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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Ash CircleCasselberry, Florida Street Address
Phone: PHONE NUMBER AVAILABLEEMAIL AVAILABLEObjectiveLooking for a position in Healthcare Administration field to provide high quality service based on my 15 years of experience working as an Admission Coordinator, Utilization Management intake coordinator, Insurance Specialist, and Patient Financial Services.SkillsFully bilingual English and Spanish, able to communicate verbally and in writing.Proficient in MICROSOFT OFFICE.Experienced Data Entry capable to type over 40 wpm.Experienced in working with medical programs such as MEDITEC, JIVA, and other administrative medical related programs.Organization skills, detail oriented, interpersonal skills, self-motivated, multi-tasking, costumer oriented.Hard working, highly motivated team player, and leadership skillsExperienceUtilization Management/Intake CoordinatorCareplus Health Plans Doral, Florida November 2019- March 2024Responsible for being the first point of contact for addressing Providers queries, entering administrative authorization data for members, and ensuring accurate documentation into the system. Processing incoming authorizations via fax, phone, and online portal. Working at a high level of productivity-55 to 75 daily authorizations. Duties involved the following:Processing in-patient and out- patient authorization request.Review and approve request based on Health Choice establish guidelines, if determination not made forward the prior authorization request to Nurse or Medical Director.Fax decision to requesting providers. Enter appropriate authorizations and notify providerPrepare member denial letter following final decision of Medical Director.Complete processing within establish time frames.Incoming and outcoming callsProcessing Durable Medical EquipmentHome Infusion/injectable MedicationHome Health CareComplex Kids RequestsICD and Dg codesMedicare/Medicaid coordination of benefits.UM ADMINISTRATIVE COORDINATORCarePlus Health Plans Miami, Florida September 2019 March 2024Performed various patient interviewing upon registration and pre- admission. Provide efficient and complete collection of demographic and financial information. To ensure effective billing and collection of revenue from all patients requiring outpatient and inpatient services. Perform financial screening and pre-registration, functions as a point of contact. Determine the patient financial responsibility and credit level an initiates collection process. Verifies insurance and third-party information in order to assure funding and settlement of patient accounts. Refers patient to the Department of Financial Services for Financial Assessment and Determination of eligibility. Facilitates pre-certification and authorization for designated payers prior to the appointment. Completes cross-training to assist in other potential service department. Maintain patient appointment logs and productivity reports as assigned. Maintain a working knowledge of basic medical terminology and inter-department functions. Input and retrieves data on personal computer as needed. Prepare and ensure proper documentation of the patient account package including designated hospital forms and copies of required documentation. Ensure that the registration documents are scanned. Verified eligibility and authorization from insurance companies. Assists with the coordination of audits and refunds according to Patient Finance Services guidelines and contractual agreements. Interact with hospital affiliated with agencies and all County, State and Federal Agencies. Assisted all patients with their accounts. Reconciles daily account flow for future admission procedure. Follow up with accounts in the Patient Benefit System. Coordinates financial clearance for potential transfer to JMH. Responding to billing inquiries as needed. Perform charge entry, patient check in and out as applicable. Develops third party funding and or evaluates patient for referral to public medical assistance programs.Medical Insurance SpecialistPARALLON BUSINESS SOLUTIONS Miramar, FL October 2013February 2015Verify members eligibility and benefits. Obtain members demographic and enter correct information to data base. Pre-registration for outpatient or inpatient services in coordination with facility. Advise member with financial responsibility and collect.Admissions CoordinatorKINDRED HEALTHCARE INC Coral Gables, FL March 2007 - March 2013Working with clinical liaison on field, receiving incoming referral for potential admissions. New patient registration. Interview persons by telephone, mail, in person, or by other means for the purpose of completing forms, applications, or questionnaires. Ask specific questions, record answers, and assist persons with completing admissions forms. May sort, classify, and file forms.Communicated clearly and concisely within the department and with other hospital departments. Processed new intake patient, entering hospital admission documents, insurance verification, assisting patient with financial responsibility for payments or payment arrangements, admission consents, provide information on admission policies procedures for patients or family members. Interacted professionally with patient and families, provide explanation and reassurance when necessary. Prepared patient chart which will include gathering I.D. card insurance card admission documents which were delivered to correct nursing unit. Notify department of any special medication or procedure such as dialysis, PCA pump surgery or ventilator.EducationCompu-Med Vocational School January 2003Medical Assisting (Vocational School Certificate)Caribbean University January 1991Business Administration (Associates Degree)References Available on Request |
