Call Center Medical Assistant

PROFESSIONAL SUMMARY

A creative and articulate professional with

demonstrated skills in Customer Service,

Office Management, and training. Ensuring all

operational service objectives delivered on

time and in accordance with customers,

business, and training requirements. Work

cross-functionally with senior leadership,

heads of department and operations team to

help them understand and address service

gaps. I build and deliver strategic value

through the effective management, training

and implementation of existing and new

management initiatives that positioned for

growth, best in class and leading edge.

PROFESSIONAL HIGHLIGHTS

• Patient Access and Revenue Cycle,

includes:

o Outpatient Registration

o Scheduling

o Surgery Scheduling

o Insurance Verification,

Billing/Collections/Financial

Counseling

o Knowledge of ICD 9 & 10 coding,

CPT, medical terminology,

commercial, managed care,

Medicare, and Medicaid

contracts/reimbursements.

• Designed, developed, and implemented

the training documentation and

operational strategy for new processes

and the support of high-volume practices.

• Experienced in Customer Engagement

and business requirements facilitation and

gathering within operations, projects, and

location management as the focal point

for customer IT service requests.

• Knowledgeable of HIPPA regulations and

use when dealing with personal health

information

• Effective communication, interpersonal

and organizational skills with superior

verbal and written communications skills,

with an emphasis on tact and diplomacy.

• Gather and analyze complex data,

utilizing deductive reasoning.

EDUCATION

AMERICAN INTERCONTINENTAL

UNIVERSITY (AIU), Houston, TX

MBA - Business Administration

(Management)

PROFESSIONAL EXPERIENCE

Millennium Physicians Financial Customer Service Supervisor 2021 – Present

• Train Financial Counselors, Insurance Verifier’s and Prior Authorization Specialists in the Call-Center and traveling to each location.

• Interview and hire new employees for Financial Counseling, Insurance Verifications, and Prior Authorizations.

• Conduct meetings and presentations for departmental updates.

• Manage employees’ time, review time off request and complete human resource paperwork.

• Monitor phone calls and document for coaching, re-education, and evaluations.

• Ensures adherence to company Policies and Procedures.

• Ensure calls effectively managed within a timely manner.

• Successfully collaborate with manager and other departments to solve issues.

• Serves as a resource to the team in resolving and documenting complex patient situations including escalated complaints in a timely manner.

• Perform all functions as needed to ensure adequate cover and staffing areas covered within a timely manner, and delegate accordingly.

• Verify eligibility and medical benefits with third-party payers for scheduled services including, but not limited to infusions treatment, injections, chemotherapy, rheumatology, bone marrows, and flow cytometry testing.

• Document detailed eligibility benefits and patient responsibility details in the patient’s electronic medical chart.

• Identify patients in need of financial assistance and submit to the financial assistance department for evaluation.

• Generate patient financial treatment estimate form, and counsel each patient prior to the start of each new treatment.

• Reconcile daily patient collections report against collections and prepare the daily deposit.

• Identifies need for additional training through observation, account reviews, and audits.

• Acts in the capacity of Manager in her absence.

Memorial Hermann - TMC 2020 – 2021

Senior Financial Counselor Transplant/VAD Services

• Obtain demographics, insurance & financial information from patient or guarantor who has been referred for Transplant/VAD services.

• Protects financial integrity by collecting patient’s liability.

• Serves as a financial and insurance resource for patients/families in navigating COB and insurance out-of-pocket liability. Albert Hargis, MBA

832-***-**** **************@*****.***

CERTIFICATIONS & TRAINING

• Medical Coding & Billing Certificate

(2013)

• Medical Assistant Certificate (2001)

• Phlebotomy Certificate (2001)

• Nursing Assistant (2003)

• First/Aid/CPR (2001)

EXPERIENCE SUMMARY

• Athena Program Management

Proficiency.

• Possess strong knowledge of EMTALA,

HIPAA, Health Insurance Terminology

and Benefits.

• Possess comprehensive knowledge and

understanding of Revenue Cycle

Operations/ Clinical Operation Process

Flows.

• Program/Project Management.

• Performance Measurement & Reporting.

• Strategic Management & ROI

maximization.

• Communication (SOP Documentation &

CBTs).

