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Quality Assurance Customer Service

Location:
Philadelphia, PA
Salary:
$62,500
Posted:
February 01, 2017

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Resume:

PROFESSIONAL PROFILE

A skilled and passionate healthcare professional that is talented at setting patients at ease and structuring treatment plans around each patient's strengths and is skilled in intakes and assessments, crisis management and comprehensive case

management. I am a well-rounded professional experienced in applying principles of psychology to personnel

handling, administration, management and marketing problems with strong leadership and relationship-building skills

and is committed to providing the highest level of care to patients and consumers

PROFESSIONAL HIGHLIGHTS

Experience with clinical case management Medicare / Medical Assistance

Exceptional presentation and communication skills Knowledge of legal and ethical standards

Experienced with diverse populations Experience working in a clinical setting

Experience performing assessments Proficiency with Windows and Microsoft

Highly motivated and results-oriented Strong Customer service skills

Medicare Claims/Appeals Long Term Support Services

Quality Assurance/Home Healthcare Regulations Scheduling/Insurance Billing

Human Resources HCSIS/ SAMS/PCA Portal/PROMISE

EXPERIENCE

Administered evaluation surveys as required by. Attended care conference, supervision, departmental, and outside

meetings and trainings as requested. Charted weekly progress notes and quarterly summaries. Collaborated with

other area service providers, Identified family members, social networks, and community systems that need to be

included in treatment plans for clients. Supervised professional and technical staff in implementing health programs,

objectives, and goals, Coordinated counseling efforts with mental health professionals, doctors, nurses, and social

workers. Referred clients to other support services as needed such as medical, housing, social services, employment

services and legal.

Patient / Family Education

Educated patients and families in community resources, insurance guidelines, and discharge procedures

Quality Assurance

Ensured and enforced nursing home compliance with HIPAA, regulations for maximum quality and control. In charge of

Medicare and HMO claims and appeals

EDUCATION

MASTER OF SCIENCE: HEALTH SERVICES MANAGEMENT 2014

Eastern University, St. David's, PA

BACHELOR OF SCIENCE: PSYCHOLOGY / HEALTHCARE MANAGEMENT 2003

Philadelphia University, Philadelphia, PA

PROFESSIONAL HISTORY

MIDATLANTIC REHABILIATION SERVICES (MARS CARE)

Philadelphia, PA

DIRECTOR OF LONG TERM SUPPORT SERVICE 06/2016 to 01/2017

LEAD WAIVER ACCOUNT MANAGER / SKILLED HOMECARE ADMISSIONS COORDINATOR 10/2014 to 06/2016

Manage a staff of 5 in office employees/400 field employees

Assess individuals for long term support services in the home / Obtain Insurance Authorizations

Work closely with Office of Long Term Living/Medicaid/PA Waiver Programs

Advised patients on community resources, made referrals and devised realistic treatment plans. Compiled

socio-psychiatric case histories to facilitate accurate diagnoses. Evaluated and addressed individual client

needs and concerns.

Quality Assurance

Medicaid Compliance

Networking with the Better Health Network (providing services for the consumers in underserved areas in the Tri-State Area

Interviewing/Hiring/Managing Time off Requests

Providing In-services/Training

SKYLINE HEALTHCARE: WILLOW TERRACE NURSING & REHABILITATION CENTER

Philadelphia, PA

DIRECTOR OF SOCIAL SERVICES/MEDICAID SPECIALIST 06/2012 to 10/2014

Discharge Planning

Medicare D / Medicare A Conversion Daily Charting Completing MDS 3.0 Assessments

Medicare Claims and Appeals

Participating in Care Conference, PASRR ID completion, Quality Assurance, Insurance Verification Medical Assistance Grant Completion.

Working in conjunction with the Philadelphia County Assistance Office

Interviewed clients individually and with families to determine what services would best address their needs.

Working with local Dialysis Centers to maintain continuity of care for nursing home residents.

Advised patients on community resources, made referrals and devised realistic treatment plans.

Communicated with relatives of patients about diagnoses and treatment programs

Assessed patient and delivered comprehensive case management services. Interviewed patients and their relatives to compile detailed social and psychiatric information. Communicated with public social and welfare agencies to obtain and provide information.

Admissions / Marketing Director

Marketing to local area Hospitals Evaluating Hospital Charts Census Projection Conducting Facility Tours

Completing Daily Census and Census Log Medicare D / Medicare A Conversion HMO Contract negotiating

Daily Charting Completing Medicare Logs/ Medicare Denial Letters Family Council Liaison

Working with on-staff Behavior Health Educator & Psychiatrist Completing MDS Assessments

PASRR ID Training

SKYLINE HEALTHCARE: WYNDMOOR HILLS HEALTHCARE & REHAB CENTER

Philadelphia, PA

DIRECTOR OF SOCIAL SERVICES / ADMISSIONS 11/2010 to 06/2012

Discharge Planning

Evaluating Hospital Charts

Medicare D / Medicare A Conversion, Verified Health Insurance

Patient Registration and Daily Charting

Medicare Denial Letters / Appeals and Claims

Completed MDS Assessments Participating in Care Conference

PASRR ID completion

Quality Assurance

KEARSLEY RETIREMENT COMMUNITY

Philadelphia, PA

DIRECTOR OF ADMISSIONS / SOCIAL SERVICES 09/2007 to 09/2010

Interviewed clients individually and with families to determine what services would best address their needs.

Advised patients on community resources, made referrals and devised realistic treatment plans. Compiled

socio-psychiatric case histories to facilitate accurate diagnoses. Evaluated and addressed individual client

needs and concerns. Maintained a caseload of 84 patients, working under strict deadlines.

Coordinated with hospitals and families to ensure appropriate skilled nursing home care.

Marketed in hospitals in the Tri-State area

Created and updated the daily census and working closely with hospital social workers and medical

insurance case managers.

Leader of the Quality of Life Team and Meetings / In charge of Insurance Appeals and Claims

CERTIFICATIONS

Six Sigma Certification (White Belt)

AFFILIATIONS

National Association of Professional Women (VIP)

Healthcare Executives Network

Hospital and Healthcare Administration

Eldercare Networking Group

Network of Professional Social Workers

Professional Women's Network



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