Medical Transcriptionist Data Entry

Jean Cruz 1-708-***-****

********@***.***

Frankfort, IL 60423

PROFESSIONAL SUMMARY

Detail oriented with many years of medical clerical duties in a busy hospital and medical facilities. Ability to work independently, maintaining a superior work ethic. Strong health care background and high proficiency relating to medical terminology. Can prioritize workload, maintain and organize work space. Exercises good judgment. Team player with a positive attitude.

SKILLS

Quality Management Insurance Verification Medical Coding

Quality Assurance Patient Referrals Data Entry

CPT codes Epic Quick Cap System

EXPERIENCE

01/2022 to present - Disability Resource Specialist/FMLA Coordinator

Speciality Physicians of Illinois, Olympia Fields, IL 60461

●Manages leave requests and accommodations requiring specialized attention under the FMLA (Family and Medical Leave Act), ADA (Americans with Disabilities Act), short term or long term disability plans and Aflac.

●Provides decision support as needed.

11/2020 to 12/2021 - Prior Authorization Specialist

Franciscan Physician Network, Munster, IN 46321

●Obtained prior authorization for provider practices which may include outpatient services, specialty care and other ancillary services.

●Verifies insurance coverages and eligibility determination.

●Gather clinical information for the Medical Director’s review and to ensure that all reimbursement requirements are met.

2/2018 to 11/2020 - Referral Coordinator

Specialty Physicians of IL, LLC, Olympia Fields, IL 60461

●Reviews/processes incoming referrals in EPIC work queue for Orthopedic, Urology, Dermatology and Pain Management Departments.

●Submits referrals into Quick Cap System with downloaded clinicals for the Medical Director’s review and determination.

●Supports physicians, medical staff, providers and patients with referral questions, coordination and authorization.

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Jean Cruz

6/2011 to 2/2018 - Referral/Utilization Management Specialist

St. James PHO (Physician Health Organization), Chicago Heights, IL 60411

●Processes internal and external referral requests from medical providers which include verification of eligibility, coverage determination and resolution.

●Works in collaboration with the clinical services team, Medical Director and providers to ensure that referrals are completed in accordance with policies and procedures.

●Applies MCG Guidelines and Medical Group Guidelines determination as appropriate.

●Support the delivery of quality care for all patients.

9/2003 to 6/2011 - Referral Coordinator

Well Group Health Partners, LLC, Chicago Heights, IL 60411

●Processes internal and external referrals from PCPs and specialists using the QSI system, and later transitioned into EPIC.

●Worked closely with the clinical staff to ensure proper completion and documentation of referral requests are in accordance with the group and/or insurance policies, procedures and protocols for Medical Director’s review and determination.

6/2001 to 9/2003 - Quality Management Specialist/Data Coordinator

Suburban Heights Medical Center, Chicago Heights, IL 60411

●Worked on Quality Improvement studies, data and projects related to patient care, risk management and liability issues, contracted insurance carrier site, medical record audits, and patient quality care concerns and issues.

●Prepared monthly specialty department meetings, took meeting notes, transcribed, distributed and filed appropriately.

12/2000 to 6/2001 - Medical Transcriptionist

Pronger Smith Medical Center, Blue Island, IL 60406

●Listen to voice recordings that physicians and other healthcare workers make and convert them to written reports.

●Review and edit medical documents created when necessary.

7/1998 to 12/2000 - Medical Transcriptionist

Suburban Heights Medical Center, Frankfort, IL 60423

●Listen to voice recordings of assigned physicians and convert them to written reports.

●Review and edit medical documents created when necessary.

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Jean Cruz

12/1997 to 6/1998 - Patient Account Representative (Lien Rep)

Suburban Heights Medical Center, Chicago Heights, IL 60411

●Corresponded with insurance companies and attorneys regarding patient’s claims and physician’s lien information.

●Assisted in organizing attorney negotiations with different insurance companies.

●Typed, prepared and organized third/party claims.

12/1984 to 5/1997 - Secretary

South Suburban Medical Associates, Markham, IL 60426

●Directed and assisted in the performance of all administrative functions of the medical facility.

●Arranged detailed plans for seminars, appointments and meetings of administrative staff.

●Reviewed, tracked, processed monthly budgets/expenses, and maintained CME hours of Medical Director.

●Assisted in enforcement of office codes and procedures.

EDUCATION

Working knowledge of EPIC and Quick Cap Systems, Microsoft, Excel, Word.

Certified Medical Coding/Billing Specialist & Health Unit Coordinator - 2004

Prairie State College, Chicago Heights, IL 60411

Certified Executive Secretary - 1983

Southwest School of Business, Chicago, IL 60652

LANGUAGES

English, Tagalog

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