Marcisha Turner
Pittsburgh
Summary
Talented Case Manager adept at handling high caseloads without sacrificing quality of care. Operates in high-pressure environments while recommending best resources and courses of action to benefit client needs and return each to optimal quality of life.
Overview
22
22
years of professional experience
Work History
Income Maintenance Caseworker
Department of Human Services
05.2019 - Current
- Determined if applicants met eligibility for public assistance programs.
- Operated computer and imaging equipment to retrieve and enter data into electronic case records.
- Gathered information via telephone, mail, or in person from clients applying for assistance.
- Made referrals to appropriate services.
- Scheduled appointments with applicants to gather information and explain benefits processes.
- Reviewed applications for different aid programs and determined which qualification criteria for individuals.
- Communicated with people from various cultures and backgrounds on application process.
Collection Specialist
ZOLL Services LLC
01.2015 - 05.2019
- .
- Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.
- Resolved customer disputes and disagreements through professional, calm communication to find mutually beneficial solutions.
- Identified and contacted customers with overdue accounts to address payment status.
- Documented customer payment interactions and account statuses for future reference.
- Verified compliance with relevant laws, regulations and best practices related to customer account management.
Appeals Analyst
Aetna Health Plan
02.2013 - 01.2015
- Utilized guidelines and review tools to conduct extensive research and analyze grievance and appeal issues.
- Represented highest level of expertise required to respond to regulators and media inquiries.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
Provider Advocate
UPMC Health Plan
03.2011 - 02.2013
- Perform duties to act as a liaison between providers, the health plan and corporate including investigating and resolving provider claims issues.
- Duties included explaining claims processing procedures: explaining amounts of claim payments reasons for denials; determining necessity for referring claims for review, or re-review.
- Served as primary contact for providers serving as a liaison between the provider and the health plan.
- Receive and respond to external provider related issues.
- Initiate entry or change of provider related database information.
- Recommend changes in pricing subsystems.
- Investigate and communicate provider changes.
- Educate providers regarding policies and procedures related to referrals and claims submission; web site education, EDI solicitation and problem solving (liaison responsibilities).
Senior Account Rep
UPMC Corporate
04.2007 - 12.2010
- Billing and collections experience for in and out-patient hospital services rendered.
- Resolved insurance denials for timely claims processing collections and insurance verification (commercial, Medicaid, Medicare), ICD 9 coding; entered and computed financial transactions into bookkeeping ledgers, initiated contact with insurance companies to ensure payments.
Insurance Verifier /Financial Counselor
UPMC Mercy Hospital
01.2003 - 04.2007
- Verified all applicable benefits for patients via online systems (HDX, UPHP, Navinet, Web MD) or by telephone call for commercial carriers.
- Obtained referrals and authorizations for patients whose insurance carrier requires one for the specific service.
- Contacted patients in regards to benefit issues, non-par issues or any other potential problem identified during the insurance verification process.
- Counseled all self-pay patients for payment plans and/ or referred to the Medical Assistance application process.
Education
Associate of Science -
Community College of Allegheny County
01.2014
Skills
- Microsoft Office
- Excel
- Power Point
- Access
- Outlook
- Lotus Notes
- Customer Service
- Interpersonal Skills
- Accuracy
- Interviewing techniques
- HIPAA compliance
- Policy interpretation
Administrative Skills
- Microsoft Office
- Excel
- Power Point
- Access
- Outlook
- Lotus Notes
Timeline
Income Maintenance Caseworker
Department of Human Services
05.2019 - Current
Collection Specialist
ZOLL Services LLC
01.2015 - 05.2019
Appeals Analyst
Aetna Health Plan
02.2013 - 01.2015
Provider Advocate
UPMC Health Plan
03.2011 - 02.2013
Senior Account Rep
UPMC Corporate
04.2007 - 12.2010
Insurance Verifier /Financial Counselor
UPMC Mercy Hospital
01.2003 - 04.2007
Associate of Science -
Community College of Allegheny County
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