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Customer Service Managed Care

Location:
Valrico, FL
Posted:
August 19, 2023

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Resume:

Sarah Phillips

Director of Administration

Dover, FL 33527

ady13x@r.postjobfree.com

+1-904-***-****

Work Experience

Director of Administrative Coordination

Move Mobile Therapy - Jacksonville, FL

February 2021 to Present

• Insurance verification

• Submission of orders to referring doctors for signature, tracking and uploading to chart

• Creating Instructional packets for other clinicians and employees on pertinent functions of their scope within the company

• Weekly billing for Medicare patients as well as secondary insurances

• Creating invoices for Auto injury patients as well as self pay patients

• Posting Eras, remits for patients

• Troubleshooting billing issues, patient issues dealing with doctors and coordination of care

• Maintaining accounting spreadsheet as well as Order tracking Clinical Scheduling/ Team Coordinator

Nurse On Call

November 2018 to Present

• Census 100-150

• Coordinating/Staffing home bound patient's physician ordered disciplines to rehabilitate patient's to previous if not a more functional status

• Disciplines include PRN and Fulltime RN, LPN, PT, PTA, OT, OTA, ST, MSW, HHA all scheduled according to Medicare guidelines

• Adhering to authorization based insurances and requirements for patient's to obtain further care as deemed necessary by utilization management and documentation of patient's care/progression

• Lab coordination with nursing staff or outsourcing to IPS Mobile Lab Company

• Supply tracking for wound care patients

• Managing full time staff schedules to point based systems varying from 30 -35 points amongst RN, LPN, PT, PTA

• Actively innovating processes and approaches to office /insurance perspectives

• Administrative tasks as following SOC packet/Admission/Consents

• Verifying and uploading paper visits for patients

• On-boarding - Training new schedulers

Intake/ Scheduling Manager

Urban Jacksonville INC - Jacksonville, FL

June 2018 to November 2018

Intake Coordinator/Office Assistant/Orders Manager

• Census of 120-160

• Coordinating and staffing skilled home care disciplines PT, OT, ST, disciplines

• AHCA survey preparation and completion of HIPPA policies, infection control etc We did not have any COPS and had minor infractions upon completion of the 3 day survey

• Assigning lab requests and orders to clinicians

• Scheduling transportation for wheelchair bound patients, stretcher or ambulatory patients

• Assisting clients with finding resources for assistance with medication co-pays, finding new primary care physicians

• DME coordination for clients discharged from hospitals and skilled nursing facilities/ walkers, wheel

• chairs, 3-in-1 commodes etc..

• Medical supply knowledge - gathering supplies for ordered wound care services/ catheters

• Creating new approaches on how to inform clients of services beginning and ending in different grant funded programs ( i.e. I created the welcome and termination letters to alleviate client concerns, phone calls to the office with the intention to eradicate confusion and have the clients informed)

• Managing and maintaining internal calendars/spreadsheets regarding time off requests/coverage for weekends

• Auditing Medicare/Managed care (HMO/PPO insurances) for frequency/order compliance

• Client demographic verification

• Authorization/Insurance Specialist (MyAbility, DDE, Kinnser, Serv tracker, PECOS, NPI Registry,

• Allscripts, Curaspan, Uni vita, Carecentrix, Zirmed, etc )

• Maintaining monthly insurance verification process of all home health/managed care/grant clients

• Creating and modifying care plans for clients in various departments (Case management/CCE/Relief)

• Managed Care billing, denials, appeals, posting payments

• Maintaining home health clients orders incoming/outgoing (Faxing, receiving, checking into EMR)

• Scheduling client's visits per disciplines when authorization is received

• Entering all patient data into appropriate databases for patient's needs in regards to referral Clinical Scheduler

Home First Home Health Care

May 2017 to June 2017

• Census 150-220

• Coordinating/Staffing home bound patient's physician ordered disciplines to rehabilitate patient's to previous if not more functional status

• Disciplines include PRN and Fulltime RN, LPN, PT, PTA, OT, OTA, ST, MSW, HHA all scheduled according to Medicare guidelines

• Adhering to authorization based insurances and requirements for patient's to obtain further care as deemed necessary by utilization management and documentation of patient's care/progression

