Patricia Clark-Barnes

Upper Marlboro, MD

ad1800@r.postjobfree.com

301-***-****

● HEDIS Outreach Specialist with 7+ years of vast experience in fast-paced settings

● Well-versed in handling an average of 100-115 calls daily while resolving member issues

● Call Center 13+ years of vast experience in fast-paced settings

● Trained and tested on the following NCQA, HEDIS Measures: Well Child 3-6, Cervical Cancer, Adolescent Well Care, Diabetic Eye, Lead, SSI Adult, SSI Child and Postpartum Care

● Trained and tested on DHMH state of Maryland Measure: Social Security Income Adult, Social Security

● Child, and Value Based Purchasing Lead

● Proficient in MS Office programs (Outlook, Word, Excel, PowerPoint, MS Access), Lync (IM)

● Proficient in QNXT & Catalyst Database, HEDIS Outreach, Call Tracking, 2010, Alchemy Search, NCQA HEDIS, Suncoast database Requirements

● Knowledge in CPT/ICD codes and medical terminology

● Ability to work well under pressure in a fast-paced, time sensitive environment with shifting priorities and multiple deadlines

● Excellent communication and interpersonal skills, experience in psychiatric or substance abuse

● Knowledge of Medicaid, Medicare, Private Insurance

● Knowledge of Home Home and Home Hospice Care

Work Experience

Patient Service Coordinator/Intake Coordinator

Professional Healthcare Resources

December 2022-Present

● Act as a liaison between patients, clinicans and administration

● Effectively manage daily office operations and scheduling clinical staff to meet the needs of the patients according to company policy and in accordance with Federal and State regulations

● Coordinate all aspects of patient care including intake, nre referral chart creation, scheduling/staffing home visits for a Skilled Nursing, OT visit or PT visit according to patients needs, chart audits and review orders from referring physicians and or facilities

● Perform continuous scheduling activities and complete daily reporting requirements

● Ultized Home Care Home Base system tools to adjust schedules on a daily basis to maximize branch patient capacity in Kensington, Baltimore, DC, Lanham locations.

● Receive and respond to scheduling change request from all sources within an appropriate and timely manner

● Monitor and addresses as necessary key milestones in regards to patient care and compliance

● Assists branch in maintaining communication with patients, ensuring coordination of care and excellent customer service

● Fulfills additional performance responsibilities as assigned and as necessary

● Communicate effectively with patients and their families to perform a welcome call as well clinicians and all staff

Support Planner/Case Manager

MMARS-Linthicum, MD

August 2022- December 2022

● Assist the participant to develop a Person Centered Ppan to help them achieve their life goals

● SP/Case Manager perform tasks to assess clients needs, situations, strengths, and support network to determine their goals

● SP/Case Manager serve as the primary point of contact with the particpants

● SP conduct home/community POS, QV or Annual visits with the participant, their family, their team

● Coordinate and facilitate team meetings with the partricpant, their family and community providers

● Accurately document all case management activities daily in LTSS

● Knowledgeable of and follow all State, Federal and DDA guidelinest

● Knowledgable of the challenges individuals with Intellectual and Develpmental Disabilites Referral Administrator

QCI Behavioral Health - Largo, MD

February 2020 to May 2020

● Overseeing and managing the activities of the clinic, in support of the business to further efficient delivery of patients service nationally.

● To receive referral intake forms from hospital, nursing home, intake facilities as well as other and transfer electronically to software.

● Provided initial assessment before rendering services

● Obtain referral authorizations before rendering services for medicaid, medicare or private insurance

● Scheduled patients appointment using Clinical Tracker (CT) System, software medical information system

● Notifying patients of their scheduled time and date of their appointments

● Receive and deal with telephone calls inquiries regarding appointments from patients and referring

● Note cancellations of appointments and offer vacant slots to other patients waiting list seeking services

● Maintain the clinical systems and to ensure patient's files are accurate are available to the therapist and doctors prior to each session

● Download and scan patients referral intake forms and added documents like notes, prescription, doctor orders into the CT system

● Maintain and monitor QCI referrals accordingly.

FUH AfterCare Coordinator-Mental Health and Substance Use Beacon Health Options/Aver, LLC. - Linthicum, MD

March 2017 to December 2017

● Call center experience

● Utilized HEDIS measures

● Collaborates with providers and Service Managers to assist members receiving behavioral health services, access alternative levels of care, and facilitate transfers to network facilities and providers whenever possible. Coordinates member's service needs with community agencies ● Assures follow up and community linkages

● Ensures continuity of patient care through direct contact with members and providers as appropriate

● Tracks and monitors members who have been transitioned from inpatient treatment to state hospitals to ensure continuity of care

● Documentation of confidential information within a timely manner into data system

● Assists members with behavioral health (MH and drug and alcohol) services/referrals

● Utilized excellent written and communication skills

● Utilized strong analytical, organizational and problem-solving skills

● Knowledge of community services/resources manages a confidential caseload

● Access the member’s situation to make an accurate appropriate referral

● Performs other duties as assigned

● Excellent written and verbal communication

● Established rapport with members and providers

● Attend monthly meetings to follow up on the status of HEDIS measures outcomes

● Performs other related duties and responsibilities as directed

● Comply with the NCQA guidelines

● Ability to handle multiple tasks simultaneously

Close out the inquiries with verification of the cla

● Utilize system Service Connect and Care Connect to obtain Beacon Health information resource ABA-Clinical Care Coordinator-Autism

Beacon Health Options - Linthicum, MD

December 2016 to March 2017

● Call center experience

● Assist members and providers with all levels of inquiries, problem-solving, insurance information, and general customer service

