Customer Service Representative
Resume:
Deana Descloux
Westerville, Oh 4381
**********@*****.***
Overview
20+ years in customer service industry
20+ years in health care field
Extensive experience with high volume call center environment
Excellent problem solving skills
Team player
Good attendance record
Computer proficiency in a Windows-based environment
Exceptional verbal and written communication skills
High degree of professionalism
Professional demeanor in a high call volume and fast paced environment with a commitment to outstanding customer service
Knowledge of ICD diagnosis codes, CPT procedure codes, Knowledge of Medicare, Medicaid and other third parties
Professional Work Experience
Dedicated senior medical center in partnership with Ohio Health
Referral coordinator
2260 Morse rd
Columbus Ohio 43229
August 2019-Present
Coordinates and processes patient referrals to completion with precision, detail and accuracy
Prioritizes HPP patients in Primary Care Physicians panel, stats, expedites and orders over 5 days.
Orders have been approved (when needed).
Schedules patient (Preferred Providers List of Specialist) and notifies them of appointment information, including, date, time, location, etc.
Uses Web IVR to generate authorizations (Availity, Careplus, Healthhelp NIA and any other approved web IVR for authorization processing).
Completes orders with proper documentation on where patient is scheduled and how patient was notified.
Referrals have been sent to specialist office & confirmed receipt.
Prepares and actively participates during physician/clinician daily huddles utilizing RITS Huddle Portal and huddle guide. Communicates effectively the physicians/clinicians needs or outstanding items regarding to patients.
Enters all Inpatient and Outpatient elective procedures in HITS tool.
Ensures patient's external missed appointment are rescheduled and communicated to the physician/clinician.
Participates in Super Huddle and provides updates on high priority patients referrals.
Addresses referral based phone calls for Primary Care Physicians panel.
Completes and addresses phone messages within 24 hours of call.
Checks out patients based on their assigned physician/clinician. (Note: If assigned Care Coordinator is unavailable at the time of check out, a colleague shall assist patient. This process does not apply to Care Specialist)
Retrieves consultation notes from the consult tracking tool.
Follows up on all Home Health and DME orders to ensure patient receives services ordered.
Provide extraordinary customer service to all internal and external customers (including patients and other
ChenMed Medical team members) at all times. Utilization of patient messaging tools.
Performs other related duties as assigned.
HMS
Insurance verification Lead
Westerville, Oh
May,2019-present
1.Lead team huddles
2.Compiled KPI reports
3.Trained employees on Medco system
4. 1-1 coaching sessions
5. Provided data for management sprint calls
6.Back up Supervisor
MD Anderson Cancer Center - Houston, TX
FCC specialist
October 2018 to May 2019
1. Obtain and document verification of patient eligibility (and applicable effective dates) using the available institutional and/or payor systems, including real-time web portals and tools, within the applicable timeframes as outlined by department policies and procedures.
Promptly notify Patient Access and the patient, when eligibility information is invalid and/or cannot be verified
2. Work collaboratively with Patient Access to document updated and/or corrected insurance information into the system in accordance with applicable department policies and procedures
3. Obtain and document verification of patient benefits, including information regarding the product type, in-network or out-of-network status, all applicable co-payment, deductible, and co-insurance amounts or percentages, pre-existing indicator and time period, and any lifetime or annual maximums into electronic health record in a timely manner
4. Timely manage work lists for cases requiring pre-authorization and work directly with the payor or assigned third party vendor to obtain all required pre-authorizations.
Seek to obtain pre-authorization through on-line web portals and tools, when available.
Accurately document all reference and pre-authorization numbers, along with payor contact information, into electronic health record
5. For patients participating in a clinical trial, appropriately document and review with patients and the payors services being covered by the clinical trial sponsor and those designated for coverage under the patient's insurance
6. Provides financial counseling to patients which includes reviewing cost estimates, assistance with calculating expected patient liability, discussions regarding payment requirements, collection of financial amounts dues, provide information regarding available payment plan options, and provide information regarding patient financial assistance opportunities when applicable.
Financial counseling also includes reviewing ABN, MSPQ, account review and any other barriers to financial clearance with patients as needed
7. Complete and timely submit all documents (PFA, COBRA, etc,) requiring Supervisor approval for financial clearance
8. Promptly escalate any issues with financial clearance and/or counseling to the Financial Clearance Supervisor or seek assistance as appropriate from the Financial Clearance Coordinator, when needed
9. Completely and accurately document conversations and communication with Patient Access, payors, third party vendors, patients, and any other representative in and outside of the institution
10. Answer emails and phone calls in a timely manner, and respond to voicemails and in-basket messages messages within one business day
Mount Carmel Hospital-Preplanned Services
Patient Financial Specialist III-Concierge December 2009 – April 2018
Schedules out-patient testing with Physician offices and patients
Preregister patients for out-patient testing and surgery
Performs Verification Insurances, Precertification and Benefit determination such as eligibility, deductibles, copays and OOP
Gathers and evaluates financial data for purpose of determining patient responsibility and/or qualification for financial assistance
Process HCAP application
Ensures collection of accurate and complete information for input into PHS for scheduling and preregistration such as ICD-10 coding and CPT as well as Medicare, Medicaid and other third party payers
Bioscrip
Cap insurance Verification Representative May 2006 – December 2009
Cap insurance verification representative and verify Medicare Part B benefits such as ICD-9 codes, J codes for drug coverage, patient’s Medicare eligibility and Medicare deductibles
Verify secondary insurance benefits on patients such as eligibility, copays, deductibles and OOP
Work closely with physician’s offices on scheduling and any issues with eligibility on patients.
Assisted in Patient Assistant Programs between Patient and Physician office
Informed and helped patients with any billing questions
Assist customer Service Dept. in obtaining D.O.A (dates of administration for billing Medicare)
In January 2009 started working with children’s transplant patients in California – coordinated with Nurses to obtain precertification and scheduling for patients who had Medicaid funded programs. I also worked with family to obtain financial aid.
Medco Health Services
Customer Service Representative October 1995 – April 2006
Customer service representative for a pharmacy benefit manager (PBM) where I actively assisted members, physicians,,health care providers and clients prescription plan with eligibility, drug coverage deductibles, copays, OOP, caps, prior authorization and any other coverage benefits. Handle calls from our members and/or pharmacists respond to their inquiries and determining the appropriate action. Work with retail pharmacist to help process claims.
10 years experience in high volume call center
Verified primary and secondary coverage for patients
Handled Med B enrollment and coverage
Informed and helped patients obtain letter of medical necessity
Assisted in Patient Assistant Programs between Patient and Physician office
Education
Lancaster High School – Lancaster, OH
Major: science
Southern Paralegal Institute
Courses in paralegal studies
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