Customer Service Home Health

***** ****** ******* *****, ** *****

PHONE 832-***-**** E-MAIL ***************@*******.***

SARAH CONTRERAS

OBJECTIVE

I want to obtain a position in the medical field where I can use my experience and education. In

addition, I want to work for a company that has the potential for advancement and growth in my

career.

SUMMARY OF QUALIFICATIONS

Computer literate: Kinners, Carevoyant, EZ Claims, Cradle, Microsoft word, MediSoft, Excel,

Access, PowerPoint. General office skills: fax, copy, and scan. Familiar with CPT and ICD-9

coding and regulations, and Medicare/Medicaid regulations. Experience in medical insurance and

third party processors policy and procedures. Data entry of prior authorizations and retro

authorizations. Scheduling procedures for both outpatient and inpatient procedures of patients,

and scheduling for home health services.

EDUCATION

2014- Present University of Houston Clear Lake Houston, TX

BS Degree of Health Care Administration/ Concentration in Business Administration

Obtaining my bachelor’s degree in Health Care Administration with a concentration in

Business Administration.

2009-2010 University of Phoenix Houston, TX

Associate of Arts/ Concentration in Healthcare Administration

Associates degree in Health Care Administration, basic college courses and managerial

courses.

2003-2004 National Institute of Technology Houston, TX

Medical Insurance Billing and Coding

Technical learning center with hands on training of medical CPT and ICD-9 coding;

processing of claims and posting of explanation of benefits.

PROFESSIONAL EXPERIENCE

2011- 2014 Gulf Coast Community Health Services Houston, TX

Billing Specialist/ Intake Specialist/ Staffing Scheduler

Performed billing tasks as required submitted billing for both PAS and Skilled

nursing claims. Utilized computer system Easy Claims to track and submit claims as

needed.

Perform billing tasks for skilled nursing department via Cradle and calendar book.

Processing of commercial plans (Aetna, CareCentrix, UHC, BCBS, Paragon,

Applied). Required a calendar book and data entering dates into Easy Claims for proper

billing.

Posting of payments, EOB’s, and monthly statements, insurance verification for

continued services.

Intake Specialist/Staffing Scheduler

Intake

Process all referrals from referral sources- which include verifying insurance,

requesting authorizations from health plans, order DME as needed when requested by

discharge planners, contacting referrals sources of acceptance. Contact patients in regards

to home health admission.

Scheduling

Schedule all visits based on admission type (New Admission, Post Hospital or

Recertification.)

Update schedules daily as new admissions are completed & staffed with nurses;

update weekly schedules for following week and sent out to nurses. Email and fax

schedules to nurses on Friday.

2009- 2011 Christus Visiting Nurse Association (VNA) Houston, TX

Staffing Scheduler

Follow up with patients who discharged from the hospital for home health services by

calling patient information and verifying discharge. Staff patients with caregivers whom

require a new admission into home health services, and staff patients whom area already

on service and require a post hospital visit for resumption of care. Staff patients for

weekly visits and recertification visits, and supervisory visits. Manage clinician’s

schedules on a daily basis (done daily); arrangement of weekly schedules (done weekly).

Data-entry of start of care packets, recertification, and post hospital packets. Dana-entry

of orders for continuation of care, or changes of current services (done daily). Verification

of all RN, LVN, PT, OT, and HHA visits for timely billing (done monthly).

In charge of weekly reports of USFHP members for insurance company; information is

provided on what patients are admitted into our services and what services are being

complete (done for authorization purposes).

2007-2008 Fidelis Senior Care of Texas Houston, TX

Client Care Coordinator

Client Customer service via phone for arrangements of outpatient care of clients,

outpatient appointments, procedures, and transportation to and from scheduled visits.

Processed daily prior and retroactive authorizations for clients whom required

continuation of care.

Attended daily meetings and discussions on clients to up hold the well being of the client

within our program.

Created and maintained daily reports off of excel to chart care and usage of information

pertaining to the client.

2004- 2006 Gentiva Care Centrix Houston, TX

Client Care Coordinator

Client customer service via phone for arrangement of home health care. Staffed each

individual case with prominent home health care agencies by using utilization

management guidelines.

Created and maintained monthly reports to review healthcare provided to clients for

supervisor approval.

Processed prior and retroactive authorizations for home health care agencies to provide

care for clients.

Processed authorizations and personally staffed clients for the Provider Care Option

program under New Mexico’s Medicaid program.

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