Managed Care Recertification Specialist
Resume Work Experience Examples & Samples
Overview of Managed Care Recertification Specialist
A Managed Care Recertification Specialist is responsible for ensuring that patients continue to receive the necessary medical care and services as outlined by their health insurance plan. This role involves reviewing and verifying patient information, coordinating with healthcare providers, and ensuring compliance with insurance regulations and policies. The specialist must have a strong understanding of healthcare policies and procedures, as well as excellent communication and organizational skills.
The role of a Managed Care Recertification Specialist is crucial in maintaining the continuity of patient care and ensuring that patients receive the appropriate level of service. This position requires a high level of attention to detail, as well as the ability to work independently and manage multiple tasks simultaneously. The specialist must also be able to work effectively with other healthcare professionals and insurance providers to ensure that patients receive the best possible care.
About Managed Care Recertification Specialist Resume
A Managed Care Recertification Specialist resume should highlight the candidate's experience in healthcare administration, as well as their knowledge of insurance policies and regulations. The resume should also emphasize the candidate's ability to communicate effectively with healthcare providers and insurance companies, as well as their attention to detail and organizational skills.
The resume should also include any relevant certifications or training, as well as any experience working with specific insurance plans or healthcare providers. The candidate should also highlight any experience with patient care or case management, as this demonstrates their understanding of the importance of continuity of care.
Introduction to Managed Care Recertification Specialist Resume Work Experience
The work experience section of a Managed Care Recertification Specialist resume should highlight the candidate's experience in healthcare administration, as well as their knowledge of insurance policies and regulations. The candidate should also highlight any experience working with specific insurance plans or healthcare providers, as well as any experience with patient care or case management.
The work experience section should also include specific examples of the candidate's ability to manage multiple tasks simultaneously, as well as their ability to work independently and communicate effectively with healthcare providers and insurance companies. The candidate should also highlight any experience with data analysis or reporting, as this demonstrates their ability to track and monitor patient care and compliance with insurance policies.
Examples & Samples of Managed Care Recertification Specialist Resume Work Experience
Managed Care Recertification Specialist
CareFirst, Managed Care Recertification Specialist, 2010 - 2012. Reviewed and analyzed member data to determine eligibility for recertification. Collaborated with cross-functional teams to streamline recertification processes.
Managed Care Recertification Specialist
UnitedHealthcare, Managed Care Recertification Specialist, 2006 - 2008. Conducted thorough reviews of member files to ensure accurate and timely recertification. Reduced recertification errors by 25% through enhanced training and process improvements.
Managed Care Recertification Specialist
HealthCare Plus, Managed Care Recertification Specialist, 2014 - 2016. Conducted comprehensive reviews of member files to ensure compliance with recertification requirements. Achieved a 98% accuracy rate in recertification processes.
Managed Care Recertification Specialist
WellCare, Managed Care Recertification Specialist, 1984 - 1986. Managed recertification for a diverse member population, ensuring compliance with all regulatory requirements. Improved recertification accuracy by 30% through process improvements.
Managed Care Recertification Specialist
BlueCross BlueShield, Managed Care Recertification Specialist, 2004 - 2006. Managed recertification for a large member population, ensuring compliance with all regulatory requirements. Implemented a new tracking system that improved recertification efficiency by 20%.
Managed Care Recertification Specialist
Aetna, Managed Care Recertification Specialist, 2002 - 2004. Conducted comprehensive reviews of member files to ensure compliance with recertification requirements. Achieved a 99% accuracy rate in recertification processes.
Managed Care Recertification Specialist
WellPoint, Managed Care Recertification Specialist, 1994 - 1996. Conducted comprehensive reviews of member files to ensure compliance with recertification requirements. Achieved a 98% accuracy rate in recertification processes.
Managed Care Recertification Specialist
Coventry Health Care, Managed Care Recertification Specialist, 1992 - 1994. Managed recertification for a diverse member population, ensuring compliance with all regulatory requirements. Improved recertification accuracy by 25% through process improvements.
Managed Care Recertification Specialist
ABC Health Services, Managed Care Recertification Specialist, 2018 - Present. Responsible for ensuring compliance with state and federal regulations for managed care organizations. Successfully recertified over 500 members, reducing recertification errors by 20%.
Managed Care Recertification Specialist
Molina Healthcare, Managed Care Recertification Specialist, 1988 - 1990. Managed recertification for a large member population, ensuring compliance with all regulatory requirements. Implemented a new tracking system that improved recertification efficiency by 30%.
Managed Care Recertification Specialist
HealthPartners, Managed Care Recertification Specialist, 1980 - 1982. Managed recertification for a large member population, ensuring compliance with all regulatory requirements. Implemented a new tracking system that improved recertification efficiency by 35%.
Managed Care Recertification Specialist
Cigna, Managed Care Recertification Specialist, 2000 - 2002. Managed recertification for a diverse member population, ensuring compliance with all regulatory requirements. Improved recertification accuracy by 20% through process improvements.
Managed Care Recertification Specialist
Centene Corporation, Managed Care Recertification Specialist, 1986 - 1988. Conducted comprehensive reviews of member files to ensure compliance with recertification requirements. Achieved a 99% accuracy rate in recertification processes.
Managed Care Recertification Specialist
Humana, Managed Care Recertification Specialist, 1998 - 2000. Conducted thorough reviews of member files to ensure accurate and timely recertification. Reduced recertification errors by 30% through enhanced training and process improvements.
Managed Care Recertification Specialist
Amerigroup, Managed Care Recertification Specialist, 1982 - 1984. Conducted thorough reviews of member files to ensure accurate and timely recertification. Reduced recertification errors by 40% through enhanced training and process improvements.
Managed Care Recertification Specialist
HealthSpring, Managed Care Recertification Specialist, 1990 - 1992. Conducted thorough reviews of member files to ensure accurate and timely recertification. Reduced recertification errors by 35% through enhanced training and process improvements.
Managed Care Recertification Specialist
MediCare Services, Managed Care Recertification Specialist, 2012 - 2014. Coordinated with healthcare providers to gather necessary documentation for recertification. Developed a training program that reduced recertification processing time by 10%.
Managed Care Recertification Specialist
Kaiser Permanente, Managed Care Recertification Specialist, 1996 - 1998. Managed recertification for a large member population, ensuring compliance with all regulatory requirements. Implemented a new tracking system that improved recertification efficiency by 25%.
Managed Care Recertification Specialist
XYZ Health Solutions, Managed Care Recertification Specialist, 2016 - 2018. Managed a caseload of 300 members, ensuring timely and accurate recertification. Implemented a new tracking system that improved recertification efficiency by 15%.
Managed Care Recertification Specialist
HealthNet, Managed Care Recertification Specialist, 2008 - 2010. Managed recertification for a diverse member population, ensuring compliance with all regulatory requirements. Improved recertification accuracy by 15% through process improvements.
View Examples for Other Jobs：