● Staff all call center queues and adhere to performance requirements for call center response times, abandonment rates, and other productivity, schedule, and quality standards or metrics that may be established

● Gather all pertinent clinical information from the member/families in regards to ABA services by interviewing the patient/family to determine if members have sufficient information before moving forward with ABA services

● Monitor the data in the clinical care management system, collaborating with provide community; escalate issues and concerns regarding care management to senior care managers according to policies and procedures

● Receive, respond and resolve questions about accessing ABA services

● Analyze data and identify appropriate level of care to expedite linkage to care for ABA services

● Gather required clinical and financial information care for members and enter data into clinical care management system

● Acted as a liaison with parents and the health community to ensure a continuum of care and support for members

● Partake in quality improvement functions ● Knowledge of state and federal laws and regulations applicable to the call center

● Utilize strong analytical, problem solving and organizational skills. As well as interpersonal skills to frequently interact with members, families, providers and insurance representatives to address a variety of concerns and requests.

● Knowledge of Microsoft Office suite, including and Outlook, Excel and Word

● Utilize system Service Connect and Care Connect to obtain Beacon Health information resource Patient Support Representative

NovaSom, Inc. - Glen Burnie, MD

October 2016 to December 2016

● Call center experience

● Serve as an Ambassador for NovaSom to patients, providers, and other customers.

● Schedule patients within two business days of order entry.

● Complete online eligibility and coverage verification within an established time frame

● Ensure providers' orders are processed in accordance with the payer's medical policy.

● Provide education and apply skills to decrease the number of patients canceling home sleep testing.

● Provide education and apply skills to support patients in completing home sleep testing

● Meet established quality call monitoring (e.g. > 90%)

● Promptly respond to patient phone calls regarding service

● Document all patient and account contacts in the patient's file

● Take ownership to resolve customer complaints in a timely manner as well as responsibility to ensure every client request is handled promptly. Follow all policies, procedures and processes and other duties as assigned

Claims Examiner

Trizetto - Linthicum, MD

February 2016 to June 2016

● Call center experience

● Examine and enter complex claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met

● Assist the Team Lead in problem resolution, planning, and overseeing workflow; provide suggestions and recommendations to improve workflows and departmental efficiencies

● Process complex claims for multiple plans with automated and manual differences in benefits

● Utilize system & written documentation to determine appropriate payment for a specific benefit

● Approve, pending, or deny payment according to the accepted coverage guidelines

● Identify and refer all claims with potential third party liability (i.e., subrogation, COB, MVA, stop loss claims, and potential stop loss files)

● Maintain internal customer relations by interacting with staff regarding claims issues and research, ensure accurate and complete claim information, contact insured or other involved parties for additional or missing information, and update information to claim file with regard to claims status, questions or claim payment

Crisis Care Coordinator

Capital Caring, Telstar Court - Falls Church, VA

November 2014 to February 2016

● Acted as a liaison between the Crisis Care staff and the regions served, Arlington, Alexandria, Merrifield, Leesburg, Manassas, District of Columbia and Maryland

● Act as a team leader in coordinating and scheduling staffing via email and phone to meet patient needs that are facing life limiting illness battling various types of cancer

● Greet internal and external, including clinical staff from across nonprofits organization and attend meetings

● Coordinate crisis care for those patients facing life-limiting illness battling various types of cancer

● Create, update and submit team Crisis Care am/pm reports to the entire clinical staff (LPN, RN and C.N.A), crisis care team, after hour staff, case managers, supervisors, directors, social workers and chaplains with accuracy

● Utilize various databases including Sun coast Production to identifies patient’s P #number, patient history, diagnosis, treatment, medication, family history, provider’s information etc

● Utilize billing system to track and enter staffing time quickly and accurately and to review and correct reports daily

● Update/maintain weekly crisis care staff and schedule RN, LPN and CNA Nursing staff HEDIS Outreach Specialist

Maryland Physicians Care - Linthicum, MD

October 2010 to November 2014

● Call center experience

● Placed inbound/outbound calls requiring deviation from standard scripts and techniques to meet the individual needs of the member

● Analyzed member files utilizing a variety of database systems, ICD-9 codes

● Worked directly with Postpartum care, Diabetic Eye, HgbA1c, Lead, Cervical Cancer Screening (Pap Smear), Breast Cancer (Mammogram) SSI Adult, SSI Child, Well Child 3-6 as well as Adolescent Well care members with a goal to ensure approximately 575 members received appropriate health care within a timely manner

● Contacted/ Communicate with member services, primary care providers, members within a courteous manner, assign providers to members, case managers to schedule appointments, verify scheduled appointments, enter member’s demographics, claim processing, check member's eligibility and termination time frame, insurance verifier as well as confirm kept appointments for gift card incentive, outreach to members at postpartum clinics/events

● View health insurance claims, verify claims, submit claims, denial claims and approve gift card claims for gift incentives

Medical Office Assistant II/Diagnostic Radiology

Washington Hospital Center - Washington, DC

March 2009 to June 2009

● Screened calls, greeted visitors, responded to inquiries and scheduled patient’s appointments

● Transcribed dictation, meeting minutes, patient narrative and discharge summaries

● Registered new patients and updated information on existing patients

● Coordinated pre-admission testing for patients & entered charges into billing system

● Ensured appropriate insurance coverage by comparing charges to insurance plans

● Analyzed patient’s files utilizing a variety of database systems ICD-9 codes Education

Master of Science

Southern New Hampshire University

2018

Bachelor of Science in HealthCare Administration/HealthCare Management University of Phoenix

2012

Associates of Arts Degree in HealthCare Administration University of Phoenix

2010

Wedding & Event Planner

2017

Spiritual Advisor

2016

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