Akira N Hilton

**** ***** **, *******, ** ***** 313-***-****

adj34n@r.postjobfree.com www.linkedin.com/in/akirahilton

Summary

Over 10 years’ experience in healthcare support services in fast paced environments. Strong organizational and communication skills with the ability to concurrently work multiple job assignments at a time. Development of many skills through education and previous work history that can be used in an administrative setting to create and maintain high levels of efficiency and productivity. Advance understanding of customer and company needs with attention to detail resulting in superior customer service and high levels of client’s satisfaction.

Core Competencies

Care Management System Verbal and Written Communication Interpersonal Skills Work Independent and Team Environment Analytical and Problem Solving Skills Well organized able to work multiple projects at a time

Technology Skills

Microsoft Office and MS Access Mainframe NASCO Care Advance Medical Terminology EPIC System I Idoc Web Denis Passport Insurance Verification Care Management

Education

AMERCAN INTERCONTENTAL UNIVERSITY, Schaumburg, IL

Master of Business Administration, Healthcare Management, 02/2020

AMERICAN INTERCONTENTAL UNIVERSITY, Schaumburg, IL

Bachelor of Business Administration, Healthcare Management, 10/2018

AMERICAN INTERCONTENTAL UNIVERSITY, Schaumburg, IL

Associate of Business Administration, Healthcare Administration, 05/2015

Specialization in Healthcare Administration

Professional Experience

BLUE CROSS BLUE SHEILD OF MICHIGAN (BCBSM), Detroit, MI

Medicare Advantage Precertification Specialist, 09/2018-Present

Authorize and/or Approve MAPPO (Medicare Advantage), URMBT (UAW Retired Medical Benefits Trust) and Commercial Acute Members Inpatient Hospital Admissions, Provide Authorization Number, Verify Authorization Number Given to Hospital / Facility, Documentation (Care Advance and Content Manager), Assist in Follow-Ups / Problem Solving / Proactive Solutions, Precertification Inquiries pertaining to Authorizations Status, Assist / Answer questions from Provider Inquiry CSR Level 3 pertaining to Precertification, Verify active policy through Care Advance and/or Web Denis and ICD 10 codes for authorization, Answer Precertification Calls for MAPPO and Commercial (Acute) Members, but ONLY from Providers, Process Appeal Request for nonpayment of services, Process Request for referral of preauthorization for services and supplies, Process and respond to UM Communications for both internal and external servicing requests via email, fax and phone. Manage and assign work assignments to precertification specialist and MAPPO Nurses for daily processing. Precept and provide on the job training for new specialist.

ARROW STRATEGIES (BCBSM), Southfield, MI

Commercial / MAPPO Precertification Specialist, 1/2017-9/2018

Authorized and/or Approved MAPPO (Medicare Advantage), URMBT (UAW Retired Medical Benefits Trust) and Commercial Acute Members Inpatient Hospital Admissions, Provided Authorization Number, Verify Authorization Number Given to Hospital / Facility, Documentation (Care Advance and Content Manager), Assisted in Follow-Ups / Problem Solving / Proactive Solutions, Precertification Inquiries pertaining to Authorizations Status, Assist / Answer questions from Provider Inquiry CSR Level 3 pertaining to Precertification, Verified ICD 10 codes for authorization, Answered Precertification Calls for MAPPO and Commercial (Acute) Members, but ONLY from Providers, Processed Appeal Request for nonpayment of services, Processed Request for referral of preauthorization for services and supplies.

DMC CHILDREN’S HOSPITAL OF MI, Detroit, MI

Patient Mgmt. Clerical Associate Detroit, MI, 9/2015-5/2016

Under general supervision, registers and schedules patients for health services ensuring appropriateness of setting for services provided. Obtains insurance, medical and/or demographic data to admit or pre-admit patients to the health facility. Verified insurance coverage and benefit levels with various third party payers. Assisted patients without medical insurance coverage in completing medical assistance applications and/or making payment arrangement. Collected cash for deductibles and coinsurances, per insurer guidelines. Functions as liaison between patient and health facility by answering patients questions regarding health facility policies and billing requirements and by obtaining necessary information to efficiently register and accurately bill for services rendered. Assisted patients in completing necessary forms and obtains patient signature as dictated by facility policies and procedures. Collected referrals and authorizations; facilitates securing referrals and authorizations from referring providers as necessary. Performed admission activities. Greeted or contacted patient; collected and verifies all necessary demographic insurance and related data. Ensures that consent and other required forms are completed correctly, and patients/guardians signatures are obtained where required. Verified insurance coverage and benefit levels; secures authorizations and referrals; assesses patient liability amounts. Accessed computerized system to enter and/or update electronic systems as needed and to answer patients, stakeholders and other pertinent party’s inquiries and responded to general inquiries as required.

HENRY FORD HEALTH SYSTEM, Detroit, MI

Call Center Associate, 01/2009-01/2014

Performed high phone/computer volume processing in an accurate and rapid manner. Answered and routed calls for the Service Response Center. Paged physicians, and facilitate patron communications as required. Provided messages for medical staff and departments as directed. Scheduled 70+ patient appointments daily, maintaining empathy, accuracy, and a strong standard of customer service. Handled patient registration, insurance verification, and prescription refill request; submitted messages to staff. Followed up with patients possessing concerns and requests; documented all calls needing administrative follow up.

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