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care management resume example with 4+ years of experience

Jessica Claire
, , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Professional Summary

A motivated medical professional seeking a position in a challenging environment. Over 20 years of experience successfully providing administrative and medical support to the company. Well-developed communication and customer service skills. Proven ability to efficiently plan and manage multiple assignments to meet tight deadlines. A proactive problem-solver who gets the job done. Per previous managers “Jessicais highly self-motivated, eager to learn, honest, dependable, has a passion to learn along passion for her patients, job and company she represents.”

Skills
  • Medical Billing
  • Medical Records
  • Data Entry (60 WPM)
  • Scheduling (Office visits/Surgical procedures at hospital)
  • HIPPA knowledge
  • Multiple EMR systems: Athena, Advanced MD, Centricity & Image Now (refund)
  • HEDIS measures (reviewing charts)
  • Microsoft Office Suite
  • Decision-making
  • Detail Oriented
  • Empathy
  • Flexibility
  • #1 Respectful
Work History
02/2021 to Current
Care Management Dean Health Purcell, OK,


  • HEDIS Data Analyst- responsible for various HEDIS data submissions to state and federal agencies in a timely basis, ensuring the quality of the data submitted meets, at a minimum, the various regulatory requirements.
  • Potential diagnosis hierarchical condition categories (HCCs) adding into the chart (Athena)
  • HCCs potential diagnose risks (review charts task the provider with missing buddy codes)
  • Working closely with our ACO’s
  • Medication Adherence
  • Coordinated referrals to specialists, hospitalizations, ER visits, ancillary testing and other enabling services for patients.
  • Coordinated post-discharge care by communicating with outpatient clinics, community resources, agencies and families around patients' transitional care.
  • Worked with insurance carriers to obtain authorization approvals for medications, supplies and equipment.
  • Communicated with patients and family members to assist with information, provide literature and direct to community resources.
03/2020 to Current
Registered Medical Assistant Dean Health Springfield, IL,
  • Documented vital signs and health history for patients in clinic and hospital environments.
  • Promoted office efficiency, coordinating charts, completing insurance forms and helping patients with diverse needs.
  • Called and faxed pharmacies to submit prescriptions and refills.
  • Taught patients about medications, procedures and care plan instructions.
  • Assisted with routine checks and diagnostic testing by collecting and processing specimens.
  • Gathered forms and copied insurance cards to collect patient information for billing and insurance filing.
  • Sanitized, restocked and organized exam rooms and medical equipment.
  • Directed patients to exam rooms, fielded questions and prepared for physician examinations.
  • Collected and documented patient medical information such as blood pressure and weight.
  • Promoted into the Care Management Dept.
10/2018 to 02/2020
Registered Medical Assistant Common Spirit Berea, KY,
  • Documented vital signs and health history for patients in clinic and hospital environments.
  • Called and faxed pharmacies to submit prescriptions and refills.
  • Taught patients about medications, procedures and care plan instructions.
  • Assisted with routine checks and diagnostic testing by collecting and processing specimens.
  • Responsible for all clerical duties: phone triage, supply management, forms management, and completion of patient admission and discharge function.
  • Responsible for weekly inventory, injections (testosterone, Lupron), bladder cancer treatments, Prior Authorizations, medication prior authorization.
  • Perform Urodynamic test on patient, interpret the test, assist on biopsy’s, vasectomy’s, EKG’s along with assisting on any other procedures. Foley removals, Foley's/suprapubic changes, education on self-catheterization
  • Monthly duties: Cleaning all the instrument when needed, Autoclave maintenance, POC daily, Aegis weekly, Veriform monthly, medication inventory and order when needed. Change sharps containers out and disposal properly.
  • Prior-Authorization along with tier exception on medications
08/2017 to 11/2018
Patient Account Representative US Oncology (Cancer Care Centers Of Brevard) City, STATE,
  • Posted payments and processed refunds: to patients, insurance and/or foundations.
  • Worked with outside entities to resolve issues with billing, claims and payments. (Foundation companies the most)
  • Worked with customer to create debt repayment plan based on current financial condition.
  • Thoroughly investigated past due invoices and minimized number of unpaid accounts
  • Thoroughly reviewed remittance codes from EOBS/AR’s
  • Submitted refund request for claims pain in error or patients over paid
  • Accurately entered procedure codes, diagnosis codes and patient information into billing from hospital consultants
  • Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.


Education
Expected in
Certificate: Medical Assistant
Everest University -Melbourne, FL - Melbourne, FL,
GPA:
Expected in
Certificate: Phlebotomy/EKG
Florida Medical Training Institute - Melbourne - Melbourne, FL
GPA:
Expected in
Certificate: Medical Coding & Medical Billing
U.S. Career Institute - Fort Collins, CO
GPA:
Certifications
  • Registered Medical Assistant, American Medical Technology- 2022

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Resume Overview

School Attended

  • Everest University -Melbourne, FL
  • Florida Medical Training Institute - Melbourne
  • U.S. Career Institute

Job Titles Held:

  • Care Management
  • Registered Medical Assistant
  • Registered Medical Assistant
  • Patient Account Representative

Degrees

  • Certificate
  • Certificate
  • Certificate

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