Antricia E. Email & Phone Number

Atlanta, Ga

Established 1990, My mission is to see all infants grow up into healthy adults. Our goal is to provide your infants with the finest health care possible. In a very real sense Pediatric Healthcare Management is especially proud of how well we care for our youngest members. Infants and parents are given exceptional care with exceptional expertise and skill. We provide assistance healthcare education, and infant nurturing skills as well as health products to ensure they live their life to the fullest. Educating parents with numerous tasks to care of their newborn and skills that will allow them to dealing with challenges of caring for a infant/s. PHM offers 4 to 24 hours care or 3 months to 3 year assistance to families depending on the family’s preference.

Greater Atlanta Area

Processing medical claims and payments. Research, identify and obtain data/information needed to help process claims or resolve claims issues, ensure that proper benefits are applied to every claim, identify and apply knowledge of new plans to process claims are processed appropriately. Identify and resolve claims processing errors/issues and trends, as needed, resolve or address new or unusual claims errors/ issues as they arise, applying appropriate knowledge or prior experience. Collaborate with internal business partners to resolve claims errors/issues, document and adhering to reporting requirements, achieve applicable performance metrics, apply appropriate processes and procedures to process claims (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates).

United States

Provide a bridge between healthcare system, communities and people diagnosed or at risk for diabetes. Engaging members/families telephonically to coordinate services, community resources and treatment needs. As a Community Health Navigator I function as an advocate for members while providing and gathering information from members with diabetes to provide a culturally specific basic healthier mean to a healthy lifestyle, as well as being a support system in their efforts to make changes in their daily routine. Develop a community alliance in order to meet the needs of a specific population who has been diagnosed with diabetes. Collaborating with the member’s PCP to deliver and coordinate necessary services and monitoring members test results and closing the gap and eliminating health care disparities among the members with diabetes and their providers. Conduct a health risk assessment on member as well as assisting members with any other needs and documenting cases in a timely manner. Answers inbound and making outbound call to enroll members into the wellness programs, schedule appointments, collaborating with coaches and nurses, as well as managing incoming communication calls/fax and emails and documenting all members’ related activities.

Marietta, Ga

Work with the clinical team to manage request for services from members and providers. Manage the referral process, as well as incoming and outgoing referrals; and prior authorizations, including intake, notification and census roles. Receive care coordination notification cases for non-clinical assessment and interventions and appropriate triage. Review requests for adverse determination, approval notification and processing notification requirements. Assist the clinical staff with setting up documents/triage cases for clinical coverage review as well as handling resolutions and inquiries from members and providers that include: benefits and eligibility information, customer material requests, and explanation of benefits. Compiles information to determine the status of various program activities such as medical enrollments, output, schedules appointments with nurses and maintains a status report. Responds to information requests, explains resource, services, and administrative processes. Create and updates a variety of reports while answering requests from a variety of sources, contacts originators to resolve deficiencies and maintain tracking systems. Maintain confidentiality of sensitive information under HIPPA security guild lines.

Greater Atlanta Area

Work in all facets of sales including international, domestic, military and government joint venture, as well as promotions, and vendors. Maintain accountability for meeting monthly, quarterly, and annual revenue and sales goals as well as supporting the company vision and mission. Utilize computerized tracking and booking systems vie Delta Term, Axis, when coordinating with travel agencies, airport personnel, and government entities. Maintain familiarity with and adhere to all regulatory policies and procedures. Advise customers of Delta's rules and regulations as well as Federal and State rules for flight travel. Assist passengers to resolve problems with lost baggage/lost personal items, handicap and unaccompanied minors. Contribute to customer satisfaction and company prosperity through tact, sensitivity, and professionalism. Assist in answering customer calls. Resolve all issues associated with those calls and making certain that customers are serviced properly and efficiently. Assist supervisors and managers with special projects, as needed such as the merger of Delta and Northwest Air Lines restructuring support, developing a impression of how much their manager (or supervisor) values their contributions and cares about their well-being through perceived supervisor support. Offering a clear articulation of the companies goals, encouraging employee development, and helping attain necessary information, resources, and technology use the Delta format and following a systematic, step-by step process.

Managed front line customer service activities at Hartsfield/Jackson Atlanta International Airport for DGS, as well as administered professional, courteous and timely assistance to each and every customer. Reviewed flight documents for accuracy and provided passengers with information regarding flight procedures and security measures. Maintain in compliance with ATC and FAA regulations. Effectively presented and described Airport products and services while reinforce the company’s image of quality, integrity and superior customer service. Addressed customer complaints and facilitated satisfactory resolutions.

Bachelor Of Applied Science (Basc), Health/Health Care Administration/Management

Education record

Activities and Societies: Beta Club, Future Leaders of America, Majorette, Drill Team, Office Support