Health Information Medical Care

Yvette L. Collins

**** **** **** ***

Springfield, IL 62704 217-***-****

(***********@*****.***)

Work History:

**/**** ** *******: Illinois Department of Health and Family Services – Springfield, IL

Executive I:

Under direction, organizes, plans and evaluates the operations of the Medicare Part B Involuntary Provider Reimbursement Programs, directs the initiation of the recoupment process relative to the Medicare Part B involuntary Provider Reimbursement Programs where established recovery action fails; develops and implements procedures for the established Supplemental Medical Insurance benefits(SMB) buy-in referral process and Hospital insurance Benefits(HIB) process; organizes the goals and objectives of the Medicare Part B Involuntary Provider Reimbursement Programs; coordinates and reviews program operations with agency staff; serves as working supervisor.

Organizes, plans and evaluates the operations of the Medicare Part B Involuntary Provider Reimbursement Programs; implements policies for the administrative process of the Medicare Part B Provider Recovery Programs; directs activities to resolve discrepancies between identified claims eligible for Medicare and date in the Medicare Computerized eligibility systems including SOLQ (SSA System); ECARE (Medicare's C.W.F). Integrated Eligibility System (IES); authorizes department irritated, credit against outstanding claims; identifies unreported Medicare Part B claims and classifies Provider Credit recoveries.

Serves as working supervisor; assigns and reviews work; provides guidance and training to assigned staff, counsels staff regarding work performance; reassigns staff to meet day to day operating needs; establishes annual goals and objectives; approves time off; prepares and signs performance evaluations.

Directs the initiation of the recoupment process relative to the Medicare Part B involuntary Provider Reimbursement Programs where established recovery action fails; conducts research and determines the amount due to the Department; directs and conducts studies and investigations of problems with recoupment procedures; gathers information and edits reports of receipts and dis-allowance and recommends changes in policies and procedures.

Develops and implements procedures for the established Supplemental Medical Insurance benefits (SMB) buy-in referral process utilizing QMB/SLIB and Buy-in eligibility requirements and procedures for the established Medicare Part B (RIB) Program; confers with Non-Intuitional Providers (NIPS), Medicare and Social Security Administration to obtain information regarding the scope of coverage and effective dates on problem cases.

Organizes the goals and objectives of Medicare Part B with the Involuntary Provider Reimbursement Programs, directs research

studies of the programs; interprets and enforces agency policy/procedures and State and Federal stature requirements.

Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above.

07/2019 to 05/2021- Illinois Department of Health and Family Services – Springfield, IL

Medical Assistant Consultant II:

Under direction, performs responsible professional work in the interpretation of needs and determination of eligibility and propriety within special areas, aspects and applications of a medical assistance program extended to applicants and recipients of public assistance or rehabilitation services; including determinations regarding over utilization, fraud or abuse of medical services; assists in revising agency policies, procedures and methods in relation to the medical program.

Reviews case history records, reports and applications for medical assistance cases to determine eligibility and to secure compliance with requirements, rules and regulations.

Extends final determination of cases and gives instructions to field staff through written media; confers with and advises staff in regard to agency requirements and proper applications of operating policies of the medical program or rehabilitation services.

Determines extent of disability, propriety of medical care costs or possible cases of over utilization, fraud or abuse; analyzes and prepares detailed reports of findings and recommendations.

Confers with physician and pharmacology consultants on a weekly basis and represents the agency in meeting with and coordinating agency's efforts with other agencies in interested groups for successful attainment of medical care or rehabilitation services and confers with attorneys regarding the appeal process.

Conducts research studies of various medical care or rehabilitation services; prepares reports of findings and recommendations.

Prepares for final review, proposed revisions or new agency policies and procedures and instructional material applied in the medical care or rehabilitation programs.

Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above.

