Claims Representative Patient Services

SHERIE LONG ad5o5j@r.postjobfree.com 773-***-****

SUMMARY OF QUALIFICATIONS Exercises independent judgment, discretion, and critical analysis to reach reasonable claim determinations that are in accordance with contract provisions and time service standards.

High degree of communication skill to effectively explain claim determinations directly to customer/claimant or their representatives in verbal and written form.

Exceptional ability to establish rapport with customers, gain trust, and improve operational processes to reduce shrink and achieve optimal profitability.

Proven ability to identify and implement improvements to streamline processes and increase efficiency and productivity.

Advocate Health

Patient Financial Claims Representative

06/2018 - 10/2023

Salary: 0.00 USD per year

Hours per week: 32

Patient Services: Provides efficient, high-quality service to patients who telephone or visit in person to request appointments or information on tests and procedures, bills and charges, referrals,and other matters

•Accurately registers cases in the EMR system verifying essential billing and demographic information

•Coordinates scheduling of patient cases appointments accurately and efficiently

•Answers multiple incoming telephone lines, accurately determining the appropriate recipient of the call or message and referring them promptly and appropriately

•Distributes communications accurately,based on practice protocol. Includes pagers, faxes, emails

•Resolves a variety of patient cases questions, including HMO referrals, billing and queries about services and test results; refers complex issues to practice manager or a clinical staff member, as appropriate.

•Schedules future appointments and requisitions, laboratory tests, radiology procedures and other special diagnostic tests as needed. May coordinate with appropriate sections of hospital admission and/or outpatient cases admissions and surgery

•Accurately identifies type of insurance from card, understands different types of payers, and verifies case eligibility if necessary

•Performs other related duties as required.

•Billing Services: Ensures entry at time of service of billing information on the cases and payer and accurate follow-up on missing information

•Reviews encounter forms for accuracy and completeness, checks with physicians for missing case information.

•Enters patient charges into the EMR system according to established policies and procedures

•Record Services: Upholds standards of the practice and of the medical group for accurate and timely medical records

•Releases information from records, only according to corporate policies and procedures

•Ensures the availability of properly prepared patient medical cases, daily schedules and related forms. Maintains medical record including loose filing and re-filing of charts daily. Pull and prepare charts for appointments

•Maintains confidentiality around all patient information, both in front of each patient being treated and around other patients in the area.

Office of Emergency Management and Communication

Police Communication Operator II

1411 W. Madison Ave

Chicago, IL

12/2004 - 10/2023

Salary: $0.00 USD Per Year

Hours per week: 40

Duties, Accomplishments and Related Skills:

•Collects information and intelligence as required on assigned cases and establishes an

appropriate and up to date case file management system.

•Coordinates with vetting support agencies and the intelligence community as needed on case management and reviews, including the collection, review, and analysis of case-specific information.

•Produces unclassified and classified case profiles, for appropriate use.

•Analyzes, coordinates, and evaluates, Accomplishments and Related Skills:

•Develops, evaluates, implements, and maintains security administration concepts through policies, procedures, and methodologies used for safeguarding information, property, personnel, operations, and materials for analyzing and evaluating the character, background, and history of employees, candidates for employment, and other persons having or proposed to be granted access to classified or other sensitive information, materials, or work sites resulting in the diminish of unauthorized disclosure, misuse, theft, assault, vandalism, espionage, sabotage, or loss.

•Coordinates logistical operations and maintains contact with all cases once on assignment

•Constantly maintains status and location of police and fire units for immediate emergency communication.

•Creates and maintains records in accordance with standard operating procedures, guidelines and policies throughout the case life cycle

•Receives and processes 911 emergency calls from a 24 hour 7 day a week emergency center.

•Masterfully operates a computer-aided dispatch system used to receive and respond to emergency and non-emergency calls from the public, dispatchers, and law enforcement agencies coordinating police, fire, medical or other emergency services.

