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Click here or scroll down to respond to this candidateCandidate's Name
PHONE NUMBER AVAILABLE EMAIL AVAILABLE Street Address W Mowry St Chester PA, 1901Professional SummaryI bring a diverse range of skills, experience and knowledge that have been developed over the years through both my formal education and professional experience. A dedicated and enthusiastic professional with a commitment to excellence and a passion for continuous learning and development.Relevant skills Bachelors degree in health information management. Reviewing and uploading clinical documentation. Ability to maintain patient confidentiality and follow HIPAA requirements. Claim Processing. Insurance Authorization. Organizational, Detail Oriented, Accuracy. Computer proficiency Microsoft Word, Excel, PowerPoint Teams, Outlook, PDF, Brightree, ESPEXPERIENCEHealthcare Administration/ Authorization specialist, Ethos Therapy Solutions, May 2022-current. Communication: A) Routine/scheduled contact with patients to verify active and compliant use of therapy products, active insurance coverage, and active healthcare providers. B) Routine/scheduled contact with health care providers to obtain payer required documentation to maintain therapy in the home. C) Routine/scheduled contact with in-house stakeholders to coordinate necessary and timely product transitions based on patients' eligibility for specific therapy determined by insurance guidelines and coverage limitations. Documentation: Maintain accurate and real-time records of clinical visits, patient assessments, patient demographics, insurance information, authorizations, coverage details and communication trail in digital platforms or designated database. Eligibility Assessment: Assess patients' eligibility for specific therapy determined by insurance clinical/compliance guidelines and coverage or contract limitations. Insurance Reauthorization: Perform necessary and timely reauthorization of patients' insurance coverage for continued therapy in the home, including reviewing clinical/compliance eligibility criteria, insurance plans, and benefits. Escalation: Timely escalating cases that have or could result in delayed claims submission or unbilled claims such as product transitions, non-compliance, denied appeals. Claim Processing: Collaborate with the billing department to ensure accurate and timely claim submissions, including the completion of necessary documentation and adherence to insurance company requirements. Problem Resolution: Investigate and resolve insurance-related issues, such as denied reauthorization claims and delays by working closely with insurance companies, patients, healthcare providers and in-house stakeholders. Compliance: Adhere to federal and state regulations, as well as insurance policies and guidelines, to maintain accurate and ethical practices in insurance reauthorization processes.Physical Therapy Aide, Home Therapy Services, November 2021-April 2022 New Philadelphia, PAAssisted patients with knee replacement surgery. Patients who suffered from stroke Balance therapy is also known as vestibular rehabilitation therapy. It uses exercises to help patients improve symptoms of balance disorders and reduce risk of falling. Setting them on the road to recovery after a stroke or other chronic event or an injury. Improving patients' freedom of movement.Manager Trainee, CVS Pharmacy, August 2019-April 2022 New Philadelphia, PAMaintained current understanding of company offerings to better serve customers and team members.Analyzed sales, profits, and inventory to identify trends and provide recommendations. Responded to advanced issues with professional and relationship-focused approach. Monitored supplier operations to verify quality, delivery schedule and conformance to contract specifications.Maintain Customer/patients confidentiality.Barista, Starbucks, September 2016-August 2019New Philadelphia, PAGreeted guests with pleasant smiles and superior customer service. Operated cash register collected payments and provided accurate change. Described menu items to customers and suggested products based on stated preferences. Received and accurately processed customer payments. Managed inventory by establishing and adjusting ordering parameters, accurate forecasting, and monitoring waste.EDUCATION AND TRAININGBachelor of ScienceHealth Information Management, DeVry University, Fort Washington PA June 2019 High School DiplomaChester High School, Chester PA June 2014ACCOMPLISHMENT, VOLUNTEERAccomplishment received a recognition of academic achievement award from DeVry University 2017and 2018. Scoring high on Standardize test. Awarded for perfect attendance in High school.Volunteer (CVS) COVI-19 Vaccine 04/22/2021. Consistently maintained high customer satisfaction ratings. Registration and line management. Greeting and doing temperature checks. Maintaining safety and sanitation in the vaccination site. Monitoring the signing in and out of other volunteers as well as their designations.Volunteer Widener Partnership Chatter School 01/06/2016 Aid in an approved and appropriate school-level activity such as tutoring, chaperoning, monitoring, speaking, reading and similar activities. |
