Medical Insurance
Resume:
Doris Stratton
Matteson, IL, 60443
**************@*****.***
Experience
JenCare Medical Center
Transitional Care Coordinator
South Suburban Family
Health
Referral Coordinator
08/2016-01/2017
South Suburban Family
Health
Patient Representative
10/2013-08/2016
Schedule/Register
Communicates with physicians, physicians staff, participating hospitals and departments.
Interacts in a compassionate manner to ensure patients and representatives needs are met when appropriate
Ensures that all persons understand clinical policies for resolutions of financial responsibility
In a timely manner accurately collect, analyze, and record demographic and clinical information into system.
Answers phones
Assist physicians with completions of disability, FMLA, and other forms necessary for patients.
Ensure patients with required insurances are provided the necessary referrals for appropriate services.
Ensure patients insurance are billed properly for provided services.
Midwest Physicians/Advocate Medical Group
Patient Representative
10/2005-05/2011
Identifies and tracks patients admitted to the hospitals and other care facilities.
Tracks high risk patients after returning home.
Attends weekly meetings, assist with record keeping and problem solving for high priority patients.
Assists the care team with setting goals for quality assurance and best practices.
Provides remote medical record review and documentation, post telephone discharge telephone calls, appointment scheduling, planning and tracking of team member activities.
Remotes coordination of patient care and direct communication with primary care providers.
Builds relationships with local physicians and leaders in hospitals, post-acute facilities, and primary care clinics.
Obtains daily messages from answering service and daily Humana census.
Sends all discharges to Humana to update case status for closure.
Sends daily reconciled census reports via email to proper markets in a timely manner.
Email Center Managers list of discharged patients for four day follow ups.
Updates the patients discharge tracking tool.
Update clinical notes for Tier 2 hospitals.
Obtains and notify PCP and care teams of ER visits accordingly.
Process all referral request using appropriate ICD 10 codes protocols and office policies
Advise patients of completed referrals and assist patients with specialists, outside clinics and hospitals
Maintain records of completed as well as in-process referrals
Log all referrals for tracking and follow-up purposes
Call or submit online inquiries to insurance companies, HMO’s, PHO’s/IPA’s to obtain benefits, prior authorization and RQI’s.
Maintain liaison with insurance companies to ensure completion of all referral related activities.
Verify, update and correct patient related information including registration, insurance information, and referrals on a daily basis.
Generate charts for new patients in EMR (Allscripts).
Answer phones, schedule and confirm appointments.
Respond to in-house provider questions, request and concerns regarding status of patient referrals.
Answer, respond and document phone calls, requests and questions from patients in a timely manner.
Generate reports as needed.
Greets and registers patients in a timely, pleasant and helpful
Manner.
Follow all policies and procedures outlines by the practice.
Work closely with other care team workers to schedule, follow
up and monitor patient activity.
Maintains order and compliance in the reception and waiting
area.
Assist the care team in pre-visit preparation, screening,
accessing patient needs and monitoring patient registries,
Verifies and maintains up-to-date patient demographics and
insurance eligibility
Monitors, screens, and sorts medical home communication daily
including telephone, web encounters, fax and mail.
Utilize the registry and other performance measurement systems
to identify areas that need improvement
Schedule/Register
Communicates with physicians, physicians staff, participating
hospitals and departments.
Interacts in a compassionate manner to ensure patients and
representative’s needs are met when appropriate
Ensures that all persons understand clinical policies for
resolutions of financial responsibility
In a timely manner accurately collect, analyze, and record
demographic and clinical information into system.
Answers phones
Assist physicians with completions of disability, FMLA, and
other forms necessary for patients.
Ensure patients with required insurances are provided the
necessary referrals for appropriate services.
Ensure patients insurance are billed properly for provided
services.
Education
Prairie State College
September 2002 - May 2005
Robert Morris College
March 1984 – March 1986
South Shore High School
September 1979 – June 1983
Qualifications
Exceptional communication and organization skills.
Effective problem-solving and critical thinking skills.
Ability to build good rapport with clients and handle multiple tasks.
Comprehensive knowledge of medical terminology and procedures,
Sensitivity to confidential matters.
Contact this candidate