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Click here or scroll down to respond to this candidateCandidate's Name
SummaryExperienced healthcare professional with a strong background in care coordination, case management, and pre-authorization within Medicaid, Medicare, and private insurance environments.Proven ability to develop and implement personalized care plans, conduct comprehensive patient assessments, and coordinate healthcare services effectively.Skilled in managing benefits, processing claims, and providing support for behavioral health issues.Proficient in EMR systems, CRM documentation, and ensuring regulatory compliance.Known for excellent communication skills and delivering exceptional patient-centered care across diverse medical settitingEducation:High School Diploma - Amarillo High School, Amarillo, TXAssociates Degree - Amarillo College, Amarillo, TXSkills:Typing Speed - 75 WPMMedicaid/MedicarePatient CareCare PlansPatient AssesmentsCase ManagementInsurance VerificationPrior AuthorizationMedical BillingMedical CodingMedical RecordsMedical TerminologiesHIPPADMEMicrosoft Office SuiteMicrosoft OutlookMicrosoft Teams/ZoomCRM/EMR/Epic/Next-Gen/QNXT/Mosaic/Citrix/Patient now/AthenaCustomer ServicePhone EtiquetteProfessional Experience:First Source/Molina Health Care Insurance - Coppell, TX May 2021 to May 2024Care Coordinator/Case Manager (Medicaid/Medicare)(Amarillo, TX)Summary:Experienced healthcare professional with a strong background in care coordination, case management, and pre-authorization within Medicaid, Medicare, and private insurance environments.Proven ability to develop and implement personalized care plans, conduct comprehensive patient assessments, and coordinate healthcare services effectively.Skilled in managing benefits, processing claims, and providing support for behavioral health issues.Proficient in EMR systems, CRM documentation, and ensuring regulatory compliance.Known for excellent communication skills and delivering exceptional patient-centered care across diverse medical settings.Education:High School Diploma - Amarillo High School, Amarillo, TXAssociates Degree - Amarillo College, Amarillo, TXSkills:Typing Speed - 75 WPMMedicaid/MedicarePatient CareCare PlansPatient AssesmentsCase ManagementInsurance VerificationPrior AuthorizationMedical BillingMedical CodingMedical RecordsMedical TerminologiesHIPPADMEMicrosoft Office SuiteMicrosoft OutlookMicrosoft Teams/ZoomCRM/EMR/Epic/Next-Gen/QNXT/Mosaic/Citrix/Patient now/AthenaCustomer ServicePhone EtiquetteProfessional Experience:First Source/Molina Health Care Insurance - Coppell, TX May 2021 to May 2024Care Coordinator/Case Manager (Medicaid/Medicare)Developed and implemented individualized care plans for Medicaid and Medicare patients.Conducted comprehensive patient assessments to determine care needs.Coordinated with healthcare providers, social services, and family members to ensure optimal patient care.Monitored patient progress and adjusted care plans as necessary.Managed Medicaid and Medicare services across multiple states.Coordinated and managed benefits for Medicaid and Medicare recipients.Assisted members with behavioral health issues.Provided care coordination and case management for members with specific behavioral health needs.Processed claims and enrollments for Medicaid and Medicare members.Provided assistance with website registration and navigation.Processed written Protected Health Information (PHI).Assisted members in locating specialists and providers in their state.Documented all activities in the CRM for quality and metrics reporting.Coordinated transportation for members as needed.Managed a high volume of incoming and outgoing calls.Cardiology Center of Amarillo - Amarillo, TX Mar 2018 to Mar 2021Pre-Authorization CoordinatorVerified patients' eligibility for insurance coverage.Prepared letters of medical necessity for prior authorization requests.Collected and compiled required information from health plans prior to inpatient admissions.Utilized data entry and electronic medical records (EMR) software to maintain accurate patient charts.Conducted research on notification and determination processes as part of pre-certification.Coordinated with healthcare providers and physical therapists to ensure medical criteria were met for durable medical equipment (DME) needs.Ensured compliance with guidelines for insurance coverage and pre-authorization requirements.Communicated with patients to update them once all medical criteria were met and authorization was received.BritKare Home Medical - Coulter, TX May 2006 to May 2018Administrative AssistantAssisted patients with disabilities in obtaining durable medical equipment (DME), including power wheelchairs, manual wheelchairs, bath/shower chairs, and other necessary equipment.Managed administrative tasks such as filing, scheduling appointments, and performing general office duties.Dispatched technicians to assigned locations for equipment setup and service.Ensured prior authorizations were obtained from Medicare, Medicaid, and private insurance for necessary equipment.Collected co-payments at the time of service and set up payment arrangements for patients as needed.Coordinated with insurance companies to verify patient eligibility and coverage for DME.Maintained accurate records of patient interactions and transactions using electronic medical records (EMR) systems.Provided excellent customer service by addressing patient inquiries and concerns regarding equipment.Managed Medicaid and Medicare services across multiple states.Coordinated and managed benefits for Medicaid and Medicare recipients.Assisted members with behavioral health issues.Provided care coordination and case management for members