EUREKA HYDE acxujr@r.postjobfree.com

**-** **** ****** *** Rockaway NY 11691 Cell516-***-****

Objective To utilize and enhance my skills and experience, for a company that will

allow me opportunity for a career growth and development

Education

1992-1995 Hillcrest High School, NY- High School Diploma

Skills General knowledge of Medicaid, Medicare, HMO and PPO insurance plans

Knowledge of H.I.P.P.A Privacy rule and Knowledge of E.O.B, Hedis, Qarr and Medicare stars MS Word, Excel, Access, Power point, Outlook, Internet and 40 w.p.m. Strong medical terminology and ICD-9 CPT coding background.

Three years managed care experience.

Experience

Health Care in Partners (IPA,Medical ) Longisland NY

2013-Present Personal Care Coordinator(Case Management)

Create care plans for S.N.P members who are enrolled into case management

Initiate Health assessment forms for members enrolled into case management

Contact case management members who has been recently discharge from the hospital to complete discharge questionnaire form

Complete and Mail out and Welcome Package forms, for member who has been newly enrolled into Case management

Receive daily notification calls/faxes regarding members admitted to acute hospital

Follow up on case management members weekly to ensure that they are obtaining the correct care to prevent costly hospital admissions

Follow up with case management nurse daily to ensure that members medical care

Needs are met.

Daily outbound calls, faxes and emails to member, Doctors,hospitals and outpatient clinics

.

Health Care in Partners (IPA,Medical ) Longisland NY

2012-2013 Personal care Advocate

Contact members on a daily basis to conduct H.R.A health assessment form.

Identify member’s medical problems and forward information to medical Doctors.

Assist members with locating Doctors near there area that participate with

Members medical insurance.

Provide member with various information regarding members medical plan.

Contact Doctors office regarding approved or denied authorizations or referrals.

Train new employees .

Fax, file and copy medical documents.

2010-2013 Healthplex - Longisland NY

Customer Service Representative (Dental Insurance Company)

Answers questions and resolves issues based on phone call/letters from members

and providers

Verify member’s eligibility

Track and document member’s relative data into the database

Call members when necessary to advised on next steps and/or inform of resolution

Correspond with Doctor’s and Members regarding Pre-determination results

Handle incoming request for adjustments and appeals for the claims department

Advised member of approved, denied and pending referrals

Educate members with plan benefits, co-insurance, deductibles and co-pays

2006- 2010 Maisel, Blinderman & Bryer, Hewlett NY(Partime)

Medical Secretary (Pediatric Office)

Schedule and confirm patient appointments daily

Arrange outpatient procedure and tests

Enter patient demographics into specific medical software applications

Verify patient medical insurance and collect co-payments

Process referrals, medical claims and prior authorization

Maintain electronic and physical filing system for patient medical records

Responsible for inter-office scanning and copying of medical documents

Answer high volume calls, screen, route calls and take detail messages

2001-2004 Mercy Medical Center, Hempstead NY

Medical Secretary (Cardiovascular Department)

Assisted in administrative duties such as data entry, billing and phone support

Arranged patients medical appointments and transportation daily

Entered all sonogram testing reports into computerize medical system

Processed billing payment and invoice for patient medical service

Assisted Doctor’s and Nurse’s with patient medical information

References Available Upon Request

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