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Click here or scroll down to respond to this candidateCandidate's Name
Lexington, SC Street Address PHONE NUMBER AVAILABLE EMAIL AVAILABLETo Assist the Facility by following their Mission Statement, to assist the patients/clients as well as the team efficiently. Continuing to learn and expand my knowledge to perform to the best of my ability . Authorized to work in the US for any employerMedical Records (Street Address + years)Medical Terminology (Street Address + years)Microsoft Office (Street Address + years)Research (10+ years)Team Leader (7 years)Organizational Leadership (3 years)Data entry (10+ years)Documentation review (5 years)ICD-10 KnowledgeCustomer CareBenefits VerificationsConflict Resolution TechniquesProblem ResolutionMicrosoft Outlook CalendarHome health & DME ExperienceRecord RetrievalRemote Palliative Care Coordinator, 10/2021 - 07/2023 Resolutioncare/Vynca Eureka, CAEstablished and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.Communicated with patients, ensuring that medical information was kept private. Liaised with other healthcare professionals to develop comprehensive patient care plans and provide highest quality of care (Ie: Patient's PCP and/or specialists) Evaluates outcomes of care with the interdisciplinary team by measuring intervention effectiveness within the team on a monthly basis.Assisted about 100 patients daily with their palliative care needs along with a Nurse, MD, and Chaplain in a team environment.Also assisted the team's RN & MD with scheduling tele-health appointments daily and other patient needs, such as DME, Incontinence Supplies, Transportation, etc PROFESSIONAL SUMMARYSKILLSWORK HISTORYMedicare TOC Program II / Lead, 12/2016 - 09/2020Absolute Total Care Columbia, SCAssisted the Medicare Case Managers Daily, when notified their patient was admitted to the hospital and followed until discharged home.Received new members by emailed daily reports and assigned to the Case Managers available for outreach to the member and facility discharge plannerDocumented in the system (TruCare) of every Medicare member that was enrolled into CLTC Notified the member's PCP (if applicable) or their patients transition via fax with date of transition, facility, and diagnosisResearched Medical Records and Authorization information to confirm the admission, transfer & discharge details were correct and to determine if TOC was required Kept record of Case Managers schedules for assignment purposes Kept a daily excel spreadsheet of all members and transition details to be able to run reports upon a managers request and to assist with ideas to implement process changes to be able to work more efficiently Uploaded and Noted any correspondence received by fax or mail Assisted direct manager with training and interview Processes Additional Information:Top Performer while in this role and was first point of contact for any TOC related questions, issues, member updates, etcHelped create the Initial TOC Process and assisted with process changes under the TOC Committee and Completed 2 years of Medicaid-Medicare Dual Program (MMP) New Member Campaign with a success Worked under stringent daily deadlines.Medicaid Inbound Member/Provider SR Customer Service Representative, 06/2008 - 12/2016 Absolute Total Care Columbia, SCAnswered incoming member calls pertaining to Medicaid Eligibility, Benefits, Incentives, Issues/ ComplaintsAnswered Incoming Provider calls pertaining to claim status, billing errors/questions, pre-authorizations status/questions, web portal assistance, Issues/Complaints Team PlayerDiverse knowledge within other departments - Referral, Pharmacy, Provider Relations, Eligibility Departments as we worked togetherAverage 80 calls daily depending on volume.High school diploma or GEDEDUCATIONMid Carolina High School - Prosperity, SC |
