Sales Medical

Kalila Pugh

**** ******* **. #***

Houston, TX **074

Phone 832-***-****

**********@*****.***

Objective:

To obtain a challenging position that will continue to enhance and develop

my skills, demonstrate my strength in customer support and service and to

use my past experience and advance with company.

Education (1997 -1999) Sharps Town High School Houston TX -Diploma

MV Transportation (Driver) September 2011- Present)

. Transport clients to and from different locations

. Train other drivers how to operate the Metro van

. Secure clients wheelchairs and personal property

. Keep a record of client's ticket numbers and time client was picked up

and dropped off.

Memorial Hermann Hospital (Patient Access Specialist Rep II) February 2008-

June 2010

. Communicate with patients, referral sources.

. serves as a resource to patients and families within assigned

service groups across the continuum of care.

. Work with medical staff and multidisciplinary teams to resolve

patient problems and identify and improve them.

. Document communication with payers, patients.

. Provide estimated cost for treatment.

. Responsible for insurance verification and responds to insurance

patient correspondence according to procedures.

. Receive screen and document referral contracts.

. Coordinate financial arrangements with various payers in order to

ensure maximum reimburse.

. Facilitates patient medical and finical clearance across a

continuum of care.

. Refer patients not meeting medical acceptance criteria for

clinical review.

. Work with payer to negotiate patient specific arrangements when

necessary.

. Provide estimated cost of treatment based upon treatment plan.

. Provide clinical information to payers to obtain authorization

for services.

. Work on special projects to support Benefits objectives.

. Works on news later for all Business Centers

. Provides highly responsible complex administrative and date entry

duties.

. Monitor and report compliance process and activities.

. maintains confidential files in secure area.

. Instructs employees in new or difficult procedures

. coordinates recredentialing activities

. Utilizes communication strategies to ensure effective information

exchange between the departments

. Develops systems and procedures to ensure consistent,

efficient administrative support for the department.

. Assists with developing, analyzing and managing various projects

involving quality improvement, strategic planning and operations.

. Assist with financial counseling of patients as needed.

. Obtain initial limited information to start a referral.

. Educate departments on new soft ware. Assist with one on one

training sessions as needed.

. Assist and advise departments on new software and procedures.

. Records meeting meet.

. Develops and implements departmental procedures.

. Reviews complete work.

. Compiles/creates meeting documents.

. Call all patients to let them aware of appoints as. Knowledgeable

with Managed Care, HMO, POS, EPO, PPO, Commercial

Insurance Medicare, Medicaid and Cobra.

. Knowledgeable with AFA process, HCHD and Cancer Manager.

. Knowledgeable with Managed Care Online, assigning PRM code to verify

Medicare and Medicaid

. MDACC Policy and Procedure. HIPAA. Care System. IDX

. ICD-9 and CPT codes

. Participates in the development of new events, seminars, workshops

and meetings and out side organization.

. Responsible for some training and development needs of faculty and

staff.

Alpert & Sermas Neuro. (Insurance verification) November 2002- January

2008

. Work with medical staff and multidisciplinary teams to resolve

patient problems and identify and improve them.

. Provides highly responsible complex administrative and date entry

duties.

. Insurance verification

. Make charts for new pt and hospital follow up

. Schedule appointments

. Answer multi phone lines.

. Check states for Medicaid and Medicare pt each month.

EZPawn (Sr. Sales and Lending Rep.) February 2001- November 2002

. Opening and closing the store.

. Managing a team of five employees.

. Balance out the store refunds and the end of the day.

. Writing the retrieving loans.

. Performing inventory audits on merchandise in store.

. Pull new merchandise that comes out for purchase from loans and

sales.

. Writing out the weekly schedule for employees.

Maximum Care Pharmacy (Pharmacy Tech. Assistant) April 2000- September 2000

. Count out medicine for prescriptions.

. Checking drug order slips.

. Call doctors offices to get refills approval on pt prescriptions.

. Input new pt demographic info into system.

. Stocking selves with medications.

Contact this candidate