Customer Service Project Management
Resume:
HAMMAD ALEEM
Cleveland, TX Mobile: 408-***-**** E-mail: ************@*****.***
Professional Summary
Worked in a Healthcare performed different role, having exposure of different set skills in promising area of business for more than three years. Having experience of supervising multiple teams while planning and supporting their work schedules, updating procedures and policies while performing customer service activities, decision making, onboarding, accounts receivables, billing and payroll duties.
Skills Summary
Software as a Service (SaaS), Customer relationship Management (CRM), Project Management methodologies, Business analytics, Microsoft Office, Microsoft Windows
Problem solver, Strategist, Operations Analysis, Compliance reviews, Lifecycle management, technical consulting
Work Experience
June 2022 till date Physican medical group (OPTUM)
Medical Biller and Claim analyst
Utilize data from EHR system and submit claims to billing clearing house
Reconcile payments
Resolve issues with payments, denials, resubmission of corrected claims
Reporting of revenues
Ensures services are coded correctly
Provides training to staff on service entry practices to reduce and eliminate errors
Analyze data for trends on service entry practices and provide recommendations to manager
Produce relevant reports, charts, graphs and tables from databases. Identify patterns and trends in data and report results to management.
Design and implementation of billing processes that ensure timely and accurate billing
Documentation of standard operating procedures.
Confirm patient benefits and insurance. Conduct Medicare and medical reviews as needed.
Process claims, claims management, and evaluation of payments, denials, and appeals. Perform various billing and collections functions to ensure accurate and timely claim processing.
Timely follow-up on insurance claim status and resolve insurance authorization and denial instances.
Submit billing data to the appropriate insurance providers.
Achieve maximum reimbursement for services provided.
Coordinate with programs and Accounting Services as needed to ensure that outstanding bills are collected and recorded.
Generate monthly reports and conduct audits.
Communicate with programs and providers with progress in resolving billing issues.
Perform reconciliations to internal and external records, cost reports and reconcile to THT financial records.
Train staff on knowledge, skills and abilities required to obtain program required credentials.
Manage credentialing process with all stakeholders.
Identify and implement process improvement.
Conduct duties in a professional and timely manner.
December 2021 – May 2022: El Camino-GI associates
Clinical Assistant Manager
Help the provider to mitigate old patient record into EPIC since provider has newly migrate into EPIC system.
Under general supervision, operates as part of the care team performing a variety of functions such as greeting patients, patient registration, insurance coverage and eligibility verification, scheduling and telephone management.
Work on referral to get authorization for office visit and procedures.
Send out prep instructions to patient prior to their procedure which include preparing their relevant progress note and pervious procedures.
Overseeing billing and coding process
Creating lab and prescription orders for patients.
Schedule surgery for the patient and first point of contact for any quires/to obtain prior authorization.
Schedules and registers patient appointments and information.
Help setting up the patient for in office visits (preparing room, reconcile mediation and pre=charting).
Accesses EHR to communicate to clinical staff members and/or physicians through telephone encounters using SBAR format and/or appropriate smart phrases.
Operates a multi-line telephone console.
Completes clerical and other front desk support.
April 2021 – December 2021: El Camino Health
Referral Coordinator Los Gatos
Maintain ongoing tracking and proper documentation on referrals to promote team awareness and ensure patient safety.
Work with different insurance portal (CareMore, VHP, SCIPPA, Cerecons & All care to you) to obtain pre-authorization for both HMO and PPO plans.
Ensure complete and correct registration, including patient demographic and current insurance information.
Assemble information concerning patient's clinical background and referral needs. Per referral guidelines, supply proper clinical information to specialist
Contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis and prognosis. Supply specific medical information to financial services to maximize reimbursement to the hospital and physicians.
Review details and expectations about the referral with patients
Find and use cultural and community resources. Establish and support relationships with identified service providers.
Ensure that referrals are addressed promptly.
Remind patients of scheduled appointments via mail or phone.
Ensure that patient's primary care chart is up to date with information on specialist consults, hospitalizations, ER visits and community organization related to their health.
December 2020 – March 2021: El Camino Health
Patient Care Representative Los Gatos
Produces daily/weekly reports for the COO, such as all upcoming patients & unsuccessfully scheduled. Reports all no-shows to manager. successfully
Helps develops office daily protocols.
Meets reasonable benchmarks set by COO about the error rate found with patient demographics, and duplicate accounts.
Works with the COO about patients who have outstanding balances, financial questions, questions about their account, cost of services, and questions about payment plans.
Verifies all insurance demographics and coverage by using online, or phone resources of the insurance company. Position understands that the only acceptable goal is 100% verification of all insurance demographics and coverage prior to the patient setting foot in our facility.
Perform selected medical and administrative duties as directed.
Give correct and prompt documentation to staff, insurance carriers, and companies
Oversee and help take patient histories and vital signs.
Instruct and educate patients about discharge instructions if applicable.
Perform selected medical and administrative duties as directed.
Maintain patient records for clinical use, medical records use, billing & physician review
Januray2019 – Januray2021 (per dime):
Patient service representative Action Urgent care
Oversee and help take patient histories and vital signs.
Prepare a patient for examination and treatment.
Instruct and educate patients about discharge instructions if applicable.
Direct patients to labs, COVID testing locations, or inform of weekly testing schedule set by employer
Perform selected medical and administrative duties as directed.
Supply solutions to patient concerns within the scope of position
Monitor patient chat and respond to patient inquiries about labs, consultations, discharge instructions
Abide by standard of care guidelines
Provide correct and prompt documentation to staff, insurance carriers, and companies
Maintain correspondence by phone or in writing about patient care, working with insurance carriers, physicians, non-clinic physicians
Maintain patient records for clinical use, medical records use, billing, physicians’ review, etc.
Achievements
Been promote after two months as a patient representative supervisor.
Education
Bachelor of Commerce, University of Karachi 2012-2016
Enrolled in medical and billing course (Ashworth College).
Certification
QuickBooks, Mission College 2019
Project Management Basics, Udemy 2020
Project Management Methodologies, Udemy 2020
References
Upon request.
Contact this candidate