Customer Service Medical Assistant

CLINICAL HEALTHCARE ADMINISTRATOR

SUMMARY OF QUALIFICATIONS

. EXPERIENCED HEALTHCARE ADMINISTRATOR WITH 10+ YEARS EXPERIENCE IN

CLINICAL OPERATIONS, UTILIZATION MANAGEMENT.

. Medical terminology, ICD-9, ICD-10,CPT, HCPCS

. Technical skills include MS Word, MS Excel, MS PowerPoint, MS Project

Management, Typing 60 WPM

. Medical software: Facets, IDX, Touchworks, Centricity

Internal Auditing Medical Terminology Call Center Supervising

Medicare Compliance Supervising Training & Development

Database Creation Utilization Management Facility Operations

NCQA Standards Strategic Planning Strategic Planning

PROFESSIONAL EXPERIENCE

United Health Group/Southwest Medical Associate, Las Vegas, NV

2011-Present

Senior Patient Care Coordinator, Urgent Care

. Directs, supervises, investigates, and evaluates work duties of

administrative and clinical team for high volume urgent care

. Coordinates multiple office functions, emphasizing computerized

scheduling, electronic billing, reimbursements, accounts payable, and

patient records documentation

. Monitors CPR compliance and ULearn courses

. Implements continuous quality improvement indicators to measure

business performance and meet external audit standards

. Plans, implements, and administers policies and procedures for

clinical and administrative personnel that resulted in improved

patient and employee satisfaction

. Manages staff up to 9 employees; hired, trained, supervised, and

developed skills to meet expectations

. Monitors Medicare billing for external compliance requirements;

Resolves customer service complaints

. Completes daily deposits for Urgent Care facilities; Prepared facility

financial deposits for account receivables

. Monitors employee cash collection processes; Audits internal charges

and billing claims

. Establishes work schedules and assigns duties for clinical and

administrative staff: grants systems application request

. Reviews and analyzes facility budget, authorizing department

expenditures, and coordinating financial reporting

. Telecommutes to Urgent Care Clinics in territory; Works on-call for

various Urgent Care clinical sites

. Develops and implement safety policies and procedures for emergency

preparedness

Coventry Health Care, Kansas City, MO

2008-2011

Clinical Health Coordinator

. Monitored case managers work list, supported case manager staff with

daily activities, maintained employee files, and employee reviews

. Monitored Case Management work list for NCQA compliance

. Identified and enrolled members in CHF, COPD, and Long-term Programs

. Performed case manager audits for proper documentation; Trained nurse

case managers workflow processes

. Prepared reports detailing daily monitoring activities for all

programs

. Created and developed training and policy manuals for pilot programs

. Acted as physician and social worker liaison for CHF, COPD, Diabetes,

and End of life Programs

. Created and managed provider and member financial for CHF Programs for

member and provider financial incentives

. Participated in development and implementation of Health and Wellness

Programs for members

. Produced detailed reports for processes and correspondences for health

plans

. Maintain relationships with patients, providers, and social workers

. Distributed members to case managers by territory and managed member

referral process

Town Plaza Family Practice, Overland Park, KS

2006-2008

Lead Medical Assistant

. Managed physician's schedule for patient appointments, completed

referrals, verified insurance for pre-certification, copays, cash

handling, and relayed test results to patients

. Trained Medical Assistants for front and back office duties

. Created and managed Medical Assistants schedules

. Conducted triage nursing for incoming patients

. Monitored compliance for department call center

. Checked in patients, verified insurance, greeted patients and provided

excellent customer service

. Received incoming calls, scheduled follow up appointment, administered

referrals to specialist

. Roomed and completed vitals on 20+ patients daily

. Assisted with minor surgical procedures, injections, venipuncture,

urinalysis, and diagnostic testing

. Processed medical records for proper billing and coding

American Consultants, Riverside, MO

2001-2006

Medical Assistant

. Greeted patients, Roomed and completed vitals on 30+ patients daily

. Received inbound calls in call center

. Completed diagnostic testing (EKG's, PFT's) and venipuncture daily.7-

10 daily

. Completed patient education on diabetes testing equipment and various

other conditions

. Scheduled patient appointments, completed referrals, verified

insurance for pre-certification and relayed test results to patients

. Scheduled weekly meetings, coordinated topics to discuss, prepared

minutes for meetings

. Maintained and updated patient medical records in accordance with

HIPAA and Compliance Regulations

EDUCATION

University of Phoenix, Las Vegas, NV Graduation Date: August 2013

Masters of Health Administration GPA: 3.87

DeVry University, Kansas City, MO June 2008

Bachelors of Science in Business GPA: 3.51- Honors: Cum Laude

Administration

Health Services Management

Kansas City Business College October 1994

Certified Medical Assistant

Contact this candidate