Care Coordination Claims Management

Barbara PATRICK

Lithonia, GA ***** 404-***-**** ***********@*******.*** Bold Profile

PROFESSIONAL SUMMARY

Experienced healthcare professional with a strong focus on patient support and care coordination. Specializing in team collaboration and achieving results, adaptable to changing needs in the healthcare industry. Skills include patient advocacy, healthcare navigation, medical terminology, and effective communication. A reliable and compassionate approach to ensure seamless patient experiences and achieve optimal outcomes.

SKILLS

Claims Management Proficiency

Medical Insurance Programs

Skilled in Managing Queues

Prior Authorization Processing

Knowledge of Medicare Enrollment Processes

Specialty Pharmacy Operations

Internal and External Communication

Claims Management Proficiency

WORK HISTORY

PATIENT NAVIGATOR 04/2023 to 04/2024

BLUE CROSS BLUE SHIELD (Remotely)

Delivered high-quality care coordination by managing 75-80 daily outbound calls, ensuring recently discharged senior patients received personalized recovery support.

Proactively facilitated access to Medicare benefits and health management programs, streamlining recovery processes and enhancing patient outcomes.

Achieved patient adherence by ensuring proper medication access and addressing compliance barriers.

Enhanced continuity of care by scheduling follow-up appointments, resolving conflicts, and overcoming logistical challenges.

Identified critical care gaps, connecting members to community resources and achieving comprehensive case closure.

PATIENT CARE COORDINATOR 01/2022 to 06/2022

US BIO-SERVICES (Remotely)

Advocated for patients by aligning their drug therapies with healthcare provider plans, achieving consistent and effective therapy outcomes.

Demonstrated expertise in insurance verification co-pay assistance medication cycles, and financial aid, reducing patient financial burdens.

Resolved complex patient and payer issues promptly, providing seamless communication between physicians and patients.

Maintained impeccable documentation standards, proactively identifying and addressing potential issues in pharmacy care.

CLIENT SERVICES SPECIALIST I HEALTH CONCIERGE 09/2021 to 11/2021

CVS HEALTH (Remotely)

Led benefit enrollment process for major clients (Bose, Visa, Sony Pictures, etc.), achieving a 95% registration completion rate.

Expertly administered medical, dental, and vision plans while adhering to stringent regulatory standards.

Provided concierge-level support, creating cases and escalating complex requests, ensuring exceptional client satisfaction

CLAIMS ANALYST 06/2017 to 11/2020

USA Benefit's Administer LLC Atlanta, Georgia

Verify document authenticity and determine eligibility for administering medical insurance claims based on membership benefit provisions

Conduct a thorough investigation of unpaid claims to ascertain coverage levels and make an informed decision on claim approvals or denials

Maintain precise documentation of inquiry outcomes for exact tracking and comprehensive analysis

Manage the coordination of benefits (COB), high dollar special pricing, and adjustments for claim adjudication ensuring compliance with HIPPA privacy information decide the status of medical-related claims related to physician and hospital services

BENEFITS MEMBER SERVICE REPRESENTATIVE 01/2016 to 01/2017

Morneau Shepell Atlanta, Georgia

Navigated State of Illinois employees through open enrollment periods, ensuring informed decision-making and seamless transitions.

Supported retired employees with Medicare Advantage Plans, resolving complex queries with professionalism and clarity

Applied extensive knowledge of governmental regulations (ACA, ERISA, QMCSO) to deliver accurate, compliant assistance.

CUSTOMER SUPPORT/MSABC RECRUITER 04/2015 to 08/2015

American Cancer Society Atlanta, Georgia

Successfully recruited participants for the Making Strides Against Breast Cancer Walk surpassing fundraising goals.

Enhances event participation through effective coaching, achieving a 95% registration rate and receiving the "Pink Ribbon Award"

REMOTE CUSTOMER SERVICE REPRESENTATIVE 10/2014 to 03/2015

Teleperformance Inc. (Remotely)

Delivered exceptional customer service through efficient issue resolution and upselling, earning recognition as the #1 Home Agent.

Exceeded performance metrics by handling high call volumes and providing tailored solutions to customer inquiries

EDUCATION

Healthcare Information Technology

DeVry University, Decatur, GA

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