with specific behavioral health needs.Processed claims and enrollments for Medicaid and Medicare members.Provided assistance with website registration and navigation.Processed written Protected Health Information (PHI).Assisted members in locating specialists and providers in their state.Documented all activities in the CRM for quality and metrics reporting.Coordinated transportation for members as needed.Managed a high volume of incoming and outgoing calls.Cardiology Center of Amarillo - Amarillo, TX Mar 2018 to Mar 2021Pre-Authorization CoordinatorVerified patients' eligibility for insurance coverage.Prepared letters of medical necessity for prior authorization requests.Collected and compiled required information from health plans prior to inpatient admissions.Utilized data entry and electronic medical records (EMR) software to maintain accurate patient charts.Conducted research on notification and determination processes as part of pre-certification.Coordinated with healthcare providers and physical therapists to ensure medical criteria were met for durable medical equipment (DME) needs.Ensured compliance with guidelines for insurance coverage and pre-authorization requirements.Communicated with patients to update them once all medical criteria were met and authorization was received.BritKare Home Medical - Coulter, TX May 2006 to May 2018Administrative AssistantAssisted patients with disabilities in obtaining durable medical equipment (DME), including power wheelchairs, manual wheelchairs, bath/shower chairs, and other necessary equipment.Managed administrative tasks such as filing, scheduling appointments, and performing general office duties.Dispatched technicians to assigned locations for equipment setup and service.Ensured prior authorizations were obtained from Medicare, Medicaid, and private insurance for necessary equipment.Collected co-payments at the time of service and set up payment arrangements for patients as needed.Coordinated with insurance companies to verify patient eligibility and coverage for DME.Maintained accurate records of patient interactions and transactions using electronic medical records (EMR) systems.Provided excellent customer service by addressing patient inquiries and concerns regarding equipment and services.Education:High School Diploma - Amarillo High School, Amarillo, TXAssociates Degree - Amarillo College, Amarillo, TXSkills:Typing Speed - 75 WPMMedicaid/MedicarePatient CareCare PlansPatient AssesmentsCase ManagementInsurance VerificationPrior AuthorizationMedical BillingMedical CodingMedical RecordsMedical TerminologiesHIPPADMEMicrosoft Office SuiteMicrosoft OutlookMicrosoft Teams/ZoomCRM/EMR/Epic/Next-Gen/QNXT/Mosaic/Citrix/Patient now/AthenaCustomer ServicePhone EtiquetteProfessional Experience:First Source/Molina Health Care Insurance - Coppell, TX May 2021 to May 2024Care Coordinator/Case Manager (Medicaid/Medicare)Developed and implemented individualized care plans for Medicaid and Medicare patients.Conducted comprehensive patient assessments to determine care needs.Coordinated with healthcare providers, social services, and family members to ensure optimal patient care.Monitored patient progress and adjusted care plans as necessary.Managed Medicaid and Medicare services across multiple states.Coordinated and managed benefits for Medicaid and Medicare recipients.Assisted members with behavioral health issues.Provided care coordination and case management for members with specific behavioral health needs.Processed claims and enrollments for Medicaid and Medicare members.Provided assistance with website registration and navigation.Processed written Protected Health Information (PHI).Assisted members in locating specialists and providers in their state.Documented all activities in the CRM for quality and metrics reporting.Coordinated transportation for members as needed.Managed a high volume of incoming and outgoing calls.Cardiology Center of Amarillo - Amarillo, TX Mar 2018 to Mar 2021Pre-Authorization CoordinatorVerified patients' eligibility for insurance coverage.Prepared letters of medical necessity for prior authorization requests.Collected and compiled required information from health plans prior to inpatient admissions.Utilized data entry and electronic medical records (EMR) software to maintain accurate patient charts.Conducted research on notification and determination processes as part of pre-certification.Coordinated with healthcare providers and physical therapists to ensure medical criteria were met for durable medical equipment (DME) needs.Ensured compliance with guidelines for insurance coverage and pre-authorization requirements.Communicated with patients to update them once all medical criteria were met and authorization was received.BritKare Home Medical - Coulter, TX May 2006 to May 2018Administrative AssistantAssisted patients with disabilities in obtaining durable medical equipment (DME), including power wheelchairs, manual wheelchairs, bath/shower chairs, and other necessary equipment.Managed administrative tasks such as filing, scheduling appointments, and performing general office duties.Dispatched technicians to assigned locations for equipment setup and service.Ensured prior authorizations were obtained from Medicare, Medicaid, and private insurance for necessary equipment.Collected co-payments at the time of service and set up payment arrangements for patients as needed.Coordinated with insurance companies to verify patient eligibility and coverage for DME.Maintained accurate records of patient interactions and transactions using electronic medical records (EMR) systems.Provided excellent customer service by addressing patient inquiries and concerns regarding equipment and services. |
