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Customer Service Medical

Location:
New Orleans, Louisiana, United States
Posted:
August 31, 2018

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Resume:

OBJECTIVE

My objective is to acquire and maintain an advanced position in which I am confident of my skills and ability to communicate clearly, listen well, organize and implement paramount customer service. My Medical Management leadership gives me the ability to motivate, delegate positive criticism with many different styles of employees. Conjunctively with my skills to multitask, knowledge of Department of Health and Human Services (HHS) efficiently will contribute positively to the Imagine of a reputable company. I also bring knowledge of HIPAA, PHI and Medicare, Medicaid and Tricare Guidelines.

SKILLS

Advanced education level consists of knowledge of ICD-9 coding, CPT coding ICD-10-CM coding, ICD-10-PCS, and HCPCS-II coding.

Ability to lead a team of employees into great working performance.

Excellent customer services and communication and written skills.

Knowledge of basic medical terminology, anatomy, physiology.

Ability to operate computers and printer, as well as photocopy and calculator equipment.

Knowledge to use diagnosis code books, procedure coding books.

Knowledge and skillful of data entry.

Knowledge of Medical Law and Ethics.

Knowledge of Medical Office Management policies and procedures.

Knowledge of Billing and Reimbursement.

Ability to work independently.

Knowledge of HMO/PPO.

Knowledge of hospital computer systems.

Able to work with multiple computer screens at once.

Knowledge of 485’s and care planning.

Knowledge of Xmedius system.

WORK EXPERIENCE

TriWest Healthcare Alliance

880 N Commerce St, Harahan, LA 70002 972-***-****

Complex Authorization Specialist (CAS) 01/11/2016

Pending Authorizations

Conducts research to ensure accurate documentation of the patient's clinical information.

Review and respond to referral requests from VA and civilian providers with appropriate coding and provider selection.

Takes appropriate measures to comply with HIPAA regulations to protect privacy of Veteran’s health information.

Documents the transmission of medical referrals to the facility or the network provider in line with procedures.

Documents all communications involving Veteran and provider contacts.

Develops knowledge of various software applications in use at TriWest, including procedures and processes of the VA program.

Verifies and ensures that appropriate referral procedures are followed for the various types of VA eligible beneficiaries.

Ensures procedures are followed for referrals based on Veteran category geographical location and the provider's request.

Enters data into the medical management system.

SILVER BACK CARE MANAGMENT COMPANY

1701 RIVER RUN, FORT WORTH, TX 76107

POSITION HELD: NON-CLINICAL INTAKE SPECIAIST II MAY 2015 - DECEMBER 2015

Perform high levels of data entry

High volume of inbound calls daily (100-150).

Process 100-150 authorizations and referrals daily.

Successfully handle a high level of inbound and outbound phone calls.

Be responsible for following non-clinical algorithms for initial preauthorization of services.

Audit intake documents for completeness.

Ensure the overall data integrity of documents received and into computer system.

Consistently meet performance standards of speed and accuracy.

Secure patient demographics, verify benefits, and request and enter clinical history.

Follow up on Out of Network and In Network benefits and redirect to proper PPL.

Comply with established Silverback procedures and personnel policies.

Reviewing paper and electronic medical records

Review and research denial payments, and EOC

Texas Health Harris Methodist Hospital

1301 Pennsylvania Ave, Fort Worth, TX 76104

Position Held: Patient Access Representative April 2014- Sep 2014

Process patient’s information.

Greet patients.

Successfully handle a low level of inbound and outbound phone calls.

Relay pertinent information regarding the patient’s services.

Audit intake documents for completeness.

Ensure the overall data integrity of documents received and into computer system.

Consistently meet performance standards of speed and accuracy.

Secure patient demographics, verify benefits, and request and enter clinical history.

Keep electronic medical records safe and up to date.

Assist patients during their check-out and ensure they have all the post-treatment instruction is required.

Calculates payment and deductibles, credit payments to the correct account accordingly.

Listen to concerns from the patients, and be very compassionate about their concerns.

Communicate well verbal and written.

Keep records in order.

PEOPLES HEALTH NETWORK

3800. N CAUSEWAY BLVD, LA 70002

Position Held: Authorization Specialist Assistant October 2009 - March 2014

Obtain and enter patient’s information in to the CCMS database system

Log into EPIC computer system and locate member’s hospital admission in a timely manner.

Protect the security of medical records to ensure that confidentiality is maintained.

Review records for completeness, accuracy, and compliance with regulations.

Enter data, such as demographic characteristics, history and extent of disease, diagnostic procedures, or treatment into CCMS database system.

Process patient admission or discharge documents with ICD-9 ad CPT codes

Assign the patient to diagnosis-related groups (DRGs), using appropriate computer software.

Identify, compile, abstract, and code patient data, using standard classification systems.

Responsible for the initial inquiry into CCMS database to determine eligibility of services for the members.

Entered notifications into CCMS system.

Log into Macess phone queue.

Log pre-certifications and Medical Necessity Forms into CCMS database systems.

Created authorizations and set up physicians approved and signed orders for Home Health, DME, IV Therapy, Skilled Nursing Home stays, Rehab admits

Look into CSF claims daily for pending claims.

Responsible for completing all End of the month reports.

Coordinates time-off requests with other Clerical assistants in order to provide adequate coverage.

Work with multi computer screens at one time.

Knowledge of the company’s software

Create authorizations for Home health, DME, IV orders.

