| | | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidateCandidate's Name
Orlando, FL Street Address
EMAIL AVAILABLEPHONE NUMBER AVAILABLENewly located to the Orange County area. I have professional experience ranging from pharmacy, medical pre-certification, and customer service. I look forward to joining a company where I can share my knowledge and expertise.Authorized to work in the US for any employerWork ExperiencePre-Certification AssociateMedstar Georgetown University Hospital - Washington, DC May 2018 to July 2021 Worked with multiple insurance plans to authorization Radiation treatments and diagnostic Radiology scans Initiated authorizations and Appeals for 8 Physicians Called patients in lieu of denied treatment in order to explain to them the next phase in the process Appealed denied treatments for approval with patients health plan Informed Dr. and their team of denied treatments and coordinated peer to peer process Worked with four software systems (ARIA, MedConnect, IDX, & Invision) to perform daily functions Entered departmental charges into SMS system for claim processing Assisted manager with monthly charge reports as well as conducted audit in absence of manager Provided department with knowledge of different insurance plans, and changes that would affect patients treatment Kept up with current medical policies to ensure that patients treatments are within insurance guidelines for paymentPatient Access SpecialistCaremetx (Contractor)- MedImmune/AstraZeneca - Gaithersburg, MD June 2017 to May 2018 Perform in depth research into patients insurance, prior authorization, pharmacy coordination, and specialty distribution. Submit authorization for specialty drugs with patient health plans Communicate with payers, third party administrators, and other departments on behalf of the provider Manage day to day activities of health care providers support requests and other services Document all relevant information into the Access 360 Case Management System Escalate cases appropriately to the Team Lead and work closely to resolve complex cases Created insurance payer resources for co-workers to use for assistance in authorization Trained new employees with authorization process Medical Receptionist/Surgery SchedulerEYE DOCTORS OF WASHINGTON - Washington, DCFebruary 2014 to May 2017 Highly skilled in performing front desk duties in a healthcare setting Well-versed in greeting and interacting with patients and relatives Documented success in answering telephone calls on multi-line system Well-versed in scheduling patient appointments Able to coordinate transportation for patients Demonstrated ability to interact with patients, nurses and doctors check-in and check-out patients efficiently Able to multitask and work in a fast-paced environment Excellent customer service. Able to schedule tests and procedures and enter referrals into the system adept at managing busy waiting room Knowledge of EMR and Clearwave software Working knowledge of computers and Microsoft Windows, Word and Excel Reimbursement CounselorAerotek (Contractor)- Lash Group - Rockville, MDOctober 2016 to February 2017 Collects and reviews all patient insurance benefit information Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers Coordinates with inter-department associates to obtain appropriate medical records as they relate to the reimbursement process Reports any reimbursement trends/ delays to supervisor (billing denials, claim denials, pricing errors, payments, etc.)Medical Receptionist/Surgical coordinatorRetina Group of Washington - Washington, DCMarch 2009 to February 2015 Schedule and accurately complete full registration for patients requesting appointments adhering to policies and procedures regarding appointment scheduling and registration processes, performing these tasks accurately with attention to detail to ensure the highest quality standards. Initiate pre-registration process and ensure all demographic insurance information is accurate, complete and up to date on patients screen. Verification of insurance information, verification of benefits and insurance referral information. Verification of private patient insurance information for same day appointments or by request. Adhere to HIPPA standards related to patient privacy and confidentiality. Obtain legal photo identification and (if applicable) insurance card (s), and validate patient identity and coverage (if applicable) prior to services being rendered thereby ensuring patient safety and financial reimbursement. Assure ease of patient flow through clinical care process. Provide patients with all required information regarding appointments and payment policies (e.g. medical records, parking, cash policies, anticipated charges, cancellation policy). Intervene as liaison/advocate for patients, physicians, and staff in facilitating ease of care. Assist in identifying trouble spots and problem patterns in the provision of care. Maintain a working knowledge of medical symptoms, signs, and anatomical systems to identify and differentiate type and urgency of medical need. Maintain knowledge of insurance referral requirements to ensure access based on third party reimbursement criteria. Notify appropriate parties of the appointment time, referral criteria, insurance verification, and prior authorization requirements. Performs all above-mentioned tasks by paying attention to detail and providing excellent customer service skills with Patients, Physicians and other related members Maintains positive attitude consisting of cooperation, self-motivation, courtesy, and professionalism. Comply with company compliance policies and standards Punctual, Detail orientated, Accurate, Self-Motivated, Team Player, Fast Paced Worker Pharmacy TechnicianAlmands Drug Store - Rocky Mount, NCApril 2002 to September 2008 Enter customer prescriptions into the computer without error Inspect customers prescriptions to make sure that they are not fraudulent or forged Maintain a level of confidentiality in accordance with HIPPA Laws in regards to a customers prescription information and health status Answer multiple phone lines in a timely manner Assist customers in person and over the phone to insure satisfactory customer service Bill insurance companies and handle any claim issues by calling and getting rejections resolved in order to process claims Fax needed documents and other materials to doctor offices and insurance companies Take monetary payments from customers Maintain accurate prescription records and file them properly Teach relief pharmacist our computer system in absence of permanent pharmacist and help them run the pharmacyEducationNash Central High SchoolSkills Pharmacy Technician Experience Medical Billing Insurance Verification Medical Receptionist Medical Office Experience Medical Records Medical Terminology Multi-line Phone Systems EMR Systems Medical Scheduling Medical Coding CPT coding ICD-10 Medicare Clerical Experience HIPAA ICD-9 Epic ICD Coding Quality Assurance Cerner Customer service Microsoft Excel Microsoft Office Organizational skills Microsoft Word English Serving Restaurant experience Cash handling Accounting Experience Administering Injections Physiology Knowledge Transcription Anatomy KnowledgeAssessmentsAdministrative assistant/receptionist CompletedOctober 2021Using basic scheduling and organizational skills in an office setting Full results: CompletedIndeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field. |