• Lab coordination with nursing staff or outsourcing to IPS Mobile Lab Company

• Supply tracking for wound care patients

• Managing full time staff schedules to point based systems varying from 30 -35 points amongst RN, LPN, PT, PTA

• Actively innovating processes and approaches to office /insurance perspectives

• Creating protocols for patients based off their diagnosis that have been implemented company wide and to our contracted insurance affiliates

Home Health Clinical Scheduler

Urban Jacksonville INC - Jacksonville, FL

April 2014 to April 2017

November 2015 promoted to current title)

Intake Coordinator/Office Assistant/Orders Manager

• Census of 120-160

• Coordinating and staffing skilled home care disciplines RN, PT, OT, ST, HHA, LPN, PTA, COTA disciplines

• AHCA survey preparation and completion of HIPPA policies, infection control etc We did not have any COPS and had minor infractions upon completion of the 3 day survey

• Assigning lab requests and orders to clinicians

• Scheduling transportation for wheelchair bound patients, stretcher or ambulatory patients

• Assisting clients with finding resources for assistance with medication co-pays, finding new primary care physicians

• DME coordination for clients discharged from hospitals and skilled nursing facilities/ walkers, wheel

• chairs, 3-in-1 commodes etc..

• Medical supply knowledge - gathering supplies for ordered wound care services/ catheters

• Creating new approaches on how to inform client's of services beginning and ending in different grant funded programs ( i.e. I created the welcome and termination letters to alleviate client concerns, phone calls to the office with the intention to eradicate confusion and have the clients informed)

• Managing and maintaining internal calendars/spreadsheets regarding time off requests/coverage for weekends

• Auditing Medicare/Managed care (HMO/PPO insurances) for frequency/order compliance

• Client demographic verification

• Authorization/Insurance Specialist (MyAbility, DDE, Kinnser, Servtracker, PECOS, NPI Registry,

• Allscripts, Curaspan, Uni vita, Carecentrix, Zirmed, etc )

• Maintaining monthly insurance verification process of all home health/managed care/grant clients

• Creating and modifying care plans for clients in various departments (Case management/CCE/Relief)

• Managed Care billing, denials, appeals, posting payments

• Maintaining home health clients orders incoming/outgoing (Faxing, receiving, checking into EMR)

• Scheduling client's visits per disciplines when authorization is received

• Entering all patient data into appropriate databases for patient's needs in regards to referral

• received

• Payroll for In-Home services Aides 50+ bi-weekly as well as their mileage

• Maintaining In-Home Services/Home Health patient's service authorizations

• Misc tasks as assigned

Clinical Health & Psychology - Jacksonville, FL

December 2013 to April 2014

• Scheduling established and new client's appointments

• Insurance verification/ billing/working denials

• Faxing/ filing/ dictation of previous day's appointments

• Medical record requests and maintenance

• New patient check in/ check out

• Collecting co-pays/Past due accounts /Invoicing vendors Medical Office Specialist

Bahri Orthopedics & Sports Medicine - Jacksonville, FL October 2012 to December 2013

Front Office/Reception/Scheduling

• Scheduling four doctors within three office locations all with different specialties

• Entering new clients into the system, Insurance verification

• New patient registration

• Filing, chart pulling, faxing/sorting incoming faxes

• Patient check-in

• Medical records, PT/MRI scripts

Hostess/Server

Mojo BBQ LLC - Jacksonville, FL

March 2012 to November 2012

• Customer Service

• Phones/messages/caterings/orders

• Sanitation/ Bussing

• Order taking, POS system, menu memorization

• Promoted to lead hostess in 3 months and then promoted to server 5 months after Receptionist

First Coast No More Homeless Pets - Jacksonville, FL August 2011 to March 2012

• Customer Service

• Greeting clients

• Filing/Faxing

• RX Requests

• Patient Intake/Discharge

• Medical Record Update

• Multi-Phone Lines

• Billing/Grant Verification

• Balancing Cash Drawer/Cash Drops

Education

High school or equivalent

Olympic College - Bremerton, WA

2007 to 2008

Skills

• Customer Service

• Front Desk

• Home Health

• Patient Care

• Home Care

• Utilization Management

• Managed Care

• Allscripts

• Insurance Verification

• Medical Records



Contact this candidate