Melanie Grace

Unit 12 #34 Sta. Maria St. Kapitolyo Pasig City -- OBJECTIVE: __________________________________________________________________________________________________________________________________________________________________ To enhance my knowledge and capabilities as a person who has the willingness and passion to work for a full-time position that your company offers. QUALIFICATIONS: __________________________________________________________________________________________________________________________________________________________________ Registered Nurse 2009 License Teacher 2006 Languages & Level: Proficient in the English Language Computer Skills: Well verse in Microsoft Office WORK EXPERIENCE: __________________________________________________________________________________________________________________________________________________________________ Lead Generation Specialist HMGRP Enterprise December 2015 – December 2016 Acquired an average of 160 leads/day Worked alongside with the sales rep and general manager. Scheduled weekly meeting with the IT managers to enhance the program we are using to create mote qualifying leads. Efficiently provide clients with necessary property information Intake Specialist Artistic Creation, Inc May 2014 – November 2015 Assign and manage daily orders in a timely fashion to ensure required turnaround time. Verify insurance eligibility for all orders. Submit prior authorizations as needed. Report and documents all critical findings. Clinical Coverage Review UnitedHealth Group November 2012 – May 2014 Delivers state-specific utilization review services to employers, third-party administrators and carriers including prospective, concurrent and retrospective reviews of the medical necessity for requested procedures. Ability to communicate in writing and verbally, all types of benefit determinations including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations. Telephonic discussion with health care providers and members to explain benefit coverage determinations and to obtain additional clinical information Acts as a resource for others with less experience Clinical Admin Coordinator UnitedHealth Group March 2012 – November 2012 Receive and coordinate all incoming calls for appropriate service. Includes those calls that need pre-certification. Determine the necessity for pre-certification of services requested based upon policy and benefit protocols, correct service center etc. Review past medical/claim history and document updates in the medical management system as appropriate. Completes first level reviews based on national, evidence-based guidelines and coordinate these reviews with our clients’ Physician Advisors. Utilization Review Nurse Genesis One BPO February 2011 – February 2012 Completes medical review and interpretation of medical record to obtain authorization of care and service. Obtain medical records from providers via phone call during initial contact, and follow up with written correspondence if necessary. Provide clear and accurate information to insurance representative, MD offices and Case managers. Medical Records Assistant September 2009 – January 2011 Files all documentation in the appropriate charts. Maintain tracking system of patient records. Communicate with physicians and other healthcare professionals to clarify diagnoses or to obtain additional information Maintain electronic health records (EHR) databases. Analyze electronic data. Maintain data on patient safety, patterns of disease, and disease treatment and outcome. EDUCATION __________________________________________________________________________________________________________________________________________________________________ Masters Degree: Pamantasan Lungson ng Maynila Masters in Nursing 2011 - 2012 Tertiary: Siena College Taytay Bachelor in Nursing 2009 University of Santo Tomas Bachelor of Secondary Education 2005 Special Awards/ Certifications: Lean Training Certificate July 2013 Satisfaction Champion 1st Quarter of 2013 Quality Audit Achiever 4th Quarter of 2012 Rising Star Award April 2012 Attendance Achiever March 2012 Mock Call Awardee March 2012