Customer Service Patient Services
Resume:
Thornton. CO *****
ad5c4c@r.postjobfree.com
SAMELA RUCKER
PROFILE Highly sensitive and well-trained and experienced Certified Nursing Assistant and Patient Services Rep with a strong work ethic. Adept at working well independently with little to no supervision or as support for a professional healthcare team. With a strong attention to detail and excellent communication skills. I am committed to ensuring the comfort and safety of all patients under my care. Over 2 years of hospice care experience, in home care experience and over a year of consistent CNA experience in various skilled nursing and rehab facilities in both California and Colorado. Currently working at Avista Hospital fulltime and various skilled nursing and rehab centers as a CAN.
PATIENT SERVICES REPRESENTATIVE
ADVENTIST AVISTA HOSPITAL – LOUISVILLE, COLORADO
JUNE 2023 - PRESENT
Provide clerical/office support within a physician clinic, including, but not limited to reception, telephone, medical records, charge entry, referrals, and retrieval of medical information from internal and external systems and sources. Also provide support by facilitating, communicating, and collaborating with both the healthcare team and the patient/family to identify and meet the physical, emotional, and spiritual needs of the patient. Accurately gather and process all necessary information and data to complete all requirements in medical records, referral, billing, and any medical treatment purposes. MEDICAL CLAIMS ANALYSTS
APEX SYSTEMS/KAISER PERMANENTE – SACRAMENTO, CA/ COLORADO OCTOBER 2022 – JUNE 2023
Under general supervision, analyzes, reviews, and evaluates each outside medical services bill for appropriateness of charges and processes for payment ensuring payment is made only for authorized services, procedure codes are consistent with diagnosis codes and services are not unbundled. Investigates and resolves billing problems. Utilizes multiple systems or pricing tools to calculate and apply payment to claims. Software Experience: EPIC, Tapestry
MEDICAL CLAIMS ANALYSTS II
RIVER CITY MEDICAL GROUP/VIVANT HEALTH – SACRAMENTO, CA May 2018 – September 2022
Specialize in processing medical insurance claims through verifying the authenticity and eligibility of claims, analyzing the billing, communicating with policyholders, and ensuring adherence to all policies and regulations during the entire procedure. Provide customer service for members and providers for status update of claims process, additional information, referrals, timeliness filing and re-submissions. Maintain records, files, and documentation as appropriate. Meet department production and quality standards. Claims processing for Healthnet, Blue Cross, Blue Cross Rural, Aetna and Molina. Claims include service facilities cover office, skilled nursing, durable medical equipment, inpatient, outpatient, physical therapy, audiology, optometry, telehealth, emergency room, chiropractic.
Software Experience: Quick Cap, EZ Cap
COMFORT HOME HEALTH AIDE
COMFORT KEEPERS – WOODLAND, CA
October 2019 – March 2021
Provide non-medical care to seniors in their own homes. Establish open communication and develop friendly relationships with seniors and their families. Help seniors with daily tasks such as light housekeeping and organization. Accompany seniors to the grocery stores, doctor appointments and pharmacy visits. Organize transportation, ambulance, and transfers. Encourage activity and movement. Inspire a positive, can-do attitude when it comes to daily tasks, appointments, and hobbies. Maintain a trusting and comforting environment in the home. MEDICAL CLAIMS ANALYSTS II
HEALTHNET/CENTENE - RANCHO CORDOVA, CA
November 2017 – May 2018
Process pended medical claims for Veterans, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility. Claims processing related to physician and hospital services, coordination of benefits (COB), high dollar, special pricing, refunds and/or adjustments on resubmitted claims. Research and determine status of medical related claims. Review charges, access the computer system and use payment or denial codes within established department guidelines and standards. Meet department production and quality standards.
GROUP LEVEL PROCESSOR & PROVIDER CREDENTIALING
BLUE SHIELD OF CALIFORNIA – RANCHO CORDOVA, CA
November 2015 – June 2017
Responsible for validation of practitioner’s professional qualifications to provide services to members. Maintain active status for all providers by successfully completing initial and subsequent credentialing packages as required by hospitals, surgery centers, commercial payers, Medicare, and Medicaid. Support implementations and monitor procedures and activities related to credentialing, re-credentialing, and privileges of network providers.
PAYROLL CLERK
PAYROLL SYSTEMS – WALNUT CREEK, CA
May 2010 – July 2015
Process employees’ paychecks by collecting their payroll data and timesheets. Duties include verifying employees’ work hours and payment through payroll system, issuing deductions, earnings and other statements to employees and updating payroll records regularly. Audit reports and checks, purchase office supplies, ship payroll and tax packages via FedEx, USPS, DHL and GSO.
EDUCATION APRIL 2006
ASSOCIATES OF APPLIED SCIENCE, MEDICAL ASSISTING FRONT AND BACK OFFICE HEALD COLLEGE OF CONCORD, CA
12-week Externship at Alta Bates Family Practice in Berkeley, Ca Primary front office duties include greeting and checking in patients, answering questions, collecting patient co-pays, processing paperwork, filing, and updating patient medical records and scheduling appointments. Primary back-office duties include bring patients to exam rooms, take and record vitals and record patients symptoms, concerns, and medical history.
AUGUST 2014
Phlebotomy CPT1
HEALTH CAREER COLLEGE, Pleasant Hill, CA
Externship at Martinez General Hospital, Martinez, CA AUGUST 2022
CENTERPOINTE LEARNING INSTITUTE, Sacramento, CA
CNA Certification, Graduated August 2022
Current Nurse Assistant Certification with California Board of Nursing Current BLS/CPR Certified
Internship at Sacramento Post-Acute, North Highlands
● Aided nursing staff in geriatric patient care.
● Maintained neat and clean appearance of patient residence spaces.
● Assisted with showers, bed baths, feedings, and ADLs. SKILLS
EXPERIENCE
Health Plan DOFR • Contracts & EOB Review • Medi-Cal & Medicare Claims • HCFA 1500 & UB 040 • Appeals & Grievance • Customer Service Multi-Line Phones • Microsoft Office
REFERENCES CNA Clinicals Instructor, Sterling Castillo, LVN – 707-***-**** CNA AUGUST 2022 - PRESNT
EXPERIENCE CLIPBOARD, VITAWERK, INTELY, SHIFTKEY, G-FORCE - AGENCIES North Pointe (Norwood Pines Care Center), Sacramento, CA 916-***-**** Alzheimer's and Dementia Center
Roseville Care Center, Roseville, CA 916-***-****
Skilled Nursing Center
Eskaton – Greenhaven, Sacramento, CA 916-***-****
Skilled Nursing and Rehabilitation Center
Midtown Oaks Post- Acute, Sacramento, CA 916-***-**** Rehabilitation Center
Covenant Living of Colorado, Westminster, CO
Balfour at Cherrywood, Louisville, CO
Clear Creek Care Center, Westminster, CO
Flatirons Health & Rehab, Louisville, CO
Allison Care Center, Lakewood, CO
The Center at Lowry, Denver, CO
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