Customer Service Insurance
Resume:
Afewu Hughes
**** ********** *** #***, ********* MD 21704 • 240-***-**** • ***********@*****.***
Doctor of Health Administration candidate offering experience in health system management, insurance reimbursement, patient access, and customer service excellence
Patient Registration • Project Management • Report Preparation
Research • Trend Analysis • Reimbursements • Health Systems Administration
Profile
Collaborative, analytical, and versatile with sound knowledge of Medicaid programs and Medicaid Management Information Systems (MMIS).
Possess a sharp blend of organizational, analytical, problem-solving, and critical thinking skills.
Ability to collect, organize, evaluate, and disseminate significant amounts of information.
Skilled at trend analysis, report writing, patient relations, and program administration.
Able to cooperate with patients, insurance companies, and other third-party payers to seamlessly coordinate quality, cost-effective care.
Contribute strong communication skills toward liaising between management and relevant stakeholders in support of achieving corporate objectives.
Reputation for professionalism, integrity, and steadfast commitment to confidentiality.
Professional Experience
Chickasaw Nation Industries, Norman, OK, 2016 to Present
Program Analyst
Directly support Payment Error Rate Measurement (PERM) program developed by Centers for Medicare and Medicaid Services (CMS) by analyzing claims processing systems, reporting requirements, and validating compliance with Medicaid and CHIP payment policies.
Systematically conduct audits and lead teams in ensuring that reimbursements to medical providers adhered to strict regulations and policies.
Reliably ensure, monitor, and enforce confidentiality of patient information in accordance with HIPAA regulations.
Prepare informative reports, deliver presentations, and support Medical Records Requests unit as needed.
Travel throughout Maryland, Virginia, and District of Columbia to lead and conduct comprehensive data processing reviews and audits.
Participate in development of user manuals and training materials to optimize staff competency.
CareMetx LLC, Bethesda, MD, 2014 to 2016
Reimbursement Specialist
Collected and reviewed patient insurance information for reimbursement procedures.
Proactively cooperated with physician office staff and patients to complete necessary insurance forms and program applications.
Continued …
Submitted insurance forms for prior authorizations, tracked requests, and communicated with provider representatives, third-party customer service representatives, and pharmacy staff to ensure collaborative and efficient efforts.
Expedited prior authorization requests by collecting crucial data encompassing demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians.
Frederick Memorial Hospital, Frederick, MD, 2014
Intern, Patient Access & Registration
Interviewed patients or relatives to obtain demographic and financial information for registration and admission, inputted data into EMR system, and consistently provided exemplary customer service.
Conducted insurance benefits verifications, facilitated prior authorizations on behalf of patients, and performed reimbursement case management.
Researched reasons for claim denials, responded to inquiries regarding third-party payments, investigated reimbursement issues, and communicated extensively with doctors’ offices and patients to appeal prior authorization denials.
Methodically screened and processed patient applications for assistance with high out-of-pocket costs.
Determined patient eligibility for co-pay assistance and PAP (patient assistance programs), and researched PAP enrollment status for patients as requested.
Participated in training new hires and conducted peer data audits when necessary to ensure rigorous alignment with quality control guidelines.
Frederick Memorial Hospital, Frederick, MD, 2009 to 2013
Associate, Security and Logistics
Conducted quarterly safety inspection hospital-wide including offsite locations to ensure rigorous adherence to security policies and protocols.
Planned, scheduled, and implemented monthly fire drills throughout all hospital departments to ensure optimal safety and emergency preparedness.
Partnered with safety coordinator to identify and address pertinent concerns throughout facility.
JP Morgan Chase, Frederick, MD, 2006 to 2009
Special Solution Representative
Diplomatically responded to escalated calls from customers regarding high interest rates and other issues, and effectively cooperated with customers in settling delinquent accounts and/or determining special payment arrangements to recoup losses for bank.
Improved employee training manual and participated in developing new staff members.
Education
DHA, Health Care Quality & Analytics, Capella University, Minneapolis, MN, Dec. 2020
MS, (MPH) Policy and Practices, University of Maryland School of Public Health, MD, Dec. 2018
MS, Health Informatics Administration, University of Maryland University College, Adelphi, MD, 2016
Bachelor of Science, Health System Management, University of Baltimore, Baltimore, MD, 2014
Associate of Arts, General Studies, Frederick Community College, Frederick, MD, 2013
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