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care manager resume example with 8+ years of experience

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

SKILLS Empathetic Care Manager with 21 years of experience supporting patients with daily health functions and comfort. Deliberate support personnel providing complex solutions to enduring patient concerns. Practical care organizer with time-tested history of successfully supervising skilled medical teams. Effective at improving revenue, team productivity and policies to keep the facility operating at a sustainable and profitable level. Well-versed in motivating and retaining employees, building relationships with residents and families and achieving the requirements for continued accreditation. Detail-oriented Medical and Health Services Manager passionate about facilitating excellent patient care. Adept at designing and implementing policies and procedures. Motivated team builder and supervisor focused on driving team collaboration. Hardworking and reliable leader with strong ability in all facets of healthcare and medical and pharmacy billing. Highly organized, proactive and punctual with team-oriented mentality. Also, very disciplined as I have been working remotely for several years.

Skills
  • Case assessments
  • Medical chart documentation
  • Vital sign monitoring
  • ADL support
  • Schedule management
  • Records maintenance
  • Healthcare delivery
  • Staff supervision
  • Records management
  • Quality assurance controls
  • Patient relations
  • Regulatory requirements
  • Accreditation support
  • Personnel management
  • Health information systems
  • Bookkeeping
  • Clerical writing
  • Financial calculation
  • Drafting [Document]
  • Client service
  • Denied claims
  • Workers Comp claims
  • Check processing
  • Surgery claims
  • Payroll liabilities
  • Auditing proficiency
  • Account collections
  • Billing statement management
  • Manual processing
  • Generally Accepted Accounting Principles (GAAP)
  • Peachtree experience
  • Discrepancy reconciliation
  • Bill payment
  • General ledger entries
  • Customer relations
  • A/P and A/R proficiency
  • Revenue forecasting
  • Payment transactions
  • Database updates
  • Quality control
  • Account updating
Experience
09/2021 to Current
CARE MANAGER Community Health Action Of Staten Island Staten Island, NY,
  • Facilitated communication between members of health care delivery while involving clients in decision-making processes to minimize service fragmentation.
  • Ascertained whether client needed government assistance and tracked assistance application status.
  • Identified risk management concerns and reported scenarios to appropriate management.
  • Evaluated KPIs to mitigate risk, improve patient care and implement changes to increase efficiency.
  • Communicated with patients with compassion while keeping medical information private.
  • Created and maintained facility documents and records, maintaining accuracy while managing sensitive data.
  • Facilitated peer-to-peer conflict resolution.
  • Oversaw clinic financial management, recruitment and human resources.
  • Created and implemented policies and procedures for effective pharmacy management.
  • Checked the pharmacy area regularly to ensure that it was kept neat, clean and free of debris.
  • Educated pharmacy assistants on medication assistance, ordering and insurance issues.
06/2020 to 05/2022
Office and Billing Manager MedXcel City, STATE,
  • Resolved billing issues by applying knowledge and completing in-depth research.
  • Developed improved standard operating procedures to increase billing accuracy and cash flow.
  • Conducted insurance verification and pre-authorization, coded E/M and CPT procedures and managed patient charts.
  • Conducted insurance verification and pre-authorization, coding and ICD 10 coding and managed patient charts.
  • Set up and maintained electronic billing system.
  • Managed billing calendar and scheduled claims for payments.
  • Helped customers to bring accounts into good standing by implementing payment plans.
  • Developed performance improvement plans based on deep reviews of current work.
  • Built high-performance team by collaborating with new members on procedural, administrative, collections and compliance areas.15
  • Led team of 15 staff handling and two clinics.
  • Completed month-end and year-end closings, kept records audit-ready and monitored timely recording of accounting transactions.
  • Enforced operational compliance with state and federal laws and office standards.
  • Led banking tasks, business administration and financial decision-making to ensure first-class client services.
  • Maintained current and accurate cash balances for all programs, departments and projects.
  • Verified accuracy of accounting disbursements such as payroll and vendor payments.
  • Managed contract administration, maintained files, validated codes and monitored reporting.
11/2013 to 05/2022
Billing and Insurance Reimbursement Specialist Louisiana Orthopedic Specialists City, STATE,
  • Monitored past due invoices and payments to minimize past due balances.
  • Maintained confidentiality and integrity of patient data.
  • Researched rejections, investigating problems to appeal claims.
  • Determined medical necessity, using individual insurance carrier regulations.
  • Verified technical reimbursement questions for providers, billing and coding staff.
  • Coded patient care records to provide accurate information for billing.
  • Drafted documents based on payer guidelines and submitted to necessary parties.
  • Identified opportunities for coverage access to address reimbursement barriers.
  • Enforced adherence to [State] and federal reporting regulations by performing regular compliance audits.
Education and Training
Expected in 03/2010 to to
Certified Medical Coding And Billing: Healthcare
Remington College - Lafayette, LA,
GPA:
Expected in to to
Associate of Applied Science: Nursing
LSUE - Eunice, LA,
GPA:

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Resume Overview

School Attended

  • Remington College
  • LSUE

Job Titles Held:

  • CARE MANAGER
  • Office and Billing Manager
  • Billing and Insurance Reimbursement Specialist

Degrees

  • Certified Medical Coding And Billing
  • Associate of Applied Science

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