Customer Service Care Coordinator
Resume:
Sasha Ashmore
Senior Care Coordinator Patient Representative Supervisor
Email: *********@*****.***
Industry: Medical Records, Medical Coding/Claims Processing, Health Care Administration, Wellness and Fitness
Qualification: Associates in Applied Science and Technology
Availability: Immediately/August 2023
The importance of quality care, and exceptional customer service is a top priority to me. I believe self-motivation, independence, strong attention to detail, and staying positive through difficult challenges has given me the ability to provide excellent client care. Over the years, these qualities have been sharpened with the diversity of roles I have been in. Going above and beyond, offering the highest level of patient-advocacy is top priority. Strong, consistent leadership is not only a skill, but a personality trait I have. Utilizing critical thinking and expressing professionalism enables me to provide superior service to my clients and to my team. I thrive in a busy environment, working on many projects within strict deadlines. I am strongly motivated. The importance of expert-level care to my clients is the most important task. Advocating for my clients is at the forefront of my values. Lastly, maintaining a positive attitude is key to establishing relationships of all levels, and has always been important to me.
EDUCATION
Associates
Health Information Technology Anoka Technical College
Registered Nursing Program Rasmussen University (2016 – completed 7/8 of program. However, have knowledge of Nursing Process, Procedures, Treatments, Body Systems, and Critical Thinking.)
EXPERIENCE
Patient Care Coordinator Client Assistance Operator
Mayo Clinic – Rochester
March 2023 – October 2023
Epic Systems
Regular contact with provider groups to collect clinical data for scheduling Office visits, procedures, labs, etc.
Accurate collection of demographics, insurance information, and necessary information relating to encounter(s).
Cross-department coordination of care; following complex adherence to multiple provider’s/Department’s plan of care.
Patient procedure-preparation education.
Interpretation of medical documentation, including relaying results to patient- within the scope of practice.
Forwarding Correspondence from patient/family to appropriate care team, or provider.
Fax correspondence for insurance, coordination of care plans, ROIs, etc.
Obtain copayments.
Appointment and procedure scheduling in multiple departments; explaining plan or process of care to patient per specialty.
Coordination of procedures, office visits, or telehealth visits with the providers’ schedule, with the facility availability, and the patient’s schedule.
Close attention to detail with specific patient-needs for each visit/procedure/experience
Telephone calls- inbound mostly, but also outbound.
Appointment Scheduling.
Appointment Reminder calls.
Appointment Check-in calls.
Referral Processing for outside providers and inclusive providers.
Prior Authorization initiation and process management.
Support patients in scheduling home visits and on-site visits.
Ensure that all documentation is available regarding patient conditions for the care team.
Support Providers and Nurse Care Managers with operational and clinical tasks.
Handle escalated patient issues, ensuring the appropriate resources are involved.
Follow triage protocol when needed for prioritizing appointments or visits.
Customer Service Representative Claims processing Representative
UCare Health Insurance
September 2022 – Jan 2023
Thoroughly review, analyze, and research complex health care claims to identify discrepancies, verify pricing, confirm prior authorizations, and payment processing.
Provide general claims support by reviewing/interpreting and processing claims.
Calculate accumulations, and insurance benefits.
Participate in meetings to share, discuss, and solve questions or error trends, as well as potential process improvements.
Consistently meet established productivity, schedule adherence, and quality standards.
Navigating across various computer systems to locate critical information.
Critical attention to detail to ensure accuracy, which impacts the timely processing of members’ claims, and on the other hand, the safety for scheduling procedures.
knowledge of all procedures concerning the sequencing of diagnoses, procedures
Review medical records to identify diagnoses/procedures.
Ensures that all data abstracted and/or coded are consistent with guidelines outlined by JCAHO, OSHPD and CMS, regional and local policy.
Sr. Customer Service Representative Coding Claims Processing
PreferredOne; UnitedHealth Group
Jan 2020 – Jan 2022
Thoroughly review, analyze, and research complex health care claims to identify discrepancies, verify pricing, confirm prior authorizations, and payment processing.
Provide general claims support by reviewing/interpreting and processing claims.
Calculate accumulations, and insurance benefits.
Participate in meetings to share, discuss, and solve questions or error trends, as well as potential process improvements.
Consistently meet established productivity, schedule adherence, and quality standards.
Navigating across various computer systems to locate critical information.
Critical attention to detail to ensure accuracy, which impacts the timely processing of members’ claims, and on the other hand, the safety for scheduling procedures.
knowledge of all procedures concerning the sequencing of diagnoses, procedures
Review medical records to identify diagnoses/procedures.
Ensures that all data abstracted and/or coded are consistent with guidelines outlined by JCAHO, OSHPD and CMS, regional and local policy.
Patient Care Coordinator
MNGI Digestive Health
March 2017-April 2019
Regular contact with provider groups to collect clinical data for scheduling Office visits, procedures, labs, etc.
Accurate collection of demographics, insurance information, and necessary information relating to encounter(s).
Cross-department coordination of care; following complex adherence to multiple provider’s/Department’s plan of care.
Patient procedure-preparation education.
Interpretation of medical documentation, including relaying results to patient- within the scope of practice.
