Customer Service Medical

OBJECTIVE

To continue my career as an administrative professional with an

organization that provides a positive and challenging work

environment. Seeking a clerical/reception or related position in which

I can apply my experience, develop my current skill set through growth

opportunities, and contribute to the success of the organization as a

whole. I work well independently and as part of a team; and am

committed to excellence in the services I provide.

SUMMARY OF QUALIFICATIONS

. Over 14 years of administrative experience. Management: design

and implementation.

. Process-oriented professional with quick problem-solving and

analytical skills.

. Strong organizational skills with high attention to detail

. Strong communication and presentation skills to all levels of

management

. Multilingual in English and Spanish.

TECHNICAL SKILLS

. Operations Systems: Windows XP, Vista, Win7, Mac OS

. Enterprise + Other: Exchange ActiveSync, Microsoft Exchange

Server 2003/2007, Health Connect, PARRs, Lotus Notes,

Hyperspace Epic, Mainframe, Unity and CaseMatch 2.0

. Operational knowledge of MS Office Suite, Windows, MAC, Excel,

Google Analytics

WORK EXPERIENCE

Care Team Coordinator

Gentiva Healthcare ( San Jose, CA

March 2012 - September 2012

Responsibilities:

. Customer resources representative for branch administrative

associates, caregivers and patients.

. Receiving and inputting all incoming patient, caregiver, and non-

management employee documentation.

. Coordination with team members to ensure accurate schedules while

complying with Gentiva Health Services practice.

. Preparation of clinical records for new patients upon receipt of

referral.

. Completion of quantitative administrative review of clinical

records at start of care and when patients are discharged, while

maintaining a controlled procedure for active patient files.

. Distribution of medical supplies for care team in accordance with

physician orders and company policy.

. Updating of schedules as changes occur and following up with any

identified deficiencies in scheduling process.

. Coordinating/attending care team conferences, recording minutes,

ensuring agenda issues are addressed, following up on pending

issues, and re-authorizations etc.

. Active participation in hiring practices (i.e., administers/tracks

tests, prescreening candidates, etc.)

. Reviewing/validating time slips with schedules to ensure accurate

payroll/billing.

. Performing other duties as assigned.

Senior Pre-Registration Representative

Kaiser Permanente ( San Jose, CA

July 2005 - March 2012

Responsibilities:

. Respond to all patients in a timely and professional manner.

. Run pre-registration referral reports daily and create applicable

patient charts.

. Verification of patient demographic and insurance information with

the patient; consistent with the National Registration Standards.

Additional verification processes through patient name, spouse

names, SSN, DOB and address in order to identify and minimize

duplicate medical records. (When applicable, usage of ABN software

to check for medical necessity of Medicare outpatient claims).

. Strong knowledge of Insurance Eligibility and Benefits including

Florida Shared System.

. Preadmission/pre-certification/insurance verification to support

accurate billing and collections. Follow-up on missing

authorizations/referrals. Determination and verification of co-

pays, deductibles, and co-insurance as well as patient liabilities.

. Full understanding and adherence to the rules and regulations of

Medicare, Medicaid, Managed Care and Commercial payers

acknowledging and maintaining compliance with CMS.

. Ability to acquire, and interpret a wide variety of complex

information relating to benefits.

. Conflict resolution skills to defuse patient/customer issues and

amiably resolve customer concerns. Excellent communication skills

with individuals of various ethnic/socio backgrounds.

. Capable of performing multiple responsibilities, while in receipt

of heavy call volumes.

. Efficient in high volume workload with time constraints.

. Exceptional organizational and written skills, flexibility and

ability to switch tasks frequently

. Ability to type minimum 45 with above average accuracy.

. Ability to operate compatible PC, Windows, copier, fax, phone, and

headset.

. Perform new hire/patient user education.

. Active participation in UBT and all staff meetings.

. Strong knowledge of industry standard Customer Service best

practices.

Office Manager

Joyce Family Chiropractor ( Chico, CA

July 2001 - March 2005

Responsibilities:

. Overseeing daily operations of a primary care, multi-disciplinary

health center integrated with ancillary services including physical

therapy, acupuncture, chiropractic, vision care, pharmacy, health

coaching, disease management and EAP services.

. Managing of supervisors and lead positions.

. Responsible for recruitment, staff training and development, in

collaboration with Medical Group leadership and HR.

. Accountable for health center administration (e.g., scheduling,

staffing, policies, procedures, regulatory compliance, etc.)

. Providing effective coaching, feedback and developmental action

plans to the health center team, including clinical,

administrative, and technology leads.

. Solving problems effectively with an emphasis on developing

proactive, productive approaches utilizing internal support

functions.

. Productively facilitating communication and involvement of other

functional areas (e.g., HR, IT)

. Coordinating and communicating across remote sites and sharing best

practices with peers.

. Responsible for the creation and monitoring of individual sites and

service line budgets.

. Implementing processes identified to improve the overall

performance of individual sites in addition to resolving customer

service issues while driving efficiency.

. Providing reports on a (monthly/quarterly/ad hoc) basis with

commentary outlining reasons for variance in data (productivity,

service, etc.); develops and executing an action plan for

improvements.

CERTIFICATIONS

. QBS - Qualified Bilingual Services (Level II) - 2010

. Cost Share Collection Certification - 2008

EDUCATION

Butte College ~ Chico, CA ~ Associate Degree in Behavioral Science -

1/2003

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