LULunie User
@lunieuser
Experienced member advocate with 5+ years in healthcare customer service.
United StatesWhat I'm looking for
I am a dedicated member advocate with over five years of experience in the healthcare sector, specializing in customer service and credentialing. My journey began as a Customer Service Representative, where I honed my skills in resolving member grievances and ensuring access to necessary healthcare services. This role ignited my passion for helping others and laid the foundation for my career in healthcare.
Currently, I serve as a Credentialing Specialist I at Centene Corp, where I perform re-credentialing activities in compliance with NCQA standards. My ability to communicate effectively with physicians and providers has been crucial in gathering necessary information and ensuring smooth operations. I thrive in fast-paced environments and am committed to maintaining high-quality standards while meeting production goals.
Throughout my career, I have taken on various roles that have allowed me to develop a robust skill set, including data entry, training new hires, and managing authorization processes. I am eager to continue my professional growth and contribute to a team that values excellence in member advocacy and customer service.
Experience
Work history, roles, and key accomplishments
Credentialing Specialist I
Centene Corp
Jan 2024 - Present (1 year 5 months)
Performed re-credentialing activities according to plan specifications and in compliance with NCQA standards. Communicated professionally with physicians, office managers, providers, and other third parties to secure needed information.
Referral Specialist II
Centene Corp
Mar 2022 - Dec 2023 (1 year 9 months)
Monitored and processed documents within FileNet Application and completed authorizations within TruCare Cloud. Verified member eligibility and benefits, initiating authorization processes per provider requests.
Referral Specialist I
Centene Corp
Feb 2020 - Mar 2022 (2 years 1 month)
Monitored and processed documents within the content navigator and completed authorization tasks within Trucare. Verified member eligibility and benefits, and trained new hires on onboarding and authorization building.
Customer Service Representative
Centene Corp
Jul 2019 - Feb 2020 (7 months)
Received and responded to member complaints and formal grievances, identifying and resolving potential access barriers. Participated in local community organizations to acquire knowledge regarding special healthcare needs.
Patient Navigator
Commcare Specialty Pharmacy
Jan 2017 - Dec 2019 (2 years 11 months)
Performed prior authorizations for patients, contacting physician offices and insurance companies to obtain necessary patient details. Coordinated with patients' physicians and processed billing payments.
Customer Service Advocate
EmblemHealth
Jan 2014 - Dec 2017 (3 years 11 months)
Responded to telephone inquiries regarding contractual benefits and explained health insurance benefits to members. Assisted with the selection and assignment of Primary Care Physicians and created Service Request Tickets.
Customer Account Executive
Comcast
Jan 2013 - Dec 2014 (1 year 11 months)
Received incoming calls from customers, thoroughly checking statements for charges or concerns. Set up appointments for technician visits and provided accurate notations on accounts.
Education
Degrees, certifications, and relevant coursework
Johnson & Wales University
A.A.S, Business Administration
Studied Business Administration at Johnson & Wales University. Gained foundational knowledge in business principles and practices.
University of Central Florida
Accredited Claims Adjuster 6-20 license, Claims Adjusting
Obtained an Accredited Claims Adjuster 6-20 license from the University of Central Florida. This credential supports expertise in claims adjustment.
Tech stack
Software and tools used professionally
Availability
Location
United StatesAuthorized to work in
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