•Maintains an extensive degree of initiative and independent judgment; processes and evaluates cases received.

•Determines the nature and location of the emergency; establishes priorities, and dispatches all required units and agencies as necessary and in accordance with established procedures.

•Ability to adapt and stay calm in emergency situations where sudden changes in priorities, schedules and cases may arise

•Coordinates transportation and secures movement requirements for supplies, personnel and potential hospital; patients.

•Operates a variety of communications equipment, including radio consoles, telephones and computer systems as well as monitors several complex public safety radio frequencies

•Responsible for the inputs and exports of pertinent information from various information systems regarding vehicle status, warrants and promptly provides crucial data to personnel

•Certified Emergency Medical Technician Basic by the State of Illinois; obtained the authority to administer medications previously prescribed to patients and perform non-invasive procedures.

•Annually participates and implements emergency response protocols for the state of Illinois Emergency Containment Exercise in the City of Chicago.

•Provides prompt and orderly guidance to participants and coordinated local health personnel, EMT’s Police and Firefighters associated with the response of an emergency and hazard to public safety.

•Maintains appropriate security and confidentiality of information created or encountered in the performance of assigned duties.

•Keeps informed of departmental regulations, and policies.

Premier Access Insurance Company

Title: STD-LTD Claims Management Specialist

12/2008 - 01/2013

Salary: $0.00 USD Per Year

Hours per: 40

Identified and forwarded appropriate claims for development, by specialized internal and external resources in such areas as rehabilitation and medical examinations/consultations.

• Investigated any questionable aspects of claims, determined needs for additional medical information and coverage eligibility, performed periodic medical updates to assess disability or return to work.

• Compiled and evaluated claim documentation and correspondence requiring extensive policy and factual detail.

• Accountable for identifying and referring appropriate matters to the Legal Department. Partners directly with them in pre-litigation and litigation matters.

• Skilled in utilizing medical databases, subrogation and settlement recovery.

• Accustomed to HIPAA, ERISA, appeal processes, medical terminology, and insurance industry regulations.

• Experienced in the following medical systems: ICD 10 codes, ICD 9 codes, & CPT4 codes

Evaluated and accurately input all information on IMRF forms 5.40, 5.41, 5.42, and supporting documentation submitted by IMRF members.

• Contacted employers, employees, physicians, hospitals, Social Security,and worker's compensation carriers to obtain information necessary to determine eligibility, duration, and amount of most disability benefits.

• Reviewed and analyzed medical records to determine extent of disability, and to make recommendations concerning the application of pre-existing condition language.

• Approved members for temporary disability benefits and make recommendations concerning member's eligibility for Total and Permanent disability.

• Provided customer service to employers, employees, medical providers, and other IMRF departments by answering questions concerning procedures and benefits, either in writing or by telephone.

• Offered detailed information to vested members concerning retirement benefits, including a comparison between IMRF benefits available to disabled members and benefits available to retired members.

Continental Airlines

Customer Service Agent

05/1998 - 10/2006

Salary: $0.00 USD Per Year

Hours per week: 32

Duties, Accomplishments and Related Skills:

•Interacted and greeted all customers at check-in and boarding.

•Assisted customers with check-in, ticketing, tagging and handled baggage.

•Processed customers for flights, boarding and departing passengers.

•Investigated and resolved customer inquiries and irate complaints in a timely and empathetic manner.

•Operate all ground support equipment, belt loaders, crowbar, Jet-way functions. Pushed back different model aircraft.

•Handled daily heavy flow of paperwork and cooperated with the accounting departments on invoicing. Also, completed daily handling of cash transactions with customers.

CERTIFICATIONS

Microsoft Office

EMT

Malcolm X College Chicago, IL United States

Technical or occupational certificate 9 / 2007

GPA: 3.0 of a maximum 4.0

Major: Emergency Medical Technician

Relevant Coursework, Licenses and Certifications:

Also CPR and AED Certified.

FAA Clearance

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