Medical Assistant Quality Assurance

Daniela Pratt

Throop, PA 570-***-****

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

Service-oriented care coordinator with over two years experience in claims processing. Accountable for identifying, investigating, evaluating, obtaining and analyzing information to accurately adjudicate claims. Dedicated to providing a positive experience for every customer.

Patient Care Plans

Records Management

Physician Collaboration

Quality Assurance

Medical Billing & Coding

Appeals & Grievances

Office Management

Claims Processing

HIPAA Compliance

PROFESSIONAL EXPERIENCE

Grievances and Appeals Coordinator

Federal Hearings & Appeals Services, Inc., Remote

07/2022 – 03/2023

Exceeded quality metrics, recognized by management for achieving 97% quality scores.

Analyzing, researching, and resolving upwards of 50 complex claims, per day.

Ensured timely, customer-focused responses to complaints and appeals.

Managed resolution complaint/appeal scenarios for various healthcare services.

Calming angry clients, repairing trust, locating resources and best option solutions for better problem resolution and greater customer satisfaction.

Patient Coordinator - Cardiology

Geisinger, Scranton, PA

06/2021 – 07/2022

Assisting 14 cardiology doctors and 11 nurses, daily.

Providing training and management to 7 office staff.

Managing and coordinating care for several hundred patients.

Primary liaison between hospital staff and patients, helping them understand their medical situation, options, and treatment plans.

Facilitating the flow of documents between providers and payers.

Patient Coordinator – Family Practice

Geisinger, Scranton, PA

11/2020 – 06/2021

Consistently followed established procedures for the department regarding uninsured, underinsured, worker’s compensation, and established patients.

Collaborated with insurance companies and doctors office to obtain authorization for surgery.

Communicated any schedule changes in order to ensure the highest patient satisfaction.

Maintained an up-to-date and accurate database on all current and potential referring physicians.

Providing all patients with outstanding care and support to help improve their quality of life.

Scheduling Services Coordinator – OB-GYN

Geisinger, Scranton, PA

03/2020 – 11/2020

Works on schedules of significant risk and impact to the organization requiring advanced knowledge of scheduling principles.

Coordinate with management to meet departmental goals and work to eliminate information silos.

Screened and updated established patient information for accuracy of scheduled procedures.

Transmittals of billing and patient accounts, verifying insurance and obtaining authorizations.

Provides assistance to customers, employees, and visitors in a courteous and professional manner.

Front Office Medical Assistant

Dr. Berger, Scranton, PA

08/2019 – 03/2020

Verify patient accounts, eligibility benefits, and insurance authorization.

Demonstrated proficiency in obtaining patient medical history and vital signs.

Ensured the cleanliness and sanitation of all exam rooms and equipment.

Effectively handling administrative duties (maintaining medical records, patient processing, billing and bookkeeping) which allowed doctor and nursing staff to focus on the health concern of their patients.

Claims Processor

TMG Health, Throop, PA

01/2015 – 10/2017

Consistently attaining company goals and quotas.

Preparing medical forms and documents for review.

Calculating claim and deductible amounts.

Liaison between insurance providers and customers.

EDUCATION & CREDENTIALS

Academic Diploma, Valley View High School, Archbald, PA 18403

CPR / AED Certified

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