| | | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidateCandidate's Name
Key SkillsMedical Office /Medical RecordsCustomer Service / Medical AssistantCommunication/Public RelationsEducation ManagementMicrosoft Office SuiteRecords Organization & ManagementTraining & DevelopmentInsurance VerificationSchedulingExcelProfessional ExperienceProgram SpecialistJanuary 2008- Present, (part-time)Open Arms Care CorporationMaintains updated information on clerical call date, non-count clinics (community care), patient complaints, and consult management.Responsible for scheduling as well as overseeing all scheduled appointments for the respective section while interpreting and verifying provider orders in accordance with national scheduling guidelines.Provides guidance to their respective sections concerning changes in policies and procedures, distribution, and balance of workload, creating and maintaining work schedules. assigning and evaluating the work of subordinate staff; resolving complex problems to ensure patient services are met; evaluating new products, equipment, and systems to make recommendations for improved operations.Investigate patients' problems, suggestions and manage complaints by reporting outcome to the Patient Advocate.clerical call data, clinic availability, clinic cancelations, setup of clinics, patient complaints, consult management, extracting and analyzing data to provide reports in support of performance measures to senior management.Certify timecards for Clinical Programs, maintaining time and leave records as needed and directed by position supervisor.Coordinates preparation for internal and external review programs by understanding organization objectives, structure, policies, processes, internal controls, and external regulations.Ability to excel in a fast-paced high performing environment.Consistently communicates and treats customers.Drafting standing operation procedures(sops). Skillfully organizing and directing mental health team with directions of teamwork using management techniques.Insurance Verification (Remote)Adams Bridge-NashvilleNov. 2021-April 2022,Review and assess medical records, credit reports and other documents to determine eligibility for coverage.Monitor and analyze existing policies to ensure compliance with regulations.Minimize the risk for security-providing firms/companies claims based on software model and other criteria.Handle conflicting goals, objectives, priorities, timelines, and deadlines.Validate claims for billing purposes ensuring eligibility and referring questionable coding for reviewer.Submit claims to 3rd party health Insurance Carriers, with knowledge of Medicare coverage benefits.Use a wide range of office software applications such as Microsoft Access, Excel, and Word.Patient InterviewerHealthStream-Nashville, TNJune 2016-July 2019Accountable an intermediate/expert skill level in use and navigation of a Patient Record System.Utilize data integrity of various systems, pulling reports, gathering data, labor mappings, and preparing correspondence.Coordinates preparation for internal and external review programs by understanding organization objectives, structure, policies, processes, internal controls, and external regulations.Accountable outpatient processing, medical record creation, content and format, workload data capture.Following up with study coordinators, and others regarding the forms required for their submission, and working with the others to finalize the submissions.Retrieving and analyzing training data that is used to prepare training compliance and status reports.Responding to electronic inquiries received by email or internet in a timely manner, reviewing and verifying inpatient and outpatient service records, communicating with customers using a high degree of tact, diplomacy, and compassion.Use a wide range of office software applications such as Microsoft Access, Excel, and Word.Medical Office CoordinatorEviCoreJune 2018-April 2019Answer incoming calls from healthcare plan members and providers while utilizing windows and web-based applications to provide accurate information to customers on all calls.Contact and engage existing members on the telephone regarding their enrollment and benefits.Use conflict resolution skills to handle escalated issues to achieve satisfactory resolution with patience and empathy.Complete entries on specific reasons for calls, and resolutions achieved, into internal file database on all calls with great attention to detail.Handling customer service calls from members, providers, and client representativesDistributed and balanced workload while creating and maintained work schedules, orients, and provides on-the-job training for new and current employees.Ensures all training requirements are met and provides guidance to staff members to include changes in policies and procedures.Analyzing problems brought forth during phone inquiry and applying appropriate resolutions.Confer with third party insurance companies and agents about patients medical benefits in detail and collect the necessary copayments.Work with Analysts and other departments to research problemsEstablishing and maintaining professional rapport with clients and providersOutbound Customer Service RepresentativeAtlas Management/Comcast NashvilleMay 2017 June 2018Maintains record keeping and filing system in accordance with departmental system, classifies, sorts and files correspondence, records, and other documents accordingly.Answer telephones, takes, and relays information and messages, also answer routine questions regarding hospital and departmental operations, policies, and procedures.Purges files in accordance with policyAnalyzing problems brought forth during phone inquiry and applying appropriate resolutions.Signs out and returns record correctly in the computer tracking system.Maintaining and assuring accuracy of documentationTag/enter deficiencies into the Meditech deficiency system and prepare suspension letters and completes mailing process.Ability to learn claim processing as well as adjustments.Establishing and maintaining professional rapport with clients and providersEducation & OrganizationsHealthcare Administration l University of Phoenix l 2012Medical Assistant Diploma l Kaplan Career College l 2006High School Diploma l Pearl Cohn High School l May 2003Certified in First Aid & CPRTechnology SummaryMS Office (Word, Excel, Outlook, PowerPoint) l Electronic Medical Records l |
