A Medical Management Specialist plays a critical role in the coordination of care, and helps facilitate the processing of cases and act as a conduit of information within the agency and outside resources. Work activities found on the Medical Management Specialist Resume are – managing the medical offices, overseeing the staff, handling business affairs, liaising with the emergency room, implementing health and wellness programming to all employees, and writing press releases; collaborating with medical directors, and representing the organization in scientific fora.
In order to become a Medical Management Specialist, it is mandatory to possess the following skills – knowledge of medical terminologies, communication expertise, the ability to multitask; being able to stay calm under pressure; and decision-making skills. Successful resumes in the field make a display of a degree in a relevant field, and prior office management experience.
Summary : An experienced, self-motivated and results oriented customer service supervisor with 10 years of experience in the Healthcare Industry. Consistently achieved and exceeded performance standards. Dedicated to promoting the delivery of world class service and making operational, process improvements that lead to increased productivity, cost savings and positive team morale.
Skills : Documentation Skills, Data Entry.
Description :
Coordinated, authorized, fulfillment, reporting, monitoring and tracking of services.
Responsible for responding to inquiries from Members and Providers to clarify benefits, provide member education and member referrals.
Established working relationships with referral sources, providers, community agencies and vendors to proactively coordinate access to services.
Maintained and supported documentation, logs and data entry to monitor activity and/or outcomes related to care coordination services in an accurate and timely manner.
Documented all pre-certification and authorization requests as well as member encounters utilizing the appropriate systems and resources.
Initiated contact with assigned individuals/personal representatives, guardians and providers to determine member's response to services.
Completed initial screening and makes outreach calls to members.
Experience
7-10 Years
Level
Management
Education
BS In Criminal Justice/Forensic
Medical Management Specialist Resume
Headline : To gain experience through a Medical Management Specialist position that would allow me to use my knowledge, which I have acquired through my academics and work experience.
Skills : Proficient in Microsoft Word, Excell, Outlook, Powerpoint. Strong Interpersonal .
Description :
Gathered clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review).
Provided information regarding network providers or general program information when requested.
Reviewed and assisted with complex cases.
Acted as liaison between Medical Management and/or Operations and internal departments.
Coordinated follow-up care plan needs for members by scheduling appointments or enrolling members in programs.
Assessed member compliance with medical treatment plans via telephone or through on-site visits.
Identified barriers to plan compliance and coordinates resolutions.
Experience
5-7 Years
Level
Executive
Education
Bachelors Of Arts
Medical Management Specialist Resume
Summary : Responsible for providing non-clinical support and act as the liaison between the Medical Management and/or Operation areas, including lawyers and insurance holders, for processing medical motor vehicle claims.
Skills : Managerial; Interpersonal; Psychosocial; Clinical; Care Plan Certified, Computer.
Description :
Actively collaborated with external community-based organizations to facilitate and coordinate care for children with special health care needs under the direction of an RN Case Manager.
Assisted Case manager in coordination of benefits with third party payors.
Tracked referral according to specified timelines and notifies providers and families of CCS eligibility determinations and referrals, BCC authorizations and/or deferrals.
Maintained and updated tracking databases.
Prepared UM/CM reports, documents all actions in UM/CM mainframe application and provides administrative support for UM/CM.
Handled escalated and unresolved calls, issues or correspondence for less experienced staff.
Initiated and resolved complex problems requiring technical expertise.
Experience
7-10 Years
Level
Management
Education
MS
Medical Management Specialist Resume
Objective : Medical Management Specialist with 3+ years of experience in executing support functions, assume responsibility for administrative management functions and provide key assistance in facilitating the performance of responsibilities.
Skills : Computer, Communication, People , Team Player.
Description :
Responsible for facilitating member and provider requests within the Medical Management Department.
Supported the department's business operations in developing and implementing care management services which support the Medical Management department.
Included calling members to complete health risk assessments and inputting authorization data gathered from providers in system.
Maintained the regulatory standards and department guidelines for timeliness and accuracy for telephonic contacts, correspondence and service authorizations.
Served as a liaison between CLHC and its members and providers.
Supported the department's business operations in developing and implementing care management services which support the Medical Management department.
Included calling members to complete health risk assessments and inputting authorization data gathered from providers in system.
Experience
2-5 Years
Level
Executive
Education
BA
Medical Management Specialist Resume
Headline : As a Medical Management Specialist, responsible for assisting with the development of programs of instruction and administering the department's training schedule, and also managing and be responsible for the medical surveillance program, which requires compliance with the occupational safety and health standards.
