Janice Cotton
Phoenix,AZ
Summary
Customer Service professional with over seven Years of experience providing support in the healthcare industry. Skilled in patient registration, scheduling, case management, and problem resolution. Excellent organizational and communication skills with great attention to detail. Has a passion for helping others and has a welcoming and friendly phone presence. 3 Years of experience as a Case manager- Experienced in Crisis situations with individuals with SMI, assessing behaviors, deescalating and coordination of care. Support day-to-day program operations with expertise in records management and resource coordination. Skillfully meet diverse needs and address issues to maintain efficiency and program outreach. Demonstrated success in building long-lasting relationships.
Overview
10
10
years of professional experience
Work History
Provider Customer Service II
Premera Blue Cross
09.2023 - Current
- Provide direct support to providers regarding eligibility, coordination of benefits and claim status
- Research claims, payment policies and explain how benefits applied
- Verify provider network status
- Check procedure and diagnosis codes and determine prior authorization
- Provide benefits to members enrolled in the Federal Employee Program
- Assist /Educate on varies of tools created to support Providers
211 PROGRAM SPECIALIST
SOLARI
09.2024 - 11.2024
- Respond to calls from the community to identify needs and to provide the appropriate follow-up connections and resources.
- Established a robust system for tracking and reporting on key performance indicators, allowing for a data-driven approach to program enhancements.
- Document Needs, Referrals and outcomes. Connect callers to internal department based on crisis situations, housing or Veteran services.
Member Service Rep
Teladoc - Telemedicine Company
10.2017 - 02.2022
- Assist members, documented and updated medical history
- Ensured superior customer experience by addressing customer concerns
- Demonstrated empathy by resolving problems on the spot
- Register member accounts and explain membership contracts
- Schedule consultations
- Assist with prescriptions issues
- Verifying insurance eligibility
Case Manager
Terros - Behavioral Health Group
04.2015 - 09.2017
- Provide direct social and medical services to disabled individuals in the Phoenix area
- Coordinate monthly/daily schedule, treatments and training guidance for mentally challenged clients
- Recognized by the team supervisor for high quality individual service plans (ISP)
- Manage and monitor a caseload of 45 clients in according state regulation
- Connect w/proper resource channels to secure temporary housing for clients until gainfully employed
- Use NextGen software database to verify/update medical records input medical codes demographics and insurance information manages electronic and scheduling systems for reporting formats
- Schedule and lead cross-functional patient health care team meetings
- Create email correspondences to internal and external customers
- Received several compliments from customers and visitors for handling sensitive interactions with courtesy, diplomacy and respect
- Lead weekly group classes to patients multiple times a week
- Interact with individuals of diverse backgrounds on a daily basis
Education
Diploma -
Saint Paul Public Schools
01.2005
Arizona State University
Tempe, AZSkills
- Behavioral Health
- Medical Coding
- Credit Analysis
- Account Analysis
- Case Management
- Member/ Provider Services
Timeline
211 PROGRAM SPECIALIST
SOLARI
09.2024 - 11.2024
Provider Customer Service II
Premera Blue Cross
09.2023 - Current
Member Service Rep
Teladoc - Telemedicine Company
10.2017 - 02.2022
Case Manager
Terros - Behavioral Health Group
04.2015 - 09.2017
Diploma -
Saint Paul Public Schools
Arizona State University
Similar Profiles
JOHN W. COOPERJOHN W. COOPER
Senior Software Development Engineer IV at Premera Blue Cross Of WashingtonSenior Software Development Engineer IV at Premera Blue Cross Of Washington
Anthony CoballesAnthony Coballes
Insurance Sales Agent at Premera Blue Cross Of WashingtonInsurance Sales Agent at Premera Blue Cross Of Washington
Rachel DooleyRachel Dooley
Claims Representative at Premera Blue Cross Of WashingtonClaims Representative at Premera Blue Cross Of Washington