Case Management Customer Service

BRENDA WILLIAMS-JAMES

708-***-****-Cell Home 708-***-****

******.************@*****.***

PROFESSIONAL PROFILE:

Healthcare professional with over 20 years’ experience, possessing demonstrated patient and managed care, in various healthcare environments, both health systems and health plans. Extensive claims processing, medical terminology, and HMO experience. Served in the Advocate Trinity Care Management in the role Administrative duties along with Case Management Assistant duties. Left Advocate after 20 years of service to expand Healthcare experience. 2019-2021-Dr. Joseph Thomas, M.D.

Office management, referrals processing, coding/billing of office services, patient injections, insurance verification, phone management and appointments.- part time position, and full time when needed, EPIC referrals/clinical reviews SUMMARY OF QUALIFICATIONS: 2006- 2017 (Case Management Assistance and Adm. Assistant Dept) 20 years of service in healthcare capacity. Worked for Advocate Corp for 20 years.

CPT and ICD-10 Coding on patient encounters for visits

Quality Assurance & Customer Service on Phone calls

Managed Care & Medical Claims with EOB to clients

In- Patient & Outpatient Services scheduling of referrals and testing with Prior Authorization

Member Benefits & Patient Billing, knowledge of Diagnosis codes for referral processing

Report Writing, experience in E-clinicals, along with Cerner and Athena sofeware for patient data

Insurance Verifications & Patient Preparations for Intake as Medical Assistant in MD office with vitals

Claims reconciliation /Pt Accts /Referral Coordinator

Experience in Cobius reports, Ecin reports for Care Management Dept/ usage Electronic Charts

Assistant in Referral data for Case Managers and Social Workers

Assistant in UM with daily reviews and also retro reviews.

Assisting the Internal/External clients with Statistical positive outcomes in Denials /Appeals with Resolutions for Reconciliation of payments with Analyzation of documentation with software for cases

Patient Advocate for benefits explanations and services regarding their plans CUSTOMER RELATIONS REPRESENTATIVE, 2004 – 2006

Advocate Home Health, Inc., Oakbrook IL

Facilitated calls from hospitals and md offices for customer service needs durable medical equipment and nursing orders with case managers/ intake of orders daily

Early 1982 worked in Provider Relations in contracts department at BCBS for 2-3 yrs MANAGED CARE COORDINATOR 1998 – 2004

Advocate Trinity PHO, City, State

Interacted with md offices, training md staff of updates related to insurance plans,hmo, medicaid, medicare policies

Performed Hedis reports for the insurance companies regarding selected charts from Plans

Scheduled presentations for office staff meeting/calculated and standardized data with reports for departments

Reconciled charts for review for audits /revenue funds for denied admissions with Medical Director

Researched analytical data and processed for monthly meetings for the PHO staff with Power Point data charting EDUCATION:

Circle Campus-Liberal Arts- studies

1975 -1978

Bryman Medical Assistant Technical school – trained as Medical assistant 1year program also Phlebotomy with a certificate received,experienced in injections, patient triage, intake of patients, and insurance referral process, ekgs, other duties.

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