Skills : PowerPoint, Adobe Acrobat, Type 45 wpm.
Description :
Experienced handling medical management programs and health education programs.
Interfaced with internal staff and external vendors and community resources.
Developed personalized care plans.
Regularly evaluated these plans of care and update them on an as-needed basis.
Maintained the regulatory standards and department guidelines for timeliness and accuracy for telephonic contacts, correspondence and service authorizations.
May provided quality control services.
Developed, recommended and implemented training for other staff members.
Experience
5-7 Years
Level
Executive
Education
Bachelor Of Science
Medical Management Specialist Resume
Headline : Goal-directed, results-oriented professional with a strong psychological/sociological and clinical background and education. Skilled communicator, persuasive and adaptable. Self-motivated with high energy, initiative, and focus. Keen insight into the needs and views of others - able to listen and identify issues or problem areas and form innovative solutions.
Skills : Outlook, And Access, Management Skills.
Description :
Gathered clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review, provider network).
Provided information regarding network providers or general program information when requested.
Assisted with complex cases.
Acted as liaison between Medical Management team Maintains and updates tracking databases.
Prepared reports and documented all actions.
Collaborated with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager.
Excluded conducting any utilization management review activities which require interpretation of clinical information.
Experience
5-7 Years
Level
Executive
Education
Business In Administration
Medical Management Specialist Resume
Objective : To obtain a full-time position as a Medical Management Specialist. Excellent people skills. Excels in customer service and sales environment. 90 WPM typing speed. Computer literate. Experienced in all Microsoft Office products.
Skills : Data Entry, Multitasking.
Description :
Capitalized on healthcare technology to transform medical deliverables into information easily interpreted by other departments.
Focused primarily on preparing precertification requests for reviews of medical necessity to enable reimbursement of claims.
Created efficient method for verifying urgent requests which reduced labor.
Conducted fast and accurate updates into the case management system daily, keeping on top of workload without accumulating a backlog.
Performed data entry needed to transmit high volumes of case records from one system to another.
Resulted in my attainment of the team's shared volume and the ability of others to broaden their workload.
Prioritized work assignments and project tasks by determining deadlines and strategizing best approach to meet commitments.
Experience
2-5 Years
Level
Executive
Education
MS
Medical Management Specialist Resume
Summary : A highly organized, detail-oriented healthcare worker with over 15 years of experience with an extensive background with both Medical facilities and Insurance companies.
Skills : Medical Insurance Billing And Coding, Certified Nursing Assistant, Phlebotomy, Patient Care Technician, Microsoft Office, Word, And Excel.
Description :
Responsible for verification of new members into the Special Needs Program offered by Essence Healthcare.
Maintained release of health information, medical records, or other related materials to Physician offices.
Collaborated with Physician offices and members, to insure eligibilty for the program.
Conducted referral authorizations for patient specialist visits.
Updated Health Risk Assessments for the Medical Management team, as well as the Enrollment team.
Reviewed authorizations for the Medical Management team to insure proper documentation was updated for claims to be processed.
Possessed strong written and verbal communication skills.
Experience
10+ Years
Level
Senior
Education
Certification In Certified Nursing
Medical Management Specialist Resume
Headline : Skilled Medical Management Specialist professional seeking a challenging, full-time position where I can apply my education and experience to add value, efficiency, and organization to the company.
Skills : Training Skills, Investigating Skills.
Description :
Handled first party medical benefit claims, including fatalities and wage loss.
Provided excellent customer service.
Prepared related correspondence and reports.
Investigated complex coverage concern.
Assisted defense counsel in trial preparation.
Expertised in legal and medical terminology and procedures.
Assisted in training branch office personnel.
Experience
5-7 Years
Level
Executive
Education
Bachelor Of Communications
Medical Management Specialist Resume
Objective : To obtain a Medical Management Specialist position as a team player in a people-oriented organization where I can maximize my customer service experience in a challenging environment to achieve company goals.
Skills : Planning Skills, Researching Skills.
Description :
Performed claims/billing, accounts receivable collections and other billing duties.
Used EHR documentation to verify correct coding and medical necessities.
Researched and took action to resolve charges and coding issues, followed up with customers as needed.
Completed CHDP PM160s according to patient eligibility.
Maintained required billing records, reports, and files.
Completed data entry and filing, answered multi-line phones, transferred calls to appropriate staff or took messages.
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