Customer Service Criminal Justice

Karla Flowers

** ** *** ******, *****, FL ***** 786-***-**** *******@*******.***

Objective

· Seeking a challenging career which utilizes my skills in my areas of competence, enriches my knowledge, and gives me a chance to be part of a team that contributes towards the growth of the organization, thereby yielding the twin benefits of job satisfaction and professional growth.

Education

BS 8/2001 FLORIDA INTERNATIONAL UNIVERSITY

· Major: Criminal Justice

· Minor: Social Work

· Related coursework: Public Administration

AA 8/1998 MIAMI DADE COLLEGE (MDCC)

· Major: Education

· Minor: Criminal Justice

· Related coursework: Nursing

PHARMACY TECH CERTIFICATE 10/2012 BARRY UNIVERSITY Skills & Abilities

COMMUNICATION

· ENGLISH, FRENCH, CREOLE/KREYOL & conversational SPANISH COMPUTER/SYSTEMS

· Knowledge of systems: FLORIDA, FLMMIS/FMMIS, CIRTS, REVENUE CYCLE SYSTEMS, PASSPORT, CERNER, SDIS, ALLSCRIPTS, SAVE, ONPOINT, ACE, PBAR, MICROSOFT OFFICE including WORD, EXCEL, ACCESS, ONENOTE, OUTLOOK, POWERPOINT, Vx, Availity, eCareNEXT, OneSource.

Experience

MANAGED CARE/PRIOR AUTHORIZATION COORDINATOR – VITAS HEALTHCARE 2/2018 TO PRESENT

· Responsible for verifying eligibility and benefits from patient’s insurance carriers prior to admission. Once admitted responsibilities include securing authorization for services provided, notifying Utilization Management of any Level of Care changes, providing clinical documentation to support authorization request and maintain the case until patient discharges and all claims have been paid.

ADMISSIONS COORDINATOR I – VITAS HEALTHCARE – 10/2014 TO 2/2018

· Responsible for coordinating referrals and inquiries about hospice services. Serves as a member on the Admissions Team for building and maintaining provider relationships. Providing customer services to people who facilitate the conversion of referrals to admissions through the completion of the intake process. Utilizing effective phone and customer service skills to service patients and their families.

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SFAN ELIGIBILITY SPECIALIST JACKSON MEMORIAL HOSPITAL/JACKSON HEALTH SYSTEM 6/2012 - 3/2014

· Determining eligibility of HIV+ clients for Ryan White part A program, Medicaid, PAC waiver, Affordable Care Act and/or Jackson Health System's charity care program for uninsured patients. CUSTOMER SERVICE REPRESENTATIVE ARISE VIRTUAL SOLUTIONS 8/2009 – 4/2012

· Providing virtual customer service for contracted companies via telephone, email or chat in a home based work environment.

CASE MANAGER UNITED HOME CARE SERVICES 6/2009-5/2010

. Assessing, Qualifying & Providing services to elderly and/or disabled clients who require assistance with their activities of daily living. The goal is having clients remain in their home by providing home health services in order be diverted from nursing home care. Daily/Monthly follow up to assess and verify that main goal of diversion is attainable and not detrimental to patient/client. Gathering information to qualify and apply for Medicaid waiver for Home and Community Based Services.

PATIENT ADVOCATE II TENET/NORTH SHORE HOSPITAL 5/2008 – 5/2009

. Screening and assisting uninsured patients in order to find link to local, state or federal programs which will assist in decreasing/covering medical debt and/or collecting debt for those deemed ineligible for any funding sources. Insurance verification, registration and collections. CARES ASSESSOR STATE OF FLORIDA – DEPT. OF ELDER AFFAIRS 7/2005 – 5/2008

. Assessing elderly and/or disabled clients to determine eligibility for home and community based waiver programs. Assessments were completed in the home or an assisted living facility. Eligibility is determined by reviewing medical charts, need for assistance and financial eligibility of clients. Completing nursing home reviews monthly to ensure that patients in nursing homes meet the criteria and level of care needed to remain in the nursing home. Completing desk reviews from outside agencies in order to issue a Level Of Care for their clients. ECONOMIC SELF SUFFICIENCY SPEC I STATE OF FLORIDA – DEPT OF CHILDREN AND FAMILIES 7/2002 – 7/2005

. Processing applications for food stamps, TANF, Medicaid and Medicaid waiver programs. Completing bill tracking for the Medically Needy program. Billing resolution and medical referral processing for area hospitals to determine eligibility for their uninsured or partially insured patients. Eligibility for Medicare Buy-in Program.

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