EDUCATION

BACHELORS IN SOCIAL SCIENCE, MINOR IN HEALTHCARE MANAGEMENT 2015

University of Maryland University College – Adelphi, Maryland, United States

Completion of Degree in December 2015

PROFESSIONAL OVERVIEW

HEALTH-CARE PROFESSIONAL WITH THREE (3+) YEARS OF EXPERIENCE. HAS KNOWLEDGE OF MEDICAID, MEDICARE, AND COMMERCIAL INSURANCE. SALES EXPERIENCE OF RETAIL AND CUSTOMER CARE OF ELEVEN (11+) YEARS. EXTENSIVE EXCEL AND PIVOT TABLE DEVLOPMENT, WITH STRONG SKILLS IN MAINTAINING ACCURATE EXCEL SPREADSHEETS, WITH PROFICIENCY IN MACROS, VLOOK-UP, EXCEL ADD-INS AND MAIL MERGE. STRONG SKILLS IN MS ACCESS QUERIES TO GATHER DATA FROM DATABASES, WHILE MAINTAINING DATABASES TO CREATE REPORTS. EXCELLENT INTERPERSONAL, ORGANIZATIONAL, AND ANALYTICAL AND PROBLEM SOLVING SKILLS.

PROFESSIONAL HIGHLIGHTS

PROFESSIONAL EXPERIENCE

REFERRAL/PATIENT NAVIGATOR JUNE 2015 – CURRENT

Fidelis SecureCare – Detroit, MI

Navigating through various electronic health Systems (eClinical Works, SAMI, TruCare) to resolve patient and provider issues, and then documenting in the appropriate system to show how issues and problems were resolved.

Working closely with the UM department to resolve continuity of care issues, while transitioning out-of-network patient’s into in-network providers or helping to get approvals for patients to remain with their out-of-network providers under the continuity of care rule.

Utilizing Microsoft Excel to create reports sectioned of by districts to show case coordinators, patient information, health risk assessment completed, and insurance enrollment dates.

Processing patient referral’s using correct ICD-9 and CPT codes, and ensuring authorizations are received by in-patient and out-patient facilities in a timely manner.

Conducting interviews with patient’s to identify their specific health needs, through the use of initial risk screening questionnaires, and then assigning them to the appropriate case coordinator.

Going out to the community to help locate members that have not been able to be reached before open enrollment, and completing their required assessments, or providing them with the necessary services to local area agencies.

Creating Admin plans and case plans that will allow for care coordinators to efficiently determine the needs of patients.

Working closely with hospitals to obtain information on discharged patients, while ensuring that patient’s who have been discharged received the appropriate equipment and services they need, then transferring this information into reports so providers will know what is going on with their patients.

LEAD MEDICAL RECORDS COORDINATOR AUGUST 2013 – MAY 2015

Western Wayne Family Health Centers – Inkster, MI

Maintain a full-time presence receiving, scanning and maintaining electronic records.

Prepare electronic patient charts for medical staff by scanning in all documents received by fax, email, hard copy, etc. into the appropriate medical records file.

Set up appointments for HEDIS Chart reviews for several insurance companies.

Function as the troubleshooter with Vendors to resolve any issues/problems/concerns.

Prepare outgoing electronic patient correspondence in accordance with HIPAA guidelines.

Retrieve electronic or paper medical charts for patient's scheduled for the next day.

Pull correspondences, labs, results, consult reports, medical records, etc., and electronically attach to patient charts and distribute to correct provider or medical assistant.

File all paper charts upon completion of electronic scanning in a manner that allows

easy methods of retrieving.

Develop and maintain a filing and retrieval system for stored/archived files.

Process and respond to medical record requests for stored/archived files in a timely manner.

Accurately provide patients with the required medical records forms, assist patients in completion of approved forms, and demonstrate knowledge of necessary forms.

Carefully review medical records for accuracy and completion as required by insurance companies.

Strictly followed all federal and state guidelines for release of information.

Conducted medical records reviews for HEDIS with insurance companies to abstract data and relevant information from medical records.

Implemented new policies and procedures on handling of medical records, while keeping the Medical Records Department up to date on state and federal regulations.

Generate patient invoices for records using Excel, while keeping track of all invoices sent out through Excel Spreadsheets.

Work on LEAN Project, partnered with BCBS to develop strategies to create efficient clinic practices, while presenting training to the clinic on new processes and improvements through the use and creation of PowerPoint slides.

FRONT DESK REPRESENTATIVE MAY 2012 – AUGUST 2013

Western Wayne Family Health Centers – Inkster, MI

Maintained the receptionist area, including greeting visitors and responding to in-person requests for information.

Received patients, answered calls and queries, mediated with medical staff, assisted patients in completing medical forms, and collected fees per clinic protocol.

Registered patients and informed them of medical policies to be followed, in regards to services available.

Scheduled appointments

Documented and organized patients' records for reference.

Maintained front office supplies and records of daily monetary transactions.

Completed insurance verification with health-care providers, including Blue Cross Blue Shield, Medicaid, Medicare, and HMOs servicers.

Processed patient referral request

Thoroughly investigated past due invoices and minimized number of unpaid accounts.

Directed patient flow during practice hours, minimizing patient wait time.

Troubleshot and resolved issues in a quickly manner in a high volume medical call center.

CUSTOMER ASSISTANT REPRESENTATIVE MARCH 2008 – MAY 2012

Best Buy - Westland, MI

Maintained a neat and well-presented store, while replenishing merchandise on a daily basis.

Answered and directed phone calls to the right departments.

Understood each customer’s own personal needs, while building customer rapport.

Drove sales by increasing product sales basket.

Performed consultation with customers for installation and Geek Squad.

Described use and operation of merchandise to customers.

Shared product knowledge with customers while making personal recommendations.

Demonstrated that customers come first by serving them with a sense of urgency.

Worked as a team member to provide the highest level of service to customers.

TEAM LEAD OCTOBER 2005 – JULY 2008

Radio Shack – Redford, MI

Delivered excellent customer care by greeting and assisting each customer.

Lead, drove, energized and motivated teams to do better.

Planned and delivered initiatives for market growth.

Provided a safe and secure retail environment for shoppers

Proposed and implemented promotions and special offers.

Mentored new employees.

Ensured the store operated efficiently and effectively in all operational areas, such as stock control and presentation.

Completed floor replenishment to guarantee availability and promote customer satisfaction.

Completed weekly schedules in Excel spreadsheets in accordance to payroll policies.

Worked closely with the district manager to formulate and build the store brand.

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