Forwarding Correspondence from patient/family to appropriate care team, or provider.
Fax correspondence for insurance, coordination of care plans, ROIs, etc.
Obtain copayments.
Appointment and procedure scheduling in multiple departments; explaining plan or process of care to patient per specialty.
Coordination of procedures, office visits, or telehealth visits with the providers’ schedule, with the facility availability, and the patient’s schedule.
Close attention to detail with specific patient-needs for each visit/procedure/experience
Telephone calls- inbound mostly, but also outbound.
Appointment Scheduling.
Appointment Reminder calls.
Appointment Check-in calls.
Referral Processing for outside providers and inclusive providers.
Prior Authorization initiation and process management.
Support patients in scheduling home visits and on-site visits.
Ensure that all documentation is available regarding patient conditions for the care team.
Support Providers and Nurse Care Managers with operational and clinical tasks.
Handle escalated patient issues, ensuring the appropriate resources are involved.
Follow triage protocol when needed for prioritizing appointments or visits.
Clinic Access Specialist Clinic Access Specialist III
Women's Health & Mercy Hospital - Allina Health
August 2013 – Dec 2016
Epic Systems
Regular contact with provider groups to collect clinical data for scheduling Office visits, procedures, labs, etc.
Accurate collection of demographics, insurance information, and necessary information relating to encounter(s).
Cross-department coordination of care; following complex adherence to multiple provider’s/Department’s plan of care.
Patient procedure-preparation education.
Interpretation of medical documentation, including relaying results to patient- within the scope of practice.
Forwarding Correspondence from patient/family to appropriate care team, or provider.
Fax correspondence for insurance, coordination of care plans, ROIs, etc.
Obtain copayments.
Appointment and procedure scheduling in multiple departments; explaining plan or process of care to patient per specialty.
Coordination of procedures, office visits, or telehealth visits with the providers’ schedule, with the facility availability, and the patient’s schedule.
Close attention to detail with specific patient-needs for each visit/procedure/experience
Telephone calls- inbound mostly, but also outbound.
Appointment Scheduling.
Appointment Reminder calls.
Appointment Check-in calls.
Referral Processing for outside providers and inclusive providers.
Prior Authorization initiation and process management.
Support patients in scheduling home visits and on-site visits.
Ensure that all documentation is available regarding patient conditions for the care team.
Support Providers and Nurse Care Managers with operational and clinical tasks.
Handle escalated patient issues, ensuring the appropriate resources are involved.
Follow triage protocol when needed for prioritizing appointments or visits.
Surgery Specialty Scheduler
Fairview Medical Group
2014-2015
Regular contact with provider groups to collect clinical data for scheduling Office visits, procedures, labs, etc.
Accurate collection of demographics, insurance information, and necessary information relating to encounter(s).
Cross-department coordination of care; following complex adherence to multiple provider’s/Department’s plan of care.
Patient procedure-preparation education.
Interpretation of medical documentation, including relaying results to patient- within the scope of practice.
Forwarding Correspondence from patient/family to appropriate care team, or provider.
Fax correspondence for insurance, coordination of care plans, ROIs, etc.
Obtain copayments.
Appointment and procedure scheduling in multiple departments; explaining plan or process of care to patient per specialty.
Complex coordination of procedures, office visits, or telehealth visits with the providers’ schedule, possible outside provider’s schedule, with the facility availability, and the patient’s schedule.
Close attention to detail with specific patient-needs for each visit/procedure/experience
Telephone calls- inbound mostly, but also outbound.
Appointment Scheduling.
Appointment Reminder calls.
Appointment Check-in calls.
Referral Processing for outside providers and inclusive providers.
Prior Authorization initiation and process management.
Support patients in scheduling home visits and on-site visits.
Ensure that all documentation is available regarding patient conditions for the care team.
Support Providers and Nurse Care Managers with operational and clinical tasks.
Handle escalated patient issues, ensuring the appropriate resources are involved.
Follow triage protocol when needed for prioritizing appointments or visits.
Nursing Assistant
Maple Grove Hospital
2011-2015
Epic Systems
Medical Terminology/Medical Documentation
Direct patient care within Medical-Surgical/ ICU- inpatient units; under the supervision of A Registered Nurse
SKILLS
●Analysis (Business/Revenue, Eligibility, Coordination of Care and Benefits Breakdown)
●Autonomy
●Databases
●Critical and Clinical Thinking
●Organization of Health Information/Detail oriented (10 years +)
●Practice of confidentiality; HIPAA
●Time Management
●Problem Solving & Troubleshooting
●Logistical processes and coordination
●Microsoft systems
●Utilization of Resources/Research (13 years +)
●Prioritization (10 years +)
●Patient Education (8 years)
●Collaboration/Project Management (9 years)
●Verbal/Written Communication (10 years
● Patient Advocation (10 years +)
Public Services; assist with clinic access contingency plans by adjusting appointment times, location, or dates, according to providers’ schedule.
CERTIFICATIONS
Basic Life Support Certification for healthcare professionals (BLS) – Red Cross
Medical Coding
Claims Processing
Prior Authorization Processing
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