• Microsoft Access.

• Centricity.

• Lawson.

• Medicaider.

• PeopleSoft.

• CPCDMS.

• TransChart.

• HealthQuest/VDI.

• Cerner Scheduling.

• Care4EMR.

• ClinicStation.

• EPIC.

• WorkDay.

• ADP

• Verify insurance eligibility for Pre & Post-Transplant pts., and clinic appointments and other specialty services by required timeframes.

• Monitor and update all financial information including, but not limited to authorizations, and insurance changes.

• Communicates in an effective and professional manner with Physicians, Care Management, ancillary departments, nursing staff and dialysis units, as well as patients and their families regarding barriers to access care.

• Ensures accuracy of payer coverage, pertaining to primary, secondary and/or tertiary coverage and billing when there are multiple payers.

• Maintains and submits accurate date in UNOS, TransChart, Health Quest, and Care4 systems.

Texas Oncology 2018 - 2020

Lead Senior Surgery Coordinator

• Collect patient’s demographics, clinical and financial information; including patients name, date of birth, ordering physician, ordered test

(s), diagnosis, telephone number (s) and payment mode (s).

• Answer incoming calls from patients, physicians’ offices internal and external on all functions of financial clearance.

• Schedule patient surgeries, Pre-Op appointments, and Post-Op appointments.

• Conduct Insurance Verification for all patients: Medicare, Medicaid, and all Commercial Coverage Plans via automated systems verification, and or phone.

• Obtained Medical Records, get Pre-Authorizations of services.

• Inform the physician, nurse, and patient of their scheduled test with the time, date, location, and all instructions pertaining.

• Discuss financial obligations with patients, or guarantors, secure full payment, and assist with payment plans.

• Calculate estimated allowed amounts, and patients’ responsibility to help determine profitability of case.

• Payment posting electronically/manual and adjustments to patient accounts. Balances receipts, reconciles daily work batches, and prepares deposits for bank deposit.

• Communicate and meet with physicians/staff in a respectful, and timely manner to ensure timely submission of all inquiries, and questions.

• Train new employees and served as a leader to the team and helped delegated needed coverage and other assigned duties by management. Harris Health Systems 2013 - 2017

Senior Transportation Case Manager – Service Linkage Worker

• Provided Case Management and Transportation Services to PLWHA, TDCJ, Harris County Adolescents, Homeless and Veteran clients for the Federal Qualified Healthcare Center.

• Presents new training initiatives to all levels of the organization.

• Monitors and provide additional education to training team colleagues to ensure policies followed.

• Coordinated and facilitated monthly departmental status meetings.

• Provided Insurance Verification training to new and current staff members.

• Managed and trained five analysts responsible for day-to-day operational reporting, forecasting, and developing data-driven insights to drive the business forward in a measurable way. M.D. Anderson Cancer Center 2004 –2013

Lead Patient Services Coordinator – Inpatient and Outpatient

• Cultivate and fostered positive client relationships with physicians, clinicians, and practice administrators.

• Provided training and mentoring to 6 Patient Services Coordinators responsible for providing medical records, account resolution and financial services.

• In addition to classroom training, provide on-going process improvement training and educating using methods such as newsletters and posting pertinent information.

• Provided patient intake services to ensure complete and accurate financial screening and data verification of new patients.

• Performed clinical review of new patient referrals, attaining medical overrides, developing cost estimates, gained authorization for services, and coordinated pre-determination process.

• Obtained Insurance Pre-Certifications and Verifications.

• Collaborated the efforts of multiple teams to ensure appropriate patient care, communication and documentation for payers, patients, and the treatment teams.

• Provided benefit administration functions for patients. Call Center Lead Diagnostic Imaging Coordinator 2010 - 2012

• Call Center Team Lead comprised of 15 PSC analyst providing inbound and outbound calls.

• Provided training to new and current members on the use and function for the Call Center Management System.

• Provided Quality Assurance role to call PSC agents to ensure all quality standards are adhered to.

• Verify Insurance for patients and obtain Pre-Certifications verification requiring knowledge of ICD 9 coding & CPT codes.

• Provided effective communication to patients regarding their appointments, testing requirements and ancillary appointments.

• Other duties assigned my management.

Contact this candidate