1. Kong Her
7025 Newton Ave N, Brooklyn Center, MN 55430
763-202-9760,kxher0529@gmail.com
EXPERIENCES
Humera Staffing/ Medica Health Plans
Provider Demographic Coordinator - currently employed
 Process electronic request from providers such as adding/terminating a site to/from an existing contract
 Changing a care delivery site name or address
 Adding/terminating practitioners to/from sites
 Assist with other projects are directed
 Work with internal credentialing department to ensure all request are process accurately to ensure
accurate claims billing
Delta Global Services
Passenger Service Agent 5/2015 – currently employed
 Complete paperwork and computer entries related to boarding passengers
 Key passenger information into the ticketing reservation system
 Assist passengers with reservations, ticketing, and adjustments to itinerary
 Greet and provide necessary travel and gate information
 Inform and makes announcements to ensure important information is communicated about their
itineraries, flights and luggage
 Coordinate with internal resources to ensure flights are dispatched on time
 Assist passengers with checking in plane side luggage
CVS Health
Client Operations Consultant 11/2013 – 11/2015
 Audit daily controlled reports and provide feedback to technicians
 Provide mentoring and training
 Acts as a resource, subject matter expert for other technicians
 Train technicians on new processes and system enhancements
 Participate and prepare case files for internal audits, NCQA as well CMS audits
 Maintain error tracking log
 Assist with various department projects and audits
 Upload daily reports onto company shared webpage
 Assist with updating work instructions
 Research and resolve rejected claim issues
Subject Matter Expert
 Ensure all Aetna Medicare prior authorization requests are process in compliance with internal
processes and CMS guidelines

2.  Work with providers, pharmacies and members to obtain missing information
 Prepare untimely request (IREs); gather all pertinent documents and evidence to send it to external
agency
 Process overturns as directed by Aetna’s Appeals and Grievance department
 Monitor and respond all a request received in the Medicare Issues box
 Assign faxes and monitor workload
 Assist technicians with complex situations
 Provide coaching and training, act as a go to person
 Enter overrides into the system and perform test claims
Aerotek/Prime Therapeutics
Clinical Review Pharmacy Tech 10/2012 – 09/2013
 Ensure all faxes are processed within turnaround time
 Assist providers with initiating phone prior authorizations
 Communicate results to member and providers
 Enter prior authorizations into RXCLAIM and perform test claims
Metropolitan Health Plan
Senior Community Health Specialist 03/2007 – 10/2012
 Conduct assessments to identify the needs of families
 Help families apply for social services such as Woman, Infant & Children (WIC), Medicaid, and
Minnesota Care
 Help families navigate services available within the community
 Aide in setting up medical/dental appointments and interpreter services
 Assist families in obtaining information needed to sustain health coverage and SNAP Benefits with
the county
 Develop and maintain promotional materials, work flow processes, policy and procedures for the
department
 Host weekly meetings with the outreach department to address issues and concerns
Member Benefit /Providers Services Representative
 Respond to incoming calls from members and providers regarding benefits/prior authorizations
 Update member and providers contact information
 Assist providers with billing and claims issues
 Help members locate in-network providers and pharmacies
 Verify member’s eligibility and benefits
 Assist with gathering information concerning appeals/grievances
 Arrange medical transportation and interpreters for member as needed
Saint Theresa
Administrative Assistant 2002-2004
• Answer telephone calls and forward to the appropriate party
• Greet and direct visitors
• Update internal contact information
• Receive, sort and distribute incoming mails, packages
• Maintain the cleanliness of the main lobby
• Assist with other clerical duties such as photocopying, faxing and filing documents
• Help with ordering and stocking office supplies
Skills/Assets

3. Understanding of HIPAA
Experience working with Medicaid and Medicare claims
Understanding of medical terminology and ICD 9 codes
Clinical pharmacy background
Customer service in a call center environment
Data Entry
Experience working in healthcare
EDUCATION
North Hennepin Community College
2012 Associates of Science Business Management
2013 Certified Pharmacy Technician /Minnesota Board of Pharmacy /Pharmacy Technician Certification
Board
REFERENCES
Elvira Guzman Johnson 612 -229 -7223
Latosha Robinson 612 -701- 4573
Bradley Gerber 651-354-5429