Customer Service Administrative Assistant
Resume:
LaToya Robinson
********.********@*****.*** • ***11 Pleasant Colony Drive Apt. 507, Houston, TX 77065• 281-***-****
PROFESSIONAL WORK HISTORY
Hamilton Vein Center, Sugarland, TX
Patient Benefits Coordinator 2014-2015
Verification of patients’ insurance eligibility and benefits.
Initiate PCP referrals.
Obtain necessary referrals, authorizations, pre-certifications, and/or pre-determinations for clinic services.
Review and resolve referral, authorization, pre-certification, and/or pre-determination issues.
Quarterly review of payor clinical and reimbursement policies pertaining to the services provided in the clinic.
Communicate payor requirements for referrals, authorizations, pre-certifications, pre-determinations to providers and staff as
appropriate.
Perform other duties as required and in accordance with defined task-related responsibilities.
United Health Group, Sugarland, TX
Associate Clinical Administrative Coordinator –Long Term Care (Medicare & Medicaid) 2013-Present
Responsible for initial triage of members, administrative intake of members, and managing the admission/discharge information
post-notification, working with hospitals and the Clinical team.
Manage requests for services from Providers/Members.
Provide information on available Network services and transferring members as appropriate to Clinical staff.
Manage the Referrals process and process incoming and outgoing referrals and prior authorizations.
Collaborate with Wellness Coaches and Nurses.
Answer inbound calls in a Call Center and document all calls.
Make outbound calls to enroll members into Wellness programs.
Schedule appointments with Case Managers.
Coordinate network services by managing a daily average of 70 calls, and 50 provider and member requests for services.
Executive 1 Media Group, Houston, TX
Administrative Assistant 2010-2013
Greeted clients and directed them to the correct staff member.
Maintained office filing and storage system.
Coordinated and organized appointments and meetings and took meeting minutes.
Answered 50+ incoming calls and transferred to the appropriate staff member.
Received, sorted and distributed incoming mail and monitored incoming emails and answered or forwarded as required.
Ensured all office equipment was properly maintained and serviced.
Excellent working knowledge of Lotus 1-2-3, Microsoft Excel, Power Point, Outlook, and Microsoft Word.
Exceptional knowledge of administrative and clerical procedures and systems such as word processing, managing files and
records, designing forms, and other office procedures.
Patient Account Services LLC, Houston, TX
Medical Collector/Customer Service Representative 2009-2010
Monitored insurance claims by running appropriate reports and contacting insurance companies to resolve claims that are not
paid in a timely manner.
Identified coding or billing problems from EOBs and work to correct the errors in a timely manner.
Identified problem accounts and escalated as appropriate.
Updated the patient account record to identify actions taken on the account.
Worked with patients and guarantors to secure payment on outstanding account balances.
Practiced and adhered to HIPAA and FDCPA guidelines.
Algos Behavioral Health Services, San Antonio, TX
Insurance Verification Clerk 2008-2009
Verified all commercial insurance coverage, worker’s compensation, and state programs to determine patient’s eligibility.
Obtained precertification number for physician’s office.
Knowledge of HMO's, POS's commercial/governmental payers.
Kept a current list of physician’s insurance contracts and payment schedules.
Documented pre-qualification of third-party payer prior to visits.
Maintained current information on correct and lawful practices for billing government and private payers; Followed all federal,
state, and regulatory guidelines.
Advised the patient financial counselor of any copayments, deductibles, etc.
EDUCATION
Houston Community College, Houston, TX
Undergraduate Coursework 2014-Present
Dwight D. Eisenhower High School, Houston, TX
High School Diploma 2003
**References available upon request**
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