Nursing Assistant Medical
Resume:
Deborah Hamilton
Ewing, NJ ***18
***********@*****.***
Summary
Experienced, motivated healthcare professional with high standard of honesty and integrity, respecting confidentiality of patient information at all time. A strong positive role model with a progressive history of customer service responsibilities.
Provider Enrollment & Provider Services Rep II 2015 - Presently
Credentialing, indexing of Provider Application, processing and completing individuals and groups for Hospitals, Nursing Homes, Ambulance Services, Pharmacies applications. Provides to the Provider Services team in regards to receiving, researching and responding to provider inquiries.
Managed Care Coordinator (Contractor) Horizon Blue Cross Blue Shield of NJ 2014
Support health services and utilization management functions and act as liaison between members, physicians, delegates, operational business members and member service coordinators.
•Handle initial screening for pre-certification requests from physicians/members via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff.
•Perform review of service for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.
•Prepare, document and route cases in appropriate system for clinical review.
•Initiate call backs and correspondences to members and providers to coordinate and clarify benefits.
•Review professional medical/claim policy related issues or claims in pending status.
•Authorize services based upon scripts or algorithms used for pre-review screening and upon collection of clinical and non-clinical information.
Birth Registrar/Department Secretary Labor & Delivery UMCPP 2003 – 2013
Managing the hospitals’ documentation of all live and demised deliveries at the hospital which included:
•Data entry of live and demised birth into the State’s EBC System.
•Creation of birth and death certificate for deliveries.
•Stats report for Deliveries, Post-partum depression, and Birth defects for hospital/State.
•Correspond with local townships in regards to birth/death certificates.
•Communicate and assist patients with completion of birth certificate forms.
•Scheduling of inductions, C-Sections, and Stress tests.
•Interdepartmental and external communication and material management.
Department Secretary Department of Rehabilitation UMCP 2001-2003
Managing the interdepartmental communications and additional responsibilities which included:
•Medical transcription and insurance verification.
•Registration of inpatient/outpatient therapy.
•Perform billing and reimbursement processing for Physical, Occupational and Speech therapy.
Office Secretary Princeton Surgical Associate and Dr. Levendowski 1996 – 2001
Management of large volume phone and interoffice communication and additional responsibilities which included the following:
•Scheduling of OR procedures and office visits.
•Management of medical records and billing.
•Material management.
Unit Secretary Emergency Department UMCP 1995 – 2004
Management of interdepartmental and external communication including EMT calls and the following:
•Entering of doctor’s orders and ER charges.
•Assisting with admissions of patients.
•Assisting families with the location of their loved on.
Certified Nursing and Home Health Aide. UMCP
Assisting with the care of hospice and geriatric patients in long term Nursing Care and in their private homes
Education
Deborah Hamilton
***********@*****.*** Ph# 609-***-****
Summary
Experienced, motivated healthcare professional with high standard of honesty and integrity, respecting confidentiality of patient information at all time. A strong positive role model with a progressive history of customer service responsibilities.
Molina Medicaid Solutions; Provider Enrollment & Provider Services Rep II 2015 - Presently
Credentialing, indexing of Provider Application, processing and completing individuals and groups for Hospitals, Nursing Homes, Ambulance Services, Pharmacies applications. Provides to the Provider Services team in regards to receiving, researching and responding to provider inquiries.
Managed Care Coordinator (Contractor) Horizon Blue Cross Blue Shield of NJ 2014
Support health services and utilization management functions and act as liaison between members, physicians, delegates, operational business members and member service coordinators.
•Handle initial screening for pre-certification requests from physicians/members via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff.
•Perform review of service for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.
•Prepare, document and route cases in appropriate system for clinical review.
•Initiate call backs and correspondences to members and providers to coordinate and clarify benefits.
•Review professional medical/claim policy related issues or claims in pending status.
•Authorize services based upon scripts or algorithms used for pre-review screening and upon collection of clinical and non-clinical information.
Birth Registrar/Department Secretary Labor & Delivery UMCPP 2003 – 2013
Managing the hospitals’ documentation of all live and demised deliveries at the hospital which included:
•Data entry of live and demised birth into the State’s EBC System.
•Creation of birth and death certificate for deliveries.
•Stats report for Deliveries, Post-partum depression, and Birth defects for hospital/State.
•Correspond with local townships in regards to birth/death certificates.
•Communicate and assist patients with completion of birth certificate forms.
•Scheduling of inductions, C-Sections, and Stress tests.
•Interdepartmental and external communication and material management.
Department Secretary Department of Rehabilitation UMCP 2001-2003
Managing the interdepartmental communications and additional responsibilities which included:
•Medical transcription and insurance verification.
•Registration of inpatient/outpatient therapy.
•Perform billing and reimbursement processing for Physical, Occupational and Speech therapy.
Office Secretary Princeton Surgical Associate and Dr. Levendowski 1996 – 2001
Management of large volume phone and interoffice communication and additional responsibilities which included the following:
•Scheduling of OR procedures and office visits.
•Management of medical records and billing.
•Material management.
Unit Secretary Emergency Department UMCP 1995 – 2004
Management of interdepartmental and external communication including EMT calls and the following:
•Entering of doctor’s orders and ER charges.
•Assisting with admissions of patients.
•Assisting families with the location of their loved on.
Certified Nursing and Home Health Aide. UMCP
Assisting with the care of hospice and geriatric patients in long term Nursing Care and in their private homes
Education
AAS in Nursing Mercer County Community College 2018 – Present
LPN Certificate Queens wood College 1982 – 1985 (Out of country)
Certification
Certified Nursing Assistant
Certified Home Health Assistant
References
Available upon request.
LPN Certificate Queens wood College 1982 – 1985 (Out of country)
Certification
Certified Nursing Assistant
Certified Home Health Assistant
References
Available upon request.
Contact this candidate