Customer Service Data Entry Coordinator

Objective

To become an important part of a business that utilizes my current skills and allows me to learn and develop new skills in order to perform my duties as effectively as possible.

Anthem / Elevance Health / Beacon Health Options / Orange County Mental Health Plan

Clinical Coordinator II / Utilization Review II Coordinator

Cypress, CA 07/2018 03/2020 & Remote from 3/2020 to Present

Foster a collaborative relationship between providers, community agencies, managed care organizations, and Beacon staff in order to ensure members receive timely and integrated access to services across the continuum of care.

Caseload assisting low-income adolescents and adults in accessing substance abuse use and mental health services.

Work with members to provide effective and efficient service coordination.

Assist members in scheduling appointments and accessing community resources.

Attend provider outreach events and activities as assigned to promote Beacon activities.

Produce accurate and timely documentation in company database of member activities and interventions.

Continuously expand knowledge of community resources, services and programs available to members and build ongoing relationships with these organizations to advocate for members.

Provide administrative support to the clinical team lead/supervisor/manager.

Adhere to all Beacon/Anthem policies, procedures, and standards of operations.

Completes all required and assigned trainings.

Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.

PCP Referrals created authorizations and reached out to family and provided referrals while taking OCMHP calls, faxed results back to referring provider.

Performs special projects and other duties as assigned and required.

Beacon Health Options Autism Services Group Clinical Support Department

Care Manager II

Cypress, CA 04/2013 07/2018

Serves as central point of contact and communication for members, families, providers, insurers and members of the ASG team in the linkage of care for Applied Behavioral Analysis (ABA) services for Autism Spectrum Disorder (ASD).

Responsible for maintaining and managing the internal and external utilization processes in a timely and accurate manner consistent with policies and procedures.

Performs a variety of customer service and unit-operations activities to assist clinical and administrative staff to meet operational and business performance metrics.

Gather required clinical and financial information care for members and enter data into clinical care management system.

Monitor the data in the clinical care management system, collaborating with provider community; escalate issues and concerns regarding care management to Senior Care Managers according to policies and procedures

Act as a liaison with parents and the health community to ensure continuum of care and support for members

Providence Little Company of Mary Hospital - Regional Business Office

Customer Service Rep / Physician Billing / Receptionist

Torrance, CA 03/2009 - 04/2013

ER Physician Billing (as of 10/2012-present, along with other CSR duties)

Answer a high volume of incoming patient, providers, and insurance carriers calls from dialer

Collect on past due co-pays, co-insurance, and deductibles

Submit 2ndry insurance information along with primary EOB for biller to re-bill for additional payment

Contacted customers by phone or letter to obtain payment on delinquent medical accounts

Worked all correspondence received and filed in patients files

Verified eligibility and benefits, and requested retro-authorizations

Retrieve, enter and process Charity applications

Process credit card, debt, and check by phone payments

Set up adequate payment arrangements, Registers patients in billing system with demographics and insurance

Comprehensive Behavioral Health- College Health IPA (CHIPA)

Customer Service / Claims Processor

Artesia, CA 08/2006 - 03/2009

Researched and audits patient accounts, claims processing and enter data into MIS system

Trained new hire employees with claims processing and patient/provider customer services

Verified eligibility, benefits, patient, provider and insurance information for claims resolution

Prepared billing and reviews claims prior to submission to insurance payers and providers

Followed up on outstanding claims and related documentation, EOBs and corrections on billing

Maintained a daily log of calls received from payers, providers and patients for resolution

Completes denials, refund letters and statements while on a telephone queue for claims

Interviews patient & gathers information, contacts employers/carriers to obtain authorization for treatment

Schedules follow-up appointments reports status to employers/carriers

Provide patient & telephone reception, check in/out, appointment scheduling & other department clerical duties as directed

Verifies eligibility, creates files, collects forms, & checks for legibility & completeness

Prepares schedules & provides personalized & professional patient/member service

Comprehensive Behavioral Health- College Health IPA (CHIPA)

Clinical In-Patient Office Assistant

Artesia, CA 11/2005 - 8/2006

Scheduled outpatient appointments for IP members (Ambulatory follow up) seeking therapy and or psychiatry consultations in a timely manner for excellent patient customer service

Distributed incoming and outgoing faxed documents twice daily to central mail

Prepared non-faxed authorizations and correspondence for mailing daily

Created authorizations as requested by patients and providers for accuracy of services rendered

Answered phone calls in an incoming phone queue for customer inquiries, concerns and follow up

Assisted with clerical and general office duties as needed by management requests

Adhered to HIPAA regulations, State and Federal healthcare protocols and procedures

Skills/Systems:

Knowledge of HMO, PPO, POS, Medicare, Medi-Cal, EOB Review, Commercial Managed Care,

HIPAA guidelines, customer service, general office and clerical duties along with phone etiquette

Bi-Lingual Spanish speaking translator, ICD-9, CPT, HCPC, claims review and EOB review

Medical terminology, data entry, type 45 wpm, billing, collections, claims resolution

EPIC/Hyperspace, Medi-Tech Magic, Medi-tech, IDX, CAMIS, Passport Microsoft Word, Excel, Outlook Express, Internet Explorer, Internet research savvy

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