Customer Service Management

Erika Wright

CRM Liaison - Clinical Resource Management

San Francisco, CA

**********@*****.*** - 510-***-****

Professional with 14 years of diverse experience in the customer service/healthcare industry, with a focus on

insurance. A goal-oriented individual committed to customer service and team goals. Excellent communication

skills. Able to handle multiple tasks, work independently and maintain a high degree of integrity, enthusiasm

and diplomacy.

WORK EXPERIENCE

CRM Liaison - Clinical Resource Management

ALTA BATES SUMMIT MEDICAL CENTER - November 2012 to June 2014

Executes the discharge plan of care developed by the clinicians

• Attends team rounds and unit huddles, works independently to implement the care plan under supervision

of clinicians

• Interviews client/responsible party to determine preference and provide information on financial and social

responsibilities to support the client's care. Works with facilities and vendors to obtain services/placement

acceptance.

• Verifies insurance status, benefits and or coverage, contact information and approved days.

• Coordinates benefits and patient preference with the patients/family care team, insurance companies and

community based support services according to the discharge plan.

• Coordinates all the necessary referrals or authorizations needed by federal, state and local insurance and/

or regulatory agencies.

• Actively participates as CRM team member to achieve department goals and objectives

• Monitors the plan of care and coordinates the delivery of services

Lead Case Management Coordinator - Care Management Dept

BROWN & TOLAND PHYSICIANS MEDICAL GROUP - San Francisco, CA - May 2010 to November

2012

Responsible for obtaining and accurately entering data for Inpatient authorizations, eligibility benefits checks,

and Care Management referrals into the BT Systems to track programmatic and patient activity.

• Responsible for accurate census coordination and reconciliation. Gathers information from the hospitals,

shares with the Care Management team, and any other providers. Researches and provides detailed clinical

data elements to the team to use when assessing a patient.

• Responsible for the creation and processing of denial letters, coordination and delivery of necessary member

notice of non-coverage letters, member reinstatement letters, facility denial letters, and facility reinstatement

letters. Assists health plan representatives and Care Management Team with appeal (s).

• Communicates regularly with contracted Health Plans, Brown & Toland Medical Director, and Care

Management team and any other provider when appropriate.

• Responsible for scheduling, coverage, coordinating and confirming patient appointments post discharge.(E)

• Content expert providing administrative and technical utilization support to the Care Management team

such as accurately entering authorizations for home health, Durable Medical Equipment, social services

identification, and mailings.

• Under the direction of the Supervisor and or Manager of Care Management refers patients to Ambulatory

Care Management.

• Responsible for updating and reconciling inpatient related claims in BTCARE.

• Provides administrative assistance to the Medical Services Leadership Team in regards to the needs of

health care business analysis and research data compilation.

• Accepts and performs other duties as assigned, such as cross training to support clinical care management

functions at all BTMG sites.

Case Management Coordinator

BROWN & TOLAND PHYSICIANS MEDICAL GROUP - San Francisco, CA - August 2007 to May 2010

Interface with in network and out of network hospital admission department on hospital admission notification

including obtaining daily face sheet, issuing timely authorization numbers, and notifying inpatient case

managers of admissions.

• Enter disease management referral and other referrals as requested in IDX for tracking.

• Verify eligibility and check heath plans benefits as needed prior to authorizing services.

• Track the daily inpatient census and verify accurate data entry of admissions

• Data enter discharge information from concurrent review worksheet including ICD-9 codes, bed type, denied

days, CPT codes.

• Generate denial letters for commercial and senior health plans.

• Regular communication with the health plans and contracted health plan vendors on authorization & denial

letter issues.

• Participate in development of interdepartmental processes and procedures to improve the case management

department.

SENIOR CONSULTANT

GENENTECH - South San Francisco, CA - May 2006 to April 2007

Reimbursement Specialist

• Investigates patient's insurance benefits.

• Identifies network providers, provider restrictions, co-pays as needed.

• Pursue product coverage for patient in accordance with the payor's authorization requirements within the

departments established performance criteria.

• Create written communication to customers regarding reimbursement status.

• Maintains payor profiles by recording payor specific data promptly into the system.

• Consults with team members on an as needed basis.

• Collects and enters data from distributor/vendor, conduct analysis, and create reports.

Senior Admissions Case Manager

CORAM HEALTH CARE - Hayward, CA - February 2002 to May 2006

Initiates the admissions process for patient referrals by collecting demographic and insurance information; acts

as a single point of contact for new and existing accounts.

• Oversees training and monitors the activities of the Admissions Representative and clerical support staff.

• Communicates with medical professionals, case managers and payer contacts to expedite start of care for

patients.

• Resolves Reimbursement issues with accounts, sales force and Coram management.

• Investigates level of benefit coverage.

• Maintains profiles by recording benefit and authorization data in system.

Financial Counselor

ALTA BATES COMPREHENSIVE CANCER CENTER - Berkeley, CA - August 2001 to February 2002

Admit patient registration for scheduled appointment by verifying insurance coverage.

• Process request for authorization for initial visits and procedures.

• Created, implemented and streamlined staffing standards to improve productivity.

• Acted as single point of contact for physicians and their office staff relating to patient insurance verification

and financial arrangements.

• Maintained and processed extensive patient accounts for efficiency and accuracy.

Eligibility Coordinator

MHN - San Rafael, CA - January 2001 to August 2001

Service all lines of business: regional, commercial and HMO.

• Maintain and modify monthly eligibility for large and small companies.

• Make appropriate eligibility and benefit determinations.

• Explain benefit structures, authorization procedures and make referrals as appropriate.

• Complete additional non-intake related tasks and projects as assigned.

EDUCATION

BA in Health Care Administration/RHIT

DeVry University

October 2011 to Present

ADDITIONAL INFORMATION

SKILLS: Microsoft Office applications - Word, Excel, Outlook, PowerPoint, Access, IDX, Management,

TruCare, ICD 9 coding & Medical terminology, knowledge of all major medical insurances, Administrative

Management, Case Management, Billing and Customer Service.

Contact this candidate