Data Entry Administrative Manager
Resume:
BROOKLYN, NY *****
***********@*****.***
EDUCATION AND
TRAINING
BBA
Health Administration
Universal Career School, Miami, FL
May 2009
Business Admin
AIU (Atlanta International
University)
January 2006
CANARSIE HIGH SCHOOL
June 2003
SUMMARY
To secure a responsible position with over 19 yrs of experience in healthcare, providing the quality patient care, Which will present a challenge, enhance my skills in conjunction with organizational mission, goals, superior leadership, core values and potential to increase office productivity. SKILLS
EXPERIENCE
COMMERCIAL PRIOR AUTHORIZATIONS REP. REMOTE
CVS Health/Caremark Clinical Services San Antonio, TX October 2021 - Current
SHEENA MACK
• MCKESSON SYSTEM
• RX Claims/AS400 SYSTEM
• HHA EXCHANGE,
• Microsoft Word, Microsoft office,
Excel, Outlook
• Teams app, UC1 app
• Excel SpreadSheets
• Intranet
• ARROW
• Bank Teller Certificate
• Experience in Leadership
• Computer Skills
• Data Management
• Training & Development
• Customer Service
• Work independently
• Time management
• Problem solving
• Remote worker
• Problem Resolution
• Organizational Skills
• Supervision & Leadership
• Scheduling
• Clinical authorization system
(Cas)
• people safe
• theSource
• Googlechrome
• Microsoft Edge
• learninghub
• sharepoint
• client caremark
• Used Rx claims ( AS400), people safe, Clinical Authorizations systems to input claim, prior authorization and other important medical data into system.
• Contacted pharmacies to submit and refill patients' prescriptions.
• Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
• Updated databases with new and modified customer data.
• Utilized job-related software to prepare change of address records and issue service discontinuance orders.
• Followed all Medicare, Medicaid, HIPAA and private insurance SM
CLINICAL DEPT. LEAD CLINICAL SPECIALIST REMOTE
ALLEN HEALTH CARE SERVICES, HILLS FOREST HILLS, QUEENS, NY December 2010 - May 2021
regulations and requirements.
• Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
• Notified ordering providers of denied authorizations.
• Maintained high level of professionalism when speaking to doctors and insurance companies.
• Coordinated resolutions for issues and appealed denied authorizations.
• Made outbound calls to insurance companies, patients and physicians to perform eligibility checks for patients.
• Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
• Maintained files for referral and insurance information, entering referrals into system.
• Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests, medicatcations and procedures.
• Determined which party would be liable for payment on medical services by thoroughly reviewing patient insurance coverage.
• Excellent customer service, verbal and communication skills, with great organizational and experience computer skills, Microsoft word, outlook, Excel, Microsoft office
• Oversee staff group of 10 team members, define team direction and provided guidance, process department weekly payroll
• Remote working independently, strong initiative and able to work with very little oversight, able to prioritize own workload and manage own time effectively
• Time management meeting company deadlines and departmental goals
• Over exceeding company goals by a 20% increased obtaining signed home health certifications 485 plan of care/MD orders. Verifies receipt, review & follow up with overdue physician orders and accurate documentation to be in compliance with D.O.H regulations, including but not limited to verbal orders, add-on evaluations, R.O.C, or transfer to inpatient facility
• Collaborate and established strong working relationships with physicians, Nurses, P.A's, NP's & MD assistant to obtain signed orders
• Working knowledge of medical terminology and
MEDICARE/MEDICAID RULES, Including adhered to HIPPA requirements to safeguard patient confidentiality
• Implemented client chart flow for D.O.H (Department of Health) & JCAHO (Joint commission) regulations
• Participated in ongoing training and compliance activities.
• Interacted with customers via telephone and e-mail, Verify & confirm all incoming emails, voice mail messages and mail.
• Report any concerns regarding health, safety, or well being of patient to clinical team, director of nursing, Pcp, and appropriate authority
• Update all patient information in HHA EXHANGE data base, Process data entry to EHR system including prior authorization on patients insurance, and make any corrections of ICD-9/ICD-10 coding from referrals
PLASTIC SURGEON SCHEDULING REMOTE
Goals Plastic Surgery Manhattan, NY February 2018 - November 2020 HEALTH SERVICE TECHNICIAN LEAD
Visting Nurse Association Brooklyn, NY May 2008 - November 2010
• Exercised critical thinking and problem-solving skills in non- urgent or urgent situations, Including resolve issues based on phone calls
• Checked patient insurance and collected pre-authorizations from providers. Recorded information according to insurance company requirements to maximize insurance coverage and reduce patient cost
• Evening, Night shift or as PRN Remote
• Data entry in EHR systems Patient medical records
• Worked with operating facilities to schedule procedures on behalf of 8 surgeons, Booked surgeries according to physician volume and maintained prompted turnaround times.
• Gathered current medical information and reviewed histories to gather details for surgeons, including Managed patient check-in and check-out procedures, Located scheduling barriers and implemented appropriate solutions, Scheduled follow-up appointments as designated by physician.
• Coordinated work processes and routed paperwork to appropriate physicians and staff members, Communicated with patients with compassion while keeping medical information private.
• Ordered and maintained supply inventory for medical office.
• Prepared reports, invoices, letters, or medical records using word processing, spreadsheet, or other software applications.
• Scheduled and confirmed patient appointments and consultations, Scheduled tests, lab work or x-rays for patients based on physician orders.
• Answered telephones and directed calls to appropriate medical or administrative staff, Transmitted medical records and other correspondence by mail, email, and fax
• Responsible for assisting the Regional Administrative Manager with the oversight of VNAB CHHA business operations including but not limited to customer service, scheduling, and processing of reports, oversee all the paperwork by other technicians
• Collaborate with physicians and social workers
• liaise and subsequently follow up with outside agencies on services for patients with psychiatric needs. add additional notes to patient EHR file.
• assist health care teams with managing veterans contracts patients with unhealthy wounds & chronic disease, Scheduling RN assessment visits including utilizing my health coaching skills to establish rapport with veteran and motive veterans to improve overall health
• Supervising staff members by having direct responsibility for a staff of 7 team members, Managing the day to day support operations of the clinical team by managing work schedules and assigned task to individual staff, while facilitating effective communication between clinical & Non-clinical team members
• Scheduling MCH contract (Maternal child care) cases
• Executing chart audits to ensure record management with quality accuracy, Identifies & resolves problems within the department, Collaborates with the Regional Administrative/DPS to ensure corporate
& clerical support compliance
• Set up coverage for Receptionist desk as needed, oversaw the on-boarding and training of new healthcare team members
• Created and maintained facility documents and records with sensitive data, Created and maintained electronic record management (EMR) systems to store data and develop reports
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