10/2018 to 07/2019 - Illinois Department of Health and Family Services – Springfield, IL

Office Specialist:

Under general direction, performs complex, specialized paraprofessional or technical; functions requiring substantial originality, responsibility and technical knowledge and understanding of the agency program and/or applications; presents complex ideas in a clear and concise manner, explains rules, regulations and procedures and makes decisions concerning unusual or unique situations or problems based on general guidelines or previous decisions where interpretation and judgment is inherent in work performed in the Division of Child Support Enforcement's (CSE) Call Center; researches and resolves appointment issues; researches multiple case and docket issues via the Key Information Delivery System (KIDS) and the Cook County Circuit Clerk System (T-KIDS); resolves customer inquiries by serving Income Withholding Notices (IWNs) on the Department of Employment Security; explains the legal process to custodial parents (CPs) and non-custodial parents (NCPs) without giving legal advice; confirms if Voluntary Acknowledgment of Paternity (VAP) has been received; determines if modification is warranted and explains to CP and NCP reasons for denial and/or next steps in the modification process; explains to CP only. As a paraprofessional, assists in a regulating, monitoring and controlling program or client service program provided by the agency; performs a variety of paraprofessional duties in the flow and processing of information and/or documents concerning a program area; acts as a liaison between vendors, direct service providers, clients or the general public in resolving discrepancies, responding to inquiries and explaining procedures, rules and/or services of the program; gathers information and prepares documents or reports on program activity, compliance, etc.; receives and evaluates documents, licenses, permits or contractual agreements to determine acceptability or conformance to eligibility requirements according to rules and regulations, statutes, program policy and procedures; may certify documents signed by others with public notary seal; prepares letters, audits, etc., to obtain additional information or initiate noncompliance activities; develops evaluating and monitoring procedures for program area. Performs other duties as assigned or required which are reasonably within the scope of the duties enumerated above.

04/2018 to 10/2018 - Illinois Department of Natural Resources – Springfield, IL

Office Associate:

Under direction, engaged in difficult and responsible clerical work. composes correspondence, signs outgoing letters; prepares and processes travel vouchers, contract and invoice vouchers and arranges office travel. performs a variety of complex, specialized clerical information and assistance, keyboarding, record processing, secretarial and general office support functions; work involves related steps, processes and/or methods requiring application of agency policies and procedures and the exercise of initiative and judgment in distinguishing among variables and identifying applicable standards; determines work methods and procedures to complete assignments; provides information/assistance to explain or clarify rules, processes or procedures; Prepares and maintains complex, highly specialized records and reports; reviews and verifies claims, applications for licenses or permits, contracts and similar documents, employing judgment in applying governing policies, rules, regulations and procedures; makes involved mathematical calculations; compiles and assembles data; prepares complex special or summary reports; develops methods and forms to improve the processing and control of records; prepares and maintains spreadsheet or database files to maintain records and produce reports not requiring an extensive knowledge of the application program or procedural command language; provides information concerning available services or clarifies processes and procedures to clientele, vendors and others; determines needs and makes routine operational decisions to assure compliance. Follows oral and written instructions gaining experience and knowledge and applying evolving automated office equipment and technology to complex tasks. Performs a variety of complex typing including administrative hearing complaints, findings and orders, contracts, leases where an understanding of specialized terms is required to ensure the clarity and accuracy of legal documents; determines proper format and modes of address on legal documents; proofreads for accuracy of punctuation, grammar, spelling, etc.; composes correspondence to general inquiries and signs outgoing letters for Chief Legal Counsel. Receives visitors; screens callers and incoming correspondence for priority and necessity; makes and cancels appointments; maintains and develops agency relationships through telephone and personal contacts. Reads, sorts, and distributes incoming mail; Process and Input all incoming FOIA request, and information into the DNR system; Redact documents to be sent in for request. Sets up and maintains files for correspondence, special reports, and file legal reference material. Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above.

