted with educating members about manager care rules
- Answered 60-70 inbound calls from prospective clients
- Sold Medicare Advantage plans, prescription drug, dental, vision, and supplemental policies to clients
- Advised customers through precise communication which insurance plans best suited their needs
- Provided members with premiums, effective dates, policy terminations, and policy information.
Subject Matter Expert/Team Lead- Contractor
Express Scripts, Mindlance Staffing Agency
10.2014 - 06.2015
- Worked with multiple insurance companies using their guidelines to approve medication.
- Analyzed prescriptions written by doctors to determine if prior authorization was needed.
- Researched and stay current on all new medications and companies providing them.
- Performed investigations for prescriptions written to ensure proper usage.
- Assisted with training employees and keeping other personnel updated on guidelines.
- Assisted with project management.
Health Insurance Member Representative -Contractor
Health Plan Services, Aerotek Staffing Agency
03.2014 - 10.2014
- Answered 50-60 calls daily through thecall center queue
- Recorded, utilized, evaluated financial information stored in computers
- Educated members about the coordination of benefits
- Issued renewal letters, ID cards, and multiple correspondences
- Discussed billing invoices in depth.
- Researched and identified innovative solutions to acquire resources and meet customer needs
- Negotiated fees and contracts to reach mutually beneficial agreements with clients
- Delivered outstanding service to customers to maintain and extend relationships for future business opportunities
- Consulted with customers to assess needs and propose optimal solutions
- Collaborated with clients to define project requirements and deliverables
Outpatient Diagnostic Facility Scheduler/Front Desk Assistant
Independence Park Imaging Center, Glenn Allen
06.2013 - 02.2014
- Verified that all diagnostic test orders are correct prior to processing
- Obtained insurance authorization for tests to be performed
- Responded to inquiries regarding pending authorizations and exams
- Monitored and tracked all reports to ensure TOI and ensured thephysician received them.
Education
MBA - Healthcare Administration Management
Columbia Southern University
Orange Beach, AL02.2021
Bachelor's - Healthcare Administration Management
Columbia Southern University
06.2019
Skills
- Billing Procedures
- New Agent Training
- Insurance Coverage Verification
- Form Completion and Submission
Affiliations
The National Society of Leadership and Success May 2016- Present
Trained in leadership and success skills via an introspective and interactive training session.
Participated in seminars led by celebrities and selling authors on topics such as leadership time management, and goal setting.
Participated in peer- based leadership development teams.
Experience in setting, achieving goals, receiving coaching, coaching others, and holding others accountable to commitments.
Timeline
Licensed Sales Agent
Rate Quote Direct
03.2023 - 07.2023
Sales Associate-Contractor
Publishing Concepts Inc
01.2023 - 03.2023
Licensed Sales Agent -Contractor
GetHealthe
06.2022 - 12.2022
Licensed Health Insurance Sales Agent -Contractor
CVS/ Aetna-Rose International
07.2021 - 05.2022
Vice President of Marketing -PRN
OhmyNailz
07.2020 - Current
Claims Representative
Anthem, Apple One Staffing
01.2020 - 05.2020
Licensed Health Insurance Sales Agent-Contractor
Wipro Ltd
10.2019 - 12.2019
Senior Process Executive
Cognizant Technologies
01.2017 - 09.2019
Call Operations Generalist –Contractor
Frontier Communications, Collabera Staffing Agency
03.2016 - 12.2016
Workers Compensation Coordinator (Contractor)
Health Integrated
01.2016 - 01.2017
Licensed Sales Producer- Contractor
Humana
07.2015 - 11.2015
Subject Matter Expert/Team Lead- Contractor
Express Scripts, Mindlance Staffing Agency
10.2014 - 06.2015
Health Insurance Member Representative -Contractor
Health Plan Services, Aerotek Staffing Agency
03.2014 - 10.2014
Outpatient Diagnostic Facility Scheduler/Front Desk Assistant
Independence Park Imaging Center, Glenn Allen
06.2013 - 02.2014
MBA - Healthcare Administration Management
Columbia Southern University
Bachelor's - Healthcare Administration Management
Columbia Southern University
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