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Medical Customer Service

Location:
Fort Worth, TX
Posted:
June 26, 2018

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Resume:

Janae' Crable

Fort Worth, Texas, *****

214-***-****

ac507a@r.postjobfree.com

WORK EXPERIENCE

Ryze Claims Solutions on behalf of American Integrity, Dallas, TX

IA Desk Examiner September 2017 – December 2017

Investigates, evaluates, negotiates, and resolves assigned property claims having low to moderate complexity and value, working within delegated reserve and settlement authority.

Works closely with the Unit Manager, occasionally handling claims with additional complexities related to unique coverage and exposure issues.

Working claim files from first notice of loss, to close.

CARENOW, Grand Prairie, TX

Patient Representative PRN, Feb 2017 – September 2017

Coordinate communication between patients, family members, medical staff, administrative staff, or regulatory agencies.

Refer patients to appropriate health care services or resources.

Investigate and direct patient inquiries or complaints to appropriate medical staff members and follow up to ensure satisfactory resolution.

Explain policies, procedures, or services to patients using medical or administrative knowledge.

Analyze patients' abilities to pay to determine charges on a sliding scale.

Austin Major Group, Dallas, TX

Director of Credentialing, Feb 2016 – Jan 2017

Identify key risks and mitigating factors of potential investments, such as asset types and values, legal and ownership structures, professional reputations, customer bases, or industry segments.

Gather risk-related data from internal or external resources.

Identify and analyze areas of potential risk to the assets, earning capacity, or success of organizations.

Recommend ways to control or reduce risk.

Analyze new legislation to determine impact on risk exposure.

Document, and ensure communication of, key risks.

AMN Healthcare, Dallas, Tx

Credentialing Coordinator, Sep 2014 – Feb 2016

Review healthcare providers’ submitted requirements including licensure, certifications, screens and other critical documents using AMIE system to determine HP document status versus requirements needed for specific assignments.

Create urgency with Healthcare Providers via email and phone, to encourage timely and accurate document submission by establishing target dates and monitoring document submission progress to deliver comprehensive documentation to the client facility for an on-time assignment start date.

Coordinate response to assigned client regulatory audits, Joint Commission/TWSM documentation, and other requests by client facilities by completing the requests with accuracy and within the established/provided timelines.

Coordinate with 3rd party vendors to determine appropriate dates, times and locations for HP candidates to complete necessary compliance steps including drug screens, background checks, immunizations, etc.

Negotiate with client facility to reconsider unusual or uncustomary requirements by emphasizing the value and experience of QS department with client facilities to minimize disruption of placements and perfect fill rate.

Consult clients on best practices by making recommendations on requirements expectations to streamline submission and placement processes.

Maintain up-to-date and correct facility database including updated contact information, new requirements and client correspondence by following up regularly with clients to optimize service coverage and prevent gaps in service delivery.

Methodist Health System, Dallas, Tx

Patient Advocacy, June 2012 – Sep 2014

Writing policies and procedures about cash management, insurance verification, and benefit reconciliations for diabetes self-education and PCMH pilot program.

Maintain a positive experience by being a convenient liaison between the patient and diabetic educators.

Scheduling patients, verifying insurance benefits, and financial counseling with patients and maintain strict confidentiality.

Billing correct diagnosis and procedure codes. Paying close attention to all Medicare guidelines and laws.

Answer telephones take messages and conveys correct information. Express proficiency in all medical technology systems.

Order supplies for diabetic education program and supplements for all five clinics.

Facilitates diabetes education classes on weekdays and weekends. As well as all individual screenings and appointments.

EDUCATION

University of North Texas, Dallas

B.A.A.S.

ADDITIONAL SKILLS

TPA carrier experience

Proficient with PC and ability to use Excel, Word, Outlook

Proficient in Xactimate 28/Xactanalysis and Xactware collaboration tool

Exceptional customer service

Detail-oriented

Seasoned in conflict resolution

Proficient in MS Office

Active listening skills

Strong organizational skills

CREDENTIALS AND LICENSES

Licensed in Texas, Florida, Michigan, Mississippi, Louisiana, Oklahoma, and West Virginia

TWIA Certification

State Farm Auto Certification

Tower Hill Certification

Citizens Certification

References available upon request



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