12/2013 to 04/2018 - Central Counties Health Centers – Springfield, IL

Referral Clerk:

Under general supervision, performs a variety of difficult and responsible clerical information and assistance, filing, keyboarding, record processing, secretarial and general office support functions; exercises some choice in procedures and independent action in the disposition of routine matters or in personal contact with others to give nontechnical information; work performed at this level is controlled by established methods and procedures but requires some independent judgment in preliminary assembly, formatting and editorial efforts. Independently audited, retrieved and researched the financial liability of patients. Receives, retrieves, sorts or collates documents, papers and forms in accordance with established methods and procedures for further action or final processing or filing; screens forms for presence of required information and completes and/or codes forms in accordance with established, well defined guidelines; may obtain information for form completion when sources are extremely limited or well defined; utilizes manual or automated files to retrieve, file, complete and/or review documents; records and/or maintains routine logs or reports of information pertaining to filing, data entry and retrieval or record processing activities; copies records in response to routine requests and mails to appropriate destination. Sets up and operates office equipment in performance of Duties. Researched patient information to schedule appointments, posted Audits and corrected errors. Confers with relatives, attorneys, legislators and other involved parties to acquire information in assuring the proper handling of recipient's funds. Prepared the data processing control forms indicating the appropriate adjustments made to the patient's account. Independently retrieved, analyzed, researched, audited and reviewed reimbursement accounts periodically; removes files of discharged patients; performed a variety of technical duties to obtain reimbursement from the federal government; Investigated the financial liability of patients, their estates and legally responsible relatives. Processed claims while performing, coordinating, and monitoring billing and collection activities. Closes-out files of deceased patients; determines if charges warrant adjustments. Filed records away in alphabetical or numerical order. Operate commonly used manual and automated office equipment, data base systems, Mainframe, Email and Microsoft Office products including Outlook, Word, Excel, Access, Power-point.

12/2009 to 12/2013 - Lincoln Prairie Behavioral Health System - Springfield, IL

Health Information Technician:

Under general supervision, serves as designated lead worker; assigns and reviews work; provides guidance and training to assigned staff; provides input into performance evaluations; prepares statistical reports for health services. Performs a variety of paraprofessional health information functions to prepare and maintain health information records and reports in accordance with accrediting and regulatory agencies; assists in planning, organizing, and maintaining statistical records and reports; analyzes and interprets medical records for summary and special reports. Utilizing a personal computer, software, hardware and agency mainframe applications, produces special reports, charts, forms and graphs for summaries and displays of health information records; prepares letters and notifications of patients’ medical history. Maintains and compiles all health information records and reports; analyzes and interprets health information and records for summary and special reports; organizes medical, psychological and psychiatric terminology to reflect a complete history of individuals served in a state operated facility.

Prepares statistical reports concerning population changes, admissions, discharges, bed occupancy and other data helpful in the maintenance and planning of a state facility. Composes detailed letters in reply to inquiries from relatives, friends, legal representatives, municipal, judicial and other public agencies in conformance with agency policy; notifies appropriate persons when patients are discharged. Following the death of a patient, and in accordance with departmental rules and regulations, compiles and prepares necessary notices, certificates, reports and permits.

Performs the more complex, technical aspects of coding using diagnostic classification systems; analyzes and interprets health information for summary, special reports and research projects; prepares tables and graphics for displaying more efficient methods of summarizing and displaying findings. Monitors existing health information services system procedures and standards; revises procedures where necessary; assists Health Information Services Administrator in planning and projecting overall health information services program goals. As a representative of the agency, testifies on medical records information in court ordered hearings.

Processed and independently analyzed patient discharge records. Monitored discharge summary completeness from doctors. Monitor, investigate and research delinquent records, handled outside correspondence, handled the unusual incident reporting and DCFS hot line call reports. Audited, compiled, collected and tracked data for patient records. Prepared and generated reports for monthly and quarterly audits of physician's accuracy.

Prepared reports, forms, other correspondence, and legal documents to expedite collection of reimbursement monies; explained schedule of charges, policies and procedures relevant to reimbursement program.

Independently retrieved, analyzed, researched, audited and reviewed reimbursement accounts periodically; removes files of discharged patients; performed a variety of technical duties to obtain reimbursement from the federal government; Investigated the financial liability of patients, their estates and legally responsible relatives.

Processed claims while performing, coordinating, and monitoring billing and collection activities.

Operated commonly used manual and automated office equipment, data base systems, Mainframe, Email and Microsoft Office products including Outlook, Word, Excel, Access, and Power-point.

Education:

Northwestern College & St. Louis University, IL

Heartland Community College, Bloomington, IL

Springfield College in Illinois, Springfield, IL

Sacred Heart Griffin High School – Springfield, IL

General Education:

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