Quality Control Patient Care
Resume:
Philadelphia, PA *****
267-***-**** Leonard Muchison
***************@*****.***
SUMMARY OF QUALIFICATION
A seasoned professional with several years experience in administration and processing of claims offering excellent, leadership, customer services, and provider relations skills. Major strengths in organization, planning, and facilitating. Computer literate including proficiency in Microsoft Word, excel and PowerPoint in Windows operations environment, and skilled in e-mail and Internet use. Familiar with the following systems: Unidate, Info, PBX, SMS, XL Systems. A dependable, thorough, creative, and well-organized planner who communicates effectively.
AREAS OF EFFECTIVENESS
Team Leadership Vendor/Customer Relations
Data Collection and Analysis Problem Resolution
Quality Control/Assurance Regulation Compliance
Project Management Process Efficiency
EMPLOYMENT HISTORY
Quest Dianostics 9/2015-present
Patient Care Representative
Checked Patients in for appointments verified completed hippa forms as well as care everywhere forms, updated patient insurance information created referrals for specialist, scheduled appointments conducted reminder calls for next day appointments. Answered questions asked by patients and providers.
Apollo Health Street, Conshocken, PA 01/2011- 09/2011
Patient Financial Services
Determined and validated the existence of payment by conducting detailed analysis using various systems as well as hospital guidelines. Calculated the appropriated payment amounts, issued over and under payment request letters and created account receivable. Processed inquires by assisting Beneficiaries on how to apply for Medicare supplemental coverage by performing appropriate reach utilizing problem-solving skills.
Thomas Jefferson University Hospital, Philadelphia, PA 2008- 2011
Inpatient Medical claims Coordinator/Financial Counselor-Business Office
Determined and validated the existence of payment by conducting detailed analysis using various systems as well as hospital guidelines. Calculated the appropriated payment amounts, issued over and under payment request letters and created account receivable. Processed inquires by assisting Beneficiaries on how to apply for Medicare supplemental coverage by performing appropriate reach utilizing problem-solving skills.
Social Security Administration, Philadelphia, PA 2006-2008
Benefit Authorizer (BA)
Prepared, verified, examined and maintained the beneficiaries Master Benefit Record (MBR) and initiated a full range of post-adjudicative action for benefits under the provision of the retirement, survivors insurance, and supplemental income or disability insurance benefit programs.
CIGNA International Expatriate Benefits (CIEB), Claymont, DE 2002-2006
Benefit Coordinator/Eligibility Associate
Provided eligibility and health insurance support to clients overseas. Verified and updated eligibility for internal and external customer. Determined if an applicant meets the eligibility requirements as stated in the policy.
Independence Blue Cross, Philadelphia, PA 1991-2002
Managed Care Claims Supports Coordinator/Supervision-Federal Program
Provided excellent service to our customers by accurately questioning callers or examining written inquiries/claims performing research of computer records and/ or written material and making decisions necessary to respond to basic written and telephone inquiries concerning benefits and claim payment issues. Provided leadership and direction to a staff of employees in order to effectively achieve established goals and objectives through interviewing, coaching and counseling, developing and training, motivating, appraising and evaluating, and role modeling. Facilitated activities requiring planning, decision-making analysis, problem solving, identifying and removing of barriers, effectively communicating with other, and serving in a liaison.
EDUCATION
Harcum College
Bryn Mawr, Pennsylvania
Human Services (2011 to present)
To Whom It May Concern:
After reading your job description, I am confident that my work experience and office skills are perfect match for this position.
I would bring to your company a broad range of skills, including:
Microsoft Excel/Word
Power Point
Vendor/Customer Relations
Claims Processing
Quality Control/Assurance
Problem Resolution & Decision Making
I would welcome the opportunity to further discuss this position with you. If you have questions or would like to schedule an interview, please contact me by phone at 267-***-**** or by e-mail at ***************@*****.***. I have enclosed my resume for your review, and I look forward to hearing from you.
Sincerely,
Leonard Muchison
Contact this candidate