, , 609 Johnson Ave., 49204, Tulsa, OK100 Montgomery St. 10th Floor
Home: (555) 432-1000
Cell:
resumesample@example.com
Summary
Accomplished, Hard-working health care professional with 15+ years of experience with The Johns Hopkins Health System and proven knowledge of case management, data collection, analysis, medical billing, and third-party payer issues. Experience with population health care coordination, including post-surgery, physical therapy, oncology, maternity, behavior health, with various patients, including adults, pediatrics, Med Advantage, and special needs patients. Excellent analytical, multitasking, organizational, and time management skills. I aim to leverage my skills to obtain employment with an exceptional health care organization that will allow me to display my extensive health care background while continuing to grow and develop professionally and personally.
Care Management Coordinator, 12/2013 to Current Adventist Health Nw – Kansas City, MO,
Analyzed new referrals to determine member eligibility for case management based on claims data,
diagnosis, and medical conditions and refer to appropriate case management program (context/number
show many/often) phone/electronic referrals
Collaborated the cases to the team of nurses to maintain an active case management load of 65+ cases
from a variety of lines of business, such as Priority Partners, Johns Hopkins Advantage MD, EHP, and
Johns Hopkins US Family
Assist case managers with coordinating patient care (mailing educational literature, Welcome packets,
Advance directives, Consent forms, etc.)
Verify member eligibility for all lines of business including EHP, Tricare, Johns Hopkins Advantage
MD, and Priority Partners
Worked as an Epic superuser, and proficient using Maryland Medicaid Eligibility Verification System
(EVS)
Conduct Patient Activation Measures (PAM surveys) and SF-12 Surveys telephonically and scored
surveys using Flourish and AM-I-Healthy database
Determine Proper ICD-9 and CPT coding for authorizations
Coordinate patient care and provide case management services to (Adults, Pediatric, Maternity,
Behavior health and the Elderly population)
Coordinate various member service including requests for durable medical equipment, home health
services, and specialty visits
Compose and generate patient, case managers, and physician mailings
Collect data, review and work daily reports
Train and orient new employees.
Medical Records Specialist, 02/2021 to 05/2022 Iron Mountain – Montpelier, VT,
Maintains medical records in accordance with the SNF (Skilled Nursing Facility)
Assures maintenance of active and discharge medical records
Increased the safeguards medical information against loss, destruction, or un-authorized use
Maintains system for retrieval of discharge medical records. Maintains thinned files in proper order to assure ease in retrieval and integrity of the resident s medical record
Responds to all requests for medical records copies from attorneys, medical facilities, etc., and provide copies in accordance with HIPPA regulations and state and federal laws
Maintain log of requests
Obtains necessary information on residents as needed and other requests for residents and/or health care decision makers
Monitors the discharged clinical record closed chart process, maintains the Discharge Chart Control
Log, and maintains the log of records stored off-site (Medical Records Discharge File Log)
Provided respectful assistance to patients, staff members and insurance company representatives.
Pulled patient records and transferred information to appropriate parties.
Maintained electronic medical records for all clients
Verified record copies before handing each over to check for and remove unnecessary details.
Entered patient insurance, demographic and health information into software and confirmed records.
Set up patient charts and documented information in various company software.
Streamlined day-to-day office processes to meet long-term goals.
Determined and implemented techniques to improve medical records retrieval process.
Scanned incoming documentation.
Maintained complete confidentiality in accordance with organization and legal requirements.
Case Management Clerk, 07/2011 to 12/2013 Johns Hopkins Healthcare, LLC – City, STATE,
Advised & support various disease case management program providing assistance for various complex medical request
Provided administrative support to the Case Management Assistants
Coordinated patient referrals for the Partners with Mom program
Reviewed Maryland Prenatal Risk Assessments (MPRAs) to determine member eligibility for case management, and enter into the maternity database
Collected data and issue monthly reports to the Department of Health and Mental Hygiene and Local
Health Department for analysis
Review and managed incoming Health Risk Assessments (HRAs) for completeness and accuracy
Maintained and entered complex data in the disease management databases
Generated member and physicians' mailing, fax, scan, and obtain incoming correspondence
Distributed health education information to members using disease-specific literature
Verified member eligibility for all lines of business
Maintained inventory of educational material and supplies
Participated in various departmental special projects in support of the care management department
Streamline & used multiple internal and external systems including IDX, EPR MSR MC400,
SharePoint, and multiple disease management database.
Participated in case conferences with multi-disciplinary team to discuss client care planning and progression.
Facilitated ongoing case management services to support successful outcomes and meet stabilization goals.
Cooperated with local service providers, outreach workers, case managers and collaborative agencies to facilitate services for members.
Protected patient data in alignment with HIPAA privacy protocols.
Operating Room Associate, 12/2001 to 07/2011 Johns Hopkins Hospital – City, ,
Coordinated patient registration in the Obstetrical and Gynecology unit
Arranged patient charts and assisted in a wide range of clerical duties
Performed the ordering the material and environmental supplies to support the OB/GYN unit
Transported patients and equipment
Delivered records and specimens as requested
Cleaned and stocked operating rooms, labor and delivery rooms, antepartum, postpartum rooms
according to standards and procedures
Initiated a positive work environment as an active team member.
Education and Training
Bachelor of Science (B.S: Health Service Management, Expected in 12/2022 University of Maryland-University College - Largo, MD GPA:
Associate of Science: Health Informatics and Technology, Expected in 01/2018 Community College of Baltimore County - Baltimore, MD GPA:
Associate of Arts: General Studies, Expected in 01/2013 Community College of Baltimore County - Baltimore, MD GPA:
Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.