Eugenia Fisher

Pontiac, Michigan

adozi5@r.postjobfree.com

Diverse Managed Healthcare Professional, experience working in data driven environment with population lives in excuse of one million. Functioning in areas of Customer Service, Benefit Revenue, Quality and Enrollment. Entrusted with managing projects with high claims financial yields and leading diverse staff training programs

Experience

October 2020 – August 2021 (Full-TIME)

Verification Specialist, Confidential Employer

Comprehensive home-based healthcare services, managing elderly and disable individuals with complex medical issues. Providing patients and providers with overall lower finical cost and higher patient satisfaction

• Maintain patient and provider scheduling

• Verify patient PHI and follow HIPAA guidelines

• Managing daily outbound calls from 46 to 150 calls

• Identify, analyzes and resolve a variety of scheduling issues

• Coordinate with provider departments in the development of quality

• Develop daily reporting spreadsheets for assigned patient schedule

• Document all activities for quality and metrics reporting through various systems

• Contact medical providers or members by telephone for scheduling and canceling patient appointments

August 2018 – October 2018 (Part-TiME)

Substitute Teacher

OCTOBER 2017– APRIL 2018 (PART-TIME)

Substitute Teacher

Educational staffing organization which provides qualified and professional teachers, counselors, para-professionals for Public, Private and Charter Schools.

NOVEMBER 2016 – FEBRUARY 2017 (FULL-TIME)

TEMPORARY DOCUMENT IMAGING SPECIALIST, OAKLAND UNIVERSITY

Prestigious University located in Southeastern Michigan

JANUARY 2013 – MAY 2015 (FULL-TIME)

TEMPORARY QUALITY IMPROVEMENT, BARTECH GROUP

Staffing organization, placing professionals in professional organizations

MAY 2010 – JUNE 2011 (FULL-TIME)

CLAIMS PROCESSOR, GREAT EXPRESSION DENTAL

Dental Group, located in five different states

NOVEMBER 2007 – MAY 2010 (FULL-TIME)

CUSTOMER SERVICE REPRESENTATIVE,THERAMATRIX

Physical Therapy Chain located in Michigan, which has associations located throughout the United States

AUGUST 1999 – SEPTEMBER 2007 (FULL-TIME)

LEAD CLAIMS CUSTOMER SERVICE, BEACON HEALTH/VALUEOPTION

Behavioral Health Corporation, managing Medicare, Medicaid, Employee Assistance Program, Reputable Commercial Health Insurance and Large corporation employee healthcare benefit programs

• Research claims appeals and resubmit for reimbursement and valid authorization

• Request medical records for medical necessity review appeals and authorizations

• Maintain communication between management and co-workers for process improvement

• Mentoring and training internal and external staff of lateral positions

• Process health insurance claims in excess of 150 to 300 daily

• Responded to incoming and outbound calls; maintaining less than three percent abandonment rate

• Abide by state and mandated healthcare insurance payment rules for Medicare, Medicaid and Workmen Comp

• Knowledge within adjudication rules for Hospital, Outpatient, Professional fee, Transportation, Emergency Care and Ambulatory

• Address all denial claims within 24 to 72 hour turn around time

• Document all incoming and outbound phone calls, which will ensure quality care for patient and best resolution

• Assist with communication with patient, caregiver and provide; maintaining HIPAA and Privacy Regulations

Education

September 2015

Applied Behavioral Science, Ashford University

Skills

• Microsoft Office (Access, Excel, PowerPoint, Word)

• HMO, PPO, POS, Medicare, Medicaid, COBRA, EAP, Workman Comp., H.S.A, FSA

• ServiceConnect, Facets

• HIPAA,EPIC, PHI, CPT, ICD 9-10 CM

• Claims Processing

• SharePoint, Click, Presivia, Amisys Carelink (clinical &authorization), Macess, DentalMax, Presivia

• Referrals/Authorization/ Eligibility

• Benefits and Enrollment

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