Patient navigator financial counselor

Monica Jones

Email: ************@*****.***

Phone: 619-***-****

Work Experience

Patient Navigator III, QHC Isolation Housing Analyst II, Medical Biller * Medical Collector * Customer Service * Patient Service Representative * Patient Service Specialist * Data Entry * Accounts Receivable/payable * Sales Support Representative

Patient Navigator III(Intake Coordinator)

UCSD Owen Clinic and Transition of Care, San Diego CA

March 2023 – Current

Responsible to ensure that patients are fully informed about their legal rights, teach patients about their care options and make specific recommendations based on their goals, help patients and their families navigate the process of using insurance to pay for care, Review paperwork for patients to ensure it meets all requirements, perform related tasks to make it easier for patients to receive the best possible health care at our hospital, preformed retention by utilizing secure processes and working with Outreach programs to locate and get patients back into care and connect to the appreciate resources that they need urgently and in the future, complete referrals to other programs that will aid patients with needs they have

Working with clients, family and friend support networks and health care professionals to put care plans in place, listening to clients’ concerns and providing intervention as required, recording clients’ progress including charting referrals, home visits and other notable interactions. Evaluating clients’ progress periodically and adjusting as needed to improve outcomes, following up with discharged clients to ensure they were satisfied with services and they are still in good physical and mental health

Helping patients understand and complete necessary paperwork, educating patients about resources and support services available, acting as a liaison between patients and healthcare professionals, following up with patients to monitor their condition and adherence to treatment plans, collaborating with a multi-disciplinary team to ensure holistic care, coordinating and providing care that is safe, timely, effective, efficient, equitable, and client-centered, handling case assignments, draft service plans, review case progress and determine case closure, helping clients achieve wellness and autonomy, help patients make informed decisions by acting as their advocate regarding their clinical status and treatment options, develop effective working relations and cooperate with medical team throughout the entire case management process, arrange abeyances with social services, health and governmental agencies, take the extra mile and interact with patients to keep track of their progress and to ensure satisfaction, record cases information, complete accurately all necessary forms and produce statistical reports, promote quality and cost-effective interventions and outcomes, collaborate with administrators, insurance companies, providers, medical teams, and Social Workers.

QHC Isolation Housing Analyst II

UCSD Campus EH&H/EOC, La Jolla CA

May 2022 to March 2023

Responsible for scheduling positive student Isolation transportation to Isolation housing hotels or campus dorms, Emailing OCC notifications for UCSD employees that are positive for Covid19 virus. Responsible for student and employee correspondence via email and telephone. Responsible for assisting hotel in use for Isolation students, assisting students with Isolation questions and Directors, Supervisors, Managers, Chancellor’s offices concerning the location that had covid19 positive employees

Patient service representative/Specialist

Scripps Healthcare-Primary Care/Internal Med, Pediatrics, Gastroenterology and Vein Clinic, San Diego CA

October 2017 to May 2022

Responsible for interacting with patients, payers and providers to gather information necessary for accurate registration including assigning of appropriate Medical Record Number, scheduling, referral/ authorization, point of service payment collection, document collection and arrival/check-in functions

Responds to customer billing and payment inquires as needed

Effectively manages the patient check-in and check-out process from start to finish, which includes identification verification; updating or confirming demographic and insurance information on every patient; ensuring appropriate forms are provided, signed and witnessed at the time of the patient visit; collecting patient payment responsibility and accurately preparing end of day reporting or payment reconciliation as needed

Escalating billing inquiries as needed. Accurately scheduling patient consults and Motility test appointments

Successful scheduling includes, but not limited to, exhibiting proficiency in appointment scheduling procedures, accurate documentation and routing of messages, scheduling and confirming appointments according to practice guidelines, entering appropriate insurance, performing Key User duties with minimal errors

Responsible for initiating and validating referrals/authorizations

Provides a proactive approach to customer service by listening to the patient, taking ownership of solutions and escalates issues as appropriate in order to resolve concerns.

Receives and routes messages received in the department appropriately as well as manages customer billing and payment inquires as needed.

Effectively manages the patient interaction from start to finish, which may include identification verification; updating or confirming demographic and insurance information on every patient; ensuring appropriate forms are provided, signed and witnessed at the time of the patient visit; verifying coverage including benefits, authorization, pre-determination, payer specific policy exclusions or limitations to coverage, collecting any patient responsibility and accurately preparing end of day reporting or payment reconciliation as needed

Successful scheduling includes, but not limited to, exhibiting proficiency in appointment scheduling procedures, accurate documentation and routing of messages, scheduling and confirming appointments according to practice guidelines, entering appropriate insurance, initiating authorizations and referrals, performing Key User duties with minimal errors

Regularly displays a proactive approach to customer service by listening to the patient, taking ownership of solutions and is able to accurately identify the need to involve leadership in order to resolve concerns

Medical collector II

Genoptix Laboratory, Carlsbad CA

September 2013 to October 2017

Responsible for interacting with patients, payers and providers to gather information necessary for accurate registration including assigning of appropriate Medical Record Number, scheduling, referral/ authorization, point of service payment collection, document collection and arrival/check-in functions

Responds to customer billing and payment inquires as needed

Effectively manages the patient check-in and check-out process from start to finish, which includes identification verification; updating or confirming demographic and insurance information on every patient; ensuring appropriate forms are provided, signed and witnessed at the time of the patient visit; collecting patient payment responsibility and accurately preparing end of day reporting or payment reconciliation as needed

Escalating billing inquiries as needed. Accurately scheduling patient appointments

Successful scheduling includes, but not limited to, exhibiting proficiency in appointment scheduling procedures, accurate documentation and routing of messages, scheduling and confirming appointments according to practice guidelines, entering appropriate insurance, performing Key User duties with minimal errors

May be responsible for initiating and validating referrals/authorizations

Provides a proactive approach to customer service by listening to the patient, taking ownership of solutions and escalates issues as appropriate in order to resolve concerns.

Receives and routes messages received in the department appropriately as well as manages customer billing and payment inquires as needed.

Medical Biller III

MPS Billing Company - Chula Vista, CA

January 2009 to September 2013

Professionally assisted providers and office staff with all claims and claim issue s

Ran daily claims reports to review for accuracy of information

Contacted providers and office staff regarding problem solving

Analyse explanation of Benefits to bill claims

Provided high levels of customer service to providers, office staff, insurance companies and patients

Researched missing claim information utilizing various scan software and internet services

Performed extensive follow up regarding billed/unbilled claims for payments and denials

Responsible for billing of inpatient/outpatient medical claims

Processed weekly and monthly aging reports

Reviewed prepared claims for accuracy

Assisted patients and insurance companies with various customer needs, problem solving and guidance

Provided billing support for various teams within the department

Provided training for specific duties

Created and maintained desk reference manual

Medical terminology

CPT Coding

Payment posting for HMO, PPO, private pay, Medi-Cal, Medicare and Workman's Comp insurances

Knowledge of the basic body structures and functions of the systems in the Human body

Knowledge of biohazardous waste disposal

Resolved denied claims and re-billed or appealed for payment

Verified Insurance

Request Authorizations for all types of services

Run weekly and monthly reports

Updating insurance contracts for individual Physicians

Education

San Diego Academy

National City, California

1886 to 1990

Diploma Received

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