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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Richmond Hwy, Unit 1005Richmond, VA Street Address
EMAIL AVAILABLEPHONE NUMBER AVAILABLESummary:Serve as the first point of contact for customers seeking assistance with program eligibility and benefits.Gather customer information and documentation to determine program eligibility.Calculate benefits using established formulas and guidelines. Maintain up-to-date knowledge of program changes and updates. Communicate program requirements and benefit levels to customers. Assist customers with the application process.Revenue Cycle Insurance, rebilling, and billing action complete claims for payment.Follow up, resubmit claims for payment. Process approver, biller, coding, and collections.Payment poster, adjustment of payments. EPIC SYSTEM, CERNER, and MEDIX, applies payments on excel spreadsheets.High level understanding of client host system functions. Determines eligibility for benefits using various methodsClearly documents actions taken and next steps for account resolution in patient account.Professional Experience:Reason for Gap: Due to sudden demises of husband, moved to Virginia and now actively back for work.Denver Human Services City and County of Denver, Denver, Colorado 02/2023 11/2023Eligibility Tech IServe as the first point of contact for customers seeking assistance with program eligibility and benefits.Gather customer information and documentation to determine program eligibility.Calculate benefits using established formulas and guidelines. Maintain up-to-date knowledge of program changes and updates. Communicate program requirements and benefit levels to customers. Assist customers with the application process.Follow up with customers to ensure satisfaction and address any outstanding issues.Escalate complex cases to supervisor or manager as needed. Generate reports on customer inquiries, eligibility determinations, and other data as requested. Update customer records and case files.Perform quality control checks on eligibility determinations. Participate in training and professional development opportunities.Demonstrated track record of prioritizing work, multi-tasking, and managing workload efficiently. Computer literacy and demonstrated proficiency to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel. Processed Food Stamp and Medicaid applications for clients.Interprets policies and procedures applicable to the various programs state and federal benefits programs.Navigates proficiently through various databases (ADAPTRO, Spider, MMIS, SAVE, SVES, APPEC, EPPIC, VACMS, and Common Help.Tracks and complies with state mandates for timeliness and accuracy compliance for all financial assistance programs.Conducts detailed interviews on the telephone or in person to gather required information and troubleshoot discrepancies.Provides excellent customer service including explaining programs, policies and rights and responsibilities to applicants and recipients.Gathers and analyzes verification documents received for authenticity, validity, and accuracy, and make referral to fraud as required.Secures and safeguards confidential information from applicants, recipients, and federal reports.Prepares reports and maintains client records.Identifies and assesses customer needs to make appropriate referrals for services and resources to community organizations, mental health, employment and Social Security Administration.Maintain continued client contact throughout the year to assist clients with a multitude of issues and priorities for their self-sufficiency.U. S. Equal Employment Opportunity Commission, Milwaukee, WI 08/2021- 06/2022Investigative Support Assistant (OA)Assists investigators in developing a variety of evidentiary materials surrounding charges.Includes interviewing charging parties/complainants and witnesses, requesting information, and compiling data obtained.Secures needed information, and documents information received.Reviews information regarding timeliness, bases, and standing under the laws governing discrimination complaints, and reports findings to supervisor.Summarizes and compiles comparative employment data used to examine and evaluate respondent's workforce to determine whether discriminatory practices or patterns exists.Summarizes and compiles data in the most appropriate format such as graphs, tables, and charts.Searches library and other designated sources for information and data required by investigators.Types a variety of materials such as investigative reports, memoranda, etc.Proofreads materials for correct spelling, punctuation, grammar, required format, and compliance with correspondence procedures.Assists investigators in developing a variety of evidentiary materials surrounding charges. This includes interviewing charging parties/complainants and witnesses, using standardized questions, requesting information, and compiling data obtained in hard copy or from computer tapes from respondents and other relevant sources.Summarizes and compiles comparative employment data used to examine and evaluate respondent's workforce to determine whether discriminatory practices or patterns exists.Reviews a wide range of company or union records to assist the investigator in assessing whether personnel policies and practices are violative of employment discrimination laws summarizes and compiles data in the most appropriate format such as graphs, tables, and charts.Types a variety of materials such as investigative reports, memoranda, letters, charges, and other related documents into final form. Materials typed are usually from rough drafts, handwritten notes and/or voice recordings.Proofreads materials for correct spelling, punctuation, grammar, required format and compliance with correspondence procedures