**** ***** **.

Philadelphia, PA *****

445-***-**** adv3jn@r.postjobfree.com

Susan Silas

Work Experience:

Pre-Certification Representative

Fox Chase Business Office, Cheltenham, PA. 05/2022-08/2022

Responsible for obtaining Pre-Certifications and pre-authorizations

for procedures such as CT Scans, MRI’s, Bone Scans, Mammograms,

Ultrasounds, Echocardiograms, PET/CT, and medications.

Scheduling appointments for outpatient testing with other providers.

Transcribes and triages patient calls to physicians, coordinates patient

appointments and orders.

Responsible for completing the pre-registeration and verification process

following department procedures using identified technology and hospital registration and billing systems.

Accurately identifying and verifying and document insurance coverage for scheduled services.

Utilizing all available electronics and manual sources.

Requires daily communication with patients, caregivers, schedulers and insurance companies via telephone in order to obtain accurate insurance demographics, referring provider and patient liability information

Use of EPIC, NAVINET, PEAR, RAD MD, MAGELLAN, AVAILITY, HURON, EVICORE, CARECORE, INVISION..

Patient Care Specialist (REMOTE)

CVS SPECIALITY, Monroeville, PA 09/2021-01/2022

Schedule patient’s life sustaining medication refills through Speciality Pharmacy.

Perform follow-up work on patients accounts to ensure timely and Accurate delivery of their medication.

Add and update demographics, insurance and co-pay cards information.

Add methods of payments to account.

Confirm co-pay, delivery address and date of delivery.

Transfers calls to designated departments and notate accounts after each call.

Giving status updates on Prior Authorization for medications. Resolve any problems that may arise such as damage or missing deliveries in a timely fashion.

Use of SPARCS scheduling software.

Use of dual monitors.

Perform excellent customer service.

Use of AVAYA and CISCO phone systems.

Use of WINDOWS, MICROSOFT OFFICE, INTERNET NAVIGATION and EMAIL APPLICATIONS.

Admissions Representative Fox Chase Cancer Center, Philadelphia, PA 08/2017-03/2020

Pre-admits patients by receiving bookings from physicians.

Confirming admitting privileges of physicians, interviewing patients and entering information in pre-admissions data base.

Provide patients with information by explaining hospital policies, time of admission, room selection, TV rentals, telephone availability, cell phone restrictions, answering inquiries.

Verifying insurance information is accurate and active thru HDX and

NAVINET.

Identifying patients requiring pre-admission approvals or precertifications from third party payers.

Verifying approvals and notify financial counselors of self paying admissions.

Prepare admissions folders by gathering admission paperwork for scheduled patients.

Greets and receives patients to be admitted by conducting personal interviews.

Entering demographics and insurance information, confirming preadmission information.

Obtaining signatures on legal consents and insurance forms.

Verifies patient’s identity by checking identification, ie, Driver’s license, Government photo id or passport.

Preparing and placing identification band on patients.

Ensures patients arrival to hospital room or testing area by assigning beds.

Notifying nursing unit of patient’s arrival, calling volunteer to transport Patients to the assigned area.

Execute excellent customer service.

Pre-Registeration Lead Crozer Community Hospital, Chester, PA 09/2016-07/2017

Verifying patient’s demographics is accurate.

Verifying eligibility of insurance using NAVINET, PAYERPATH and Cerner.

Creating referrals, checking subscriber information is accurate. Adding necessary co-pays for services rendered.

Verifying Worker’s Compensation and Liability Claims are active by phone.

Sending spreadsheets with inactive insurance to managers via e-mails.

Pre-registering patients for Family and Internal Medicine, Women’s Health, Neurology and Neurosurgery Departments.

Assist team members with problems and concerns pertaining to the preprocessing of the patients file.

Run weekly status reports.

Created standard format for pre-processing team.

Conduct interviews for potential employees.

Charge entry and collections.

Patient Access Specialist Cooper University Hospital, Camden, NJ 10/2015-08/2016

Register and schedule appointments in a call center environment for over 50 physicians including Internal and Family Medicine, Podiatry, Rheumatology, Orthopedics and Bone & joint.

Transfers calls to designated departments from Cooper’s 1-800 line. Handling on average of 80 calls or more on a daily basis.

Quality monitoring score of 95% and above on a monthly basis. Use of EPIC and ACOBINA to verify patient information and schedule patient’s appointments.

Verify insurance eligibility daily using NAVINET and PASSPORT for E-verification and outgoing calls for phone verifications.

Send e-mails confirmations when appointments are scheduled.

Transfer calls to designated departments.

Use of ORTHO TOOL when scheduling Orthopedic appointments.

Use of dual monitors, MICROSOFT OUTLOOK, WORD and EXCEL. Execute excellent customer service.

Patient Care Coordinator One Call Care Management, Jacksonville Fl 05/2015-09/2015

Process Worker’s Compensation Claims in a call center environment.

Contact adjuster to get authorization for all Durable Medical Equipment provided to claimants such as hospital beds, walkers, wheelchairs, crutches etc. Needed to get the claimant back to work in a timely fashion.

Create purchase orders for medical equipment ordered.

Check claim status.

Provide the necessary medical equipment needed for discharge from hospital or rehabilitation facilities.

Answer calls and transfer to designated departments.

Resolve any problems that may arise such as equipment not delivered, correcting purchase orders, wrong or damaged equipment delivered

Use of dual monitors, MICROSOFT OUTLOOK, and CSRD system.

Working with vendors to staff the DURABLE MEDICAL EQUIPMENT for delivery in a timely fashion Execute excellent customer service.

Caregiver Self Employed 07/2012-03/2015

Assist clients in addressing everyday personal needs such as bathing and grooming.

Performing light housekeeping duties such as cleaning, dusting and vacuuming.

Making beds on a daily basis and change linens as required.

Escort client to doctor appointments and therapist.

Arrange medications to be taken on schedule by providing appropriate reminders and administering medications only on doctor’s orders. Observe client for signs of deterioration or concern and report signs to doctor.

Patient Service Coordinator Soft Inc, New York, NY 05/2011-06/2012

Schedule appointments for Genetic Counseling in MICROSOFT OUTLOOK and ICIS including data entry of patient’s information into computer database.

Answering phones, transferring calls to counselors.

Tracking chart flow, entering MD approval information into computer system.

Run Genetic Counselors reports daily

Stamp and mail 200 Genetic Counselors reports daily.

Order and ship office supplies to Genetic Counselors by UPS.

Performing office duties such as faxing, filing, copying, send e-mails Scan charts into system to be shipped off to Iron Mountain for permanent retention.

EDUCATION Benjamin Franklin High School, Philadelphia, PA 09/1979-06/1983 Business Academic

SKILLS;

Data Entry, Customer Service Call Center, Faxing, Filing, Collections, Epic, Navinet, Cerner

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