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Click here or scroll down to respond to this candidateTimothy S. CreekmurStreet Address Victoria DriveCoatesville, PA Street Address
Cell: PHONE NUMBER AVAILABLEEMAIL AVAILABLEProfessional SummaryFocused and committed professional United States Veteran, with 17 1/2 years experience in legal support capacities, with the Veterans Administrative Medical Center. Track record of multi-tasking and achieving employer goals.Core Qualifications, Education: Immaculata University, Frazier, Pa, Political Science PursuanceIn-depth understanding of the Veterans Administrations Claims/Benefits systems policiesand procedures. Inept knowledge of Billing and collection ProceduresInsurance and collection procedures. Expert in Insurance BenefitsProficient in computer programs relevant to the job as well as data entry programsKnowledge of Hospital, inpatient and outpatient records maintenance.Rated Excellent (via) my recent review(s) in all phases of customer service/knowledge skills.Great communication abilities with customers superiors and other representationAbility to multi-task, answer phones, and greet customers and work in a fast paced environment.Career Work ExperiencePhiladelphia, QTC Management, Incorporation, Certified Medical Case Specialist, 11-29-2021-Present, (40hrs per week) (Full-time)Responsible for the Medical/Psychological & evaluation of needed levels of appointment services that are required, for Separating, and Veteran personnel, for Service Connected Claim submission, and Progression.Handle over 50-60 inbound/outbound evaluation placement calls a day, with the Nationwide, Veteran and active duty persons, to correctly and accurately assign Appropriate Medical Classification Providers, per the Militarily affected, Mental & Physically occurred injury, while having served in Military Service.Responsible for daily communication with the needed Mental Health/Medical Health providers, to accurately evaluate their specific specialty of practice, and availability for examination, for the soon military separated, and military Veteran population.I process over 15 required claims a day, per QTC Claims required Medical Case Specialists standard.As a certified Medical Case Specialist, I manage, and maintain pre-submitted cases for (CNP-Compensation & Pension) Cases, with a 20-30 finalization timeframe, for proper Medical/Mental Health provide Finalization schedule standards, Per QTC processing policy.Philadelphia Social Security Administration, Benefits Authorizer, 11-08-2020 to 02-12-2021 /40 hrs wk full-timeAdministrating to the SSA/MEDICARE client(s), Comprehensive knowledge of insurance regulations, processes and guidelinesMaking critical decisions to determine the amount of benefits paid to individualsGuiding perspective applying clients, thru the extensive eligibility process of their insurance claims, to include, In-depth knowledge of eligibility coding, also pertaining to SMI.Verified that the monthly payment amounts were correct -Processed the adjustments, suspension and termination of benefits when necessary.Confidently and adeptly handled claim denials and/or appeals.Provided accurate and courteous response to various telephone inquiries from internal and external customers regarding Enrollment Verification and Medicare Advantage plans.Updated financial information to guarantee accuracyOffice management/supervisory professional experienceFamiliar with commercial and private insurance carriersVeterans Administration Philadelphia Regional Benefit Office, Veterans Service Representative, 3-5-2018-7-15-2019 / 40 hrs wk full-timeMakes determinations as to eligibility for the type of benefit sought and analyzes, develops, and requests required evidence for certain claims requiring a rating decisionDecides the necessity for and type of examination, reexamination or opinions to determine the existence of or to evaluate disabilities resulting from diseases or injuriesDevelops comprehensive requests for these examination/opinions to ensure appropriate evidence is received from which to adjudicate the claimUtilizes various electronic data processing (EDP) systems for inputting data related to claims adjudication, processing, monitoring, and correspondence preparationApplies a wide variety of reference materials to include manuals, directives, letters and other guidance in the decision-making processdetermine the degree of disability, permanency of disability, and whether substantially gainful employment is precluded; entitlement to burial award; establishment of service connection for cause of death or contributory cause of death; secondary service connection; service connection as a result of examination, treatment, hospitalization, or training; permanent and total disability for compensation or pension purposes; need for aid and attendance; competency/incompetence; and other benefitsAbility to interpret and apply established guidelines, regulations and procedures to determine claimant eligibility for services and benefitsDepartment of Interior (National Parks Service) Administrative Specialist/5-30-17 12-8-2017/ 40 hrs wk full-time. (Temporarily resigned from former Federal employee (Philadelphia Veterans Hospital, due to my spouse suffering from a Medical Illness, went back Federal work with Philadelphia Federal Department of Interior)Served as an Administrative Specialist, responsible for Spreadsheet Technology, tracking and systematically managing staff member purchase contracts, for Park maintenance and enhancement. Also create and design electronic Spreadsheets that pertain to various departmental staff members assignment needs that are reviewed by department supervisors, for implantation of duties.Trained & Qualified in NPS (FMSS-Facilities Management Software System), to assist and Train other NPS employee staff, about the FMSS registration, and navigational flow of FMSS, to stay current with daily work content performance, that effects our NPS efficiency ratingsPHILADELPHIA VETERANS ADMINISTRATION MEDICAL CENTER/Medical Support Assistant/9-14-14- 4/1/1640 hrs wk full-time.Professionally Counseled/Educated an average of 30-40 Veterans along with their adjoining family, in person and by phone, in all phases of legal eligibility requirements pertaining to Veterans Medical& Service Connected claim benefits. Registered 20-30 daily, applying for Veterans Medical Benefits.Explained, educated, and helped Veterans with filling out claim forms, pertaining to Agent Orange/Vietnam affects, along with Camp Lejeune/Water Affects claims, as legislated by Congress.Handled over 25-35 inbound/outbound follow up phone calls per, to legally resolve claimant questions by Veterans, and their assisting family members, to include family members, in-person, who are (Power of Attorney) status. I processed and researched their claims for Agent-Orange & Camp Lejeune to obtain a medical appointment, for claim status determination.Responsible for processing (FOIA/Freedom of Information Act) request from U.S. citizens (spouses, Attorneys, Investigators, other Federal Agencies), pursuance, of legal and or conformational documents and information for client verification of factual data. Reviewed all (FOIA) request for permissible release of information to requesting personnel. Prepared and processed specific Determination letters for (FOIA) request.COATESVILLE VETERANS ADMINISTRATION MEDICAL CENTER/ Vocational Rehabilitation -Compensation Work Therapy Department/Program Support Assistant-Purchase Card Specialist/ 9-12-12 9-11-14/ 40 hrs. Wk. full-timeResponsible for assisting our Vocational Rehabilitation Team, constructing, coordinating, and implementing Supported Employment Interview Skills, via.. Mock Interviews with a Veteran Program Responsibility, of 60-70 Veterans.I Coordinated, and implemented a Bi-weekly (General Equivalency Diploma) course, to assisted Veterans obtaining their GED, for measured employment/career opportunities.Conducted labor market research studies and researched employment opportunities in geographic area of client in relation to education, experience, age and vocational potential.Provided vocational counseling, including assessment, for clients to assist them in determining employment strengths, skilled labor training experience, inner-personal skills.Developed individualized plans with each Veteran to help them achieve their appropriate career goal regarding college or vocational school assistance.Provided referral assistance for clients to other agencies to assist with needs regarding housing, clothing, utilities, etc.Helped clients complete job applications forms, assisted with search on various online job search sites, and helped clients develop resumes.Purchase Card Holder, responsible for managing a Compensation Work Therapy Departmental Budget between $250,000- $375,000 per FISCAL YEAR.Maintained personal records of each Veteran to evaluate each personal progress.Coordinated efforts with other agencies to be able to provide a service to Veterans that have specific disabilities.Motivated and coach clients to help them reach their personal goals.Assisted clients with the tools so they can live life more independently.COATESVILLE VETERANS ADMINISTRATION MEDICAL CENTER/ Quality Improvement Specialist/6-14-11 9-11-12/ 40 hrs. Wk. full-timeAs a Quality Improvement Specialist, I was assigned to process, edit, and perform legal research, along with other varying Hospital professionals (doctors, psychologist, police staff, nurses, administrative staff), to perform (ROOT CAUSE ANALYSIS), plans, to correct, enhance, and establish if Legal actions would need to take place between Hospital staff, and Hospital patients. Reports were presented to the Hospitals Chief of Staff department, for final solution approval by the hospital director.Processed requests for the disclosure from charge files, by aggrieved parties, respondents, and their attorneys.COATESVILLE VETERANS ADMINISTRATION MEDICAL CENTER/Mental Health Case Management Assistant/7-3-10 - 6-11-11/ 40 hrs. Wk. full-timeResponsible for Veteran Community housing living, qualify Financial Claim status with the VeteransFiduciary, with the Philadelphia Veterans Regional office, for income verification, for proof of rent.Supervised 8 to 13 (varied), Mental Health Veteran-clients, for weekly paid community Work Therapy.Explored and assisted with investigating circumstances around a Veterans Financial Service connection.COATESVILLE VETERANS ADMINISTRATION MEDICAL CENTER/Benefits Claims Assistant/4-14-06 - 7-02-1040 hrs wk full-timeAssisted with Overseeing/administrating Veteran Medical/Financial Benefit Claims (30-55 per wk day)Drafted documents pertaining to statistics such as eligibility measurements for claim receiptProduce training manuals and organize training sessions for new claims representativesResearch current Veterans Medical/Financial policies and updatesVANGUARD GROUP INC, MALVERN, PA/DATA ANALYST-CORPORATE SUPPORT/6-13-96 to 04-01-2006Analyze business needs and translate these requirements into analytical projectsInternal presentations that translate analytic insights into tangible, actionable solutionsAcquire and compile structured and unstructured data and verify quality, accuracy and reasonableness;Engage in data analytics along with stakeholder communicationProfessional CredentialsTenured Public-Notary for the Commonwealth of PennsylvaniaPennsylvania Judge School Certification Training (11/15/2022- 12/15/2022)Professional References upon Request |