and questionnaires. Understanding Interests: Recognizing the underlying needs and goals of both parties.UC Health Medical Anschutz Campus Hospital Aurora, CO 05/2021 08/2021Claim Analyst/Patient Access RepresentativeMeets with patient and/or patient's caregiver to exchange necessary information and documentation.Provides explanation of visit, instructions, and addresses concerns and questions.Communicates with referring provider's office, clinical department(s), and/or other appropriate personnel to exchange necessary information and determine schedule.Verifies insurance benefits and obtains pre-certification/authorization, as necessary.Determines and accepts required payments, including co-pays and deductibles, or refers to financial counselors for follow up.Ensures that all necessary demographic, billing, and clinical information is obtained and entered in the registration system with timeliness and accuracy.Requires critical thinking skills, decisive judgement and the ability to work with minimal supervision.Must be able to work in a fast-paced environment and take appropriate action.Rocky Mountain Regional VA Medical Center, Aurora, CO 10/2018 05/2021Advanced Medical Support AssistantWorking in the Mental Health Department, Family, PTSD, Dementia, and Neurology.Administrative support positions that perform support work in connection with the care and treatment given to patients in wards, clinics, or other such units of a medical facility.Provides administrative support in a medical/clinical environment the work includes functions such as serving as a receptionist, performing record keeping duties, and providing miscellaneous support to the medical staff of the unit.Includes work that requires a practical knowledge of computerized data entry and information processing systems, the medical facilitys organization and services, basic rules and regulations governing visitors and patient treatment, and scheduling patient appointmentsRTC, consults a practical knowledge of the standard procedures, medical records, and medical terminology of the unit supported, responds to inquiries.Plans, organizes, and directs the activities ensuring that the functional work area complies with legal and regulatory requirements and meets customer needs.Researches, interprets, analyzes, and applies guidelines, policies, regulations, manuals, etc., pertaining to fiscal accounting.Establishes, develops, and maintains effective working relationships with unit activities.Evaluates reports by analyzing facts and performing appropriate research and prepares detailed responses.Office of Community Care, Denver, CO 09/2018- 10/2018Claim Analyst/Customer Service RepresentativeDevelops, examines, adjusts, reconsiders, recommends settlement of various types of claims, receives and processes requests for authorization of healthcare services, supplies, and benefits.Prepares and develops claims and gives advice/assistance in obtaining evidence and supporting documents required to complete the transaction.Assists in determining the status of claims for services.Explains and advises the basis for payment decisions and reasons for disallowanceExplains payment methodologies used in adjudicating medical claims to resolve questions.Examines claims for errors and initiates action to correct such errors in accordance with current operational policies, as well as exercising judgment in claims resolution where policies may be vague, or interpretation may be required.Ability to navigate Google products: Gmail, Google Calendaring, Docs, Sheets, Excel, Power Point, Access Microsoft Teams, Outlook.Xtend Healthcare Navient, Hendersonville, TN 04/2017-09/2018Insurance Specialist IIRevenue Cycle Insurance, rebilling, and billing action complete claims for payment.Follow up, resubmit claims for payment. Process approver, biller, coding, and collections.Payment poster, adjustment of payments. EPIC SYSTEM, CERNER, and MEDIX, applies payments on excel spreadsheets.High level understanding of client host system functions. Determines eligibility for benefits using various methodsClearly documents actions taken and next steps for account resolution in patient accountExcellent working knowledge of Prism system and displays clear understanding of claim updates, request workflow, and action step entry into the system.Demonstrates advanced understanding of claim needs and ability to accurately perform needed billing activities (Evaluation/Correction of billing edits, claim transmission, rejections, and other claim functions).Compiles appeals and approves appeal requests for team related to technical payment denials.Demonstrates the ability to act as request approver for team members to ensure accurate actions are taken for account resolution.Ensure strong communication skills to convey intricate account information.Ability to navigate Google product: Gmail, Google Calendaring, Docs, Sheets, Excel, Power Point, Access Microsoft Teams, Outlook. Understanding Interests: Recognizing the underlying needs and goals of both parties. Communication Skills: Effectively conveying your position and actively listening to others. Strategic Planning: Developing a clear strategy and objectives before entering negotiations. Problem-Solving Abilities: Finding creative solutions that satisfy both parties' interests. Emotional Intelligence: Managing emotions, building rapport, and understanding others' perspectives.Unilever Factory (Manpower), Memphis, TN 02/2014- 03/2017Production/WarehouseWork production lineShipping and receivingWarehouse distribution dept.Final processing and packaging carton and shrink wrap materialsRework product for warehouseOperate basic equipment and understanding of warehouse manufacturingForklift operator and electric pallet jack certifiedEducation:South Shore Hs Chicago, IlGraduation date 6/1985 |
