Entry Specialist Referral
Resume:
Capricia Burleson Austin, Texas *.**********@*****.*** 512-***-****
Objective: Seeking a position where I am able to use my past experience, education, and training as a medical professional.
Experience:
October 26, 2020 to Present: Baylor Scott and White Austin, Texas
Position: Patient Service Specialist III
Responsible for referrals and authorization for the providers in Rheumatology Clinic
Outbound call to different Health Plan insurances
Some scanning/filing of patient’s medical records(HIPPA)
Check patients and reschedule at the end of appointment
Responsible for Huddle board, making sure metrics are updated daily
Responsible for getting staff ready for Huddles including CMAs, Nurses and providers
Responsible for escalated phone calls
Responsible for ordering office supplies
Responsible for mailing information to patients
Responsible for calling patients to confirm appointments
Making sure Release of Information from another Provider is completed, dated and signed.
Responsible for printing faxes from Onbase and distributing to the correct individual: Nurses, Providers, or CMAs
September 16, 2019 to October 23, 2020: Baylor Scott and White Austin, Texas
Position: Patient Service Specialist II
Responsible for referrals and authorization for the providers in Dermatology Clinic
Outbound call to different Health Plan insurances
Some scanning/filing of patient’s medical records(HIPPA)
Check patients and reschedule at the end of appointment
Responsible for Huddle board, making sure metrics are updated daily
Responsible for getting staff ready for Huddles including CMAs, Nurses and providers
Responsible for escalated phone calls
Responsible for ordering office supplies
Responsible for mailing information to patients
Responsible for calling patients to confirm appointments
Making sure Release of Information from another Provider is completed, dated and signed.
October 20, 2019 to February 21, 2020: Quality Inn Austin, Texas
Position: Shuttle Driver/Front Desk Agent/Night Auditor
Night Auditor, balancing drawer, organizing reports for General Manager, Area Manager as well as CEO.
Greeting and thanking guests in a sincere, friendly manner.
Checking guests in on arrival and out on departure.
Posting charges to appropriate guest accounts.
Responsible for guests filling out correct form for Park and Fly.
Anticipating and addressing guests’ needs, and resolving their problems and complaints.
Assisting guest with disabilities.
March 4, 2019 to 9/11/2019: Baylor Scott and White Austin, Texas
Position: Contact Center Specialist II
Scheduling appointments for Baylor Scott and White Health Clinics and Specialties
Processed the request over the phone take approximately 70-100 calls a day
Responsible for inbound only line for patients, as well as third party calls such as Health Plans, Rehab Services, Home Health Services and Physical Therapy Services.
Make some outbound calls to patients
Multitask
Updated Metrics for Team daily on Bulletin board
October 2018 to March 1, 2019: Express Employment Professionals Austin, Texas
Baylor Scott and White Austin, Texas
Position: Contact Center Specialist
Scheduling appointments for Baylor Scott and White Health Clinics and Specialties
Processed the request over the phone take approximately 20-40 calls a day
Responsible for inbound only line for patients, as well as third party calls such as Health Plans, Rehab Services, Home Health Services and Physical Therapy Services.
Make some outbound calls to patients
Multitask
November 17, 2017 to May 30, 2017: Veterans Affairs-VA Austin, Texas
Position: Medical Claims Processor
Responsible for validating information on all medical claims from patients seeking payment from their insurance.
Responsible for maintaining the company's production and quality standards.
Processed medical claims for Veterans, making sure correct CPT codes entered in correctly medical claim forms.
Responsible for training the new hires.
September 2009 – September 2018 Superior Health Plan Austin, Texas
Position: Referral Specialist Supervisor
Supervised 32 employees and two Team Leads
Conducted monthly team meeting
Conducted one on one monthly meetings when needed
Responsible for interviewing, hiring, and training new employees
Responsible for maintaining monthly reports
Leadership trainings.
Created processes and procedures to ensure the success of the team
Audited reports and set goals up to ensure the overall success of the department was met
Some projects was worked off SAT program
Position: Workforce Analyst
Responsible for overseeing Queues for the Utilization Management department
Audited 120 people on call/fax requests on a monthly basis
Responsible for monthly reports for the Stats Utilization Management Department
Some projects worked off SAT program
Position: Program Coordinator II
Responsibilities included: disturbing work to Program coordinator I
Maintained that Program coordinator I met production daily
Monthly reports
Initiated coaching for Program Coordinator I that did not meet goals
Created processes for the team daily work flow
Position: Reconciliation Coordinator
Responsible for correcting errors on claims and did not pay
Researched unpaid claims correctly or crossing over into Amisys
Maintain monthly reports for the entire Utilization Management department
Position: Program Coordinator I
Distributed work to Nurses
Ensured Nurses remain in TAT (Turn Around Time)
Maintain the Out of TAT report
Monthly reports
Position: Referral Specialist II
Responsible for overseeing work distribution for Rehab/HH/Eval Therapy Team
Maintained their production and made sure daily goals were met.
Assisted with processes and procedures to ensure the goals could be meet by the team
Position: Referral Specialist I
Responsible for inbound only line for providers
Processed fax request that came in electronic
Processed the request over the phone took approximately 20-30 calls a day.
Worked day to day projects that immediately came up.
Exceeded Production every month
July 2001 to July 2008 Iron Mountain Austin, Texas
Position: Data Entry Specialist
Responsible for request submitted from the Vendors
Entered the information based on vendor request
Maintained monthly reports in a timely manner.
Trained new hires
Education:
ITT Technical Institute 1990-1991 Diploma/Academic Secretarial/Administrative.
University of Phoenix June 2010
References:
Upon request
Contact this candidate