PAN AMERICAN LIFE INSURANCE thru (Office Team temp Service)

601 POYDRAS STREET, LA 70115

Position Held: Customer Service Representative October 2008 - April 2009

Check to ensure that appropriate changes were made to resolve customers' problems.

Refer unresolved customer grievances to designated departments for further investigation.

or work Review insurance policy terms to determine whether a particular loss is covered by insurance.

Complete contract forms, prepare change of address records, or issue service discontinuance orders, using computers.

Review insurance policy terms to determine whether a particular loss is covered by insurance.

Provide customer service, such as limited instructions on proceeding with claims.

Organize with detailed office records, using computers to enter access, search or retrieve data.

Transmit claims for payment or further investigation.

Verify benefits and eligibility.

Contact insured or other involved persons to obtain missing information.

VISITING PHYSICIAN'S NETWORK

2335 VILLA CREEK DR DALLAS, TX 75051

Position Held: Administrative Assistant / Office Manager May 2005 - October 2008

Collect, record, and maintain patient information, such as medical history, reports, and examination results.

Managed and supervise a medium size office. 3-4 caregivers, 4 MD’s 2NP’s and 1Podiatrist.

Conduct training of new hires, while making sure they have knowledge of VPN policies and procedures and expectations.

Conducting monthly in-service for staff and new hires.

Maintain certain decision making while remaining calm under pressure.

Make sure all paperwork for staff timesheet are imputed in a timely manner.

Attend weekly meeting.

Perform administrative support tasks, such as proofreading, transcribing handwritten information making sure that ICD-9 and CPT codes were correct on the superbill before submitting it to proper Insurance Company.

Receive payment and record receipts for services.

Schedule appointments and maintain and update appointment calendars

Research any operational reports and schedules to ensure accuracy and efficiency.

Plan, administer and control budgets for contracts, equipment and supplies.

Greet visitors or callers and handle their inquiries according to their needs.

Transcribe ICD-9 codes for Home health, DME, X-rays, medications per doctor’s request.

Operate office equipment such as fax machines, copiers, and phone systems, and computers.

Open, read, route, and distribute incoming mail or other materials and answer routine letters.

Knowledge of Complete forms in accordance with company procedures.

File and maintain patient’s records scheduling events into the monthly calendars.

Prepare and scan patient’s information into their charts.

Schedule and confirm appointments for clients, customers, or supervisors.

Conduct searches to find needed information, such as medication assistant programs.

DFW MEDICAL CENTER

2709 HOSPITAL BLVD, GRAD PRAIRIE TX 75051

Revenue Cycle Representative II- Outpatient Patient Registration June 2000 - October 2001

Pre-admits patients by receiving orders from physicians; confirming admitting privileges of physicians; interviewing patients; entering patient information to pre-admissions database.

Provides patients with information by explaining hospital admission policies, time of admission, room selection, television and video rentals, telephone availability, cell phone restrictions; answering inquiries

Notify patients of hospital policy and procedures regarding visitation hours, patient values.

Secures payments by screening insurance information; identifying patients requiring pre-admission approvals from third-party payers; verifying approvals; notifying patient accounts department of self-paying admissions.

Prepares admission folders by gathering admission paperwork for scheduled patients.

Greets and receives patients to be admitted by conducting personal interviews; entering demographic and insurance information; confirming pre-admission information; obtaining signatures on legal consents and insurance forms; receiving payment and recording it.

Revenue cycle, work front line registration, financial counseling and customer services related positions.

Provide the patient with HIPPA policy and disclosure of patient’s rights, and hand out brochures regarding the hospital.

Receive and route messages or documents, such as laboratory results, to appropriate staff.

Compile and record medical charts, reports, or / and correspondence, using via fax, or computer

Interview patients to complete documents, case histories, or forms, such as intake or insurance forms.

Answer multi-phone lines and direct and redirect appropriate calls.

EDUCATION

NUNEZ COMMUNITY COLLEGE

3710 PARIS RD, CHALMETTE, LA

Candidate, May 2016

Associate Degree in Health Information Technology

In the process of obtaining my Certification of Medical Insurance Billing and Coding

GPA: 3.75

EVEREST COLLEGE

5237 N. RIVERSIDE DR. #100 FORT WORTHTX

Medical Insurance Billing and Coding, August 2005 -Feb 2006

Diploma in Medical Insurance Billing and Coding.

GPA: 3.46

NORTH TEXAS CHRISTIAN ACADEMY

4701 ALTAMESA Blvd, STE.2A FORT WORTH TX

High School Diploma, Oct 2004 / March 2005

GED

GPA: 4.0

PROFESSIONAL REFERENCE

Shirley C. Savage LPN

3800 Acacia Lane

Harvey, LA 70058

P: 504-***-****

26+ YEARS

Dr. Tony Bui, M.D.

Visiting Physician’s Network

5440 Harvest Hill Road Ste. 182

Dallas, TX 75230

P: 972-***-****

F: 972-***-****

13 years

Alicia K. Thomas

Amerigroup

3850 N. Causeway Blvd,

Metairie, LA 70002

P: 504-***-****

10 years

Linda Davis, RN

Peoples Health Network

3838 N. Causeway Blvd,

Metairie, LA

P: 504-***-****

10 years

Charles Thibodeaux LPN

Jo Ellen Smith Nursing Center

4205 Gen Meyer Ave

New Orleans, LA

P: 504-***-****

19 years



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