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CARE NAVIGATOR Resume Example

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CARE NAVIGATOR
Professional Summary

Patient Service Representative with 10 years of experience in healthcare. Adept at patient advocacy and education with commitment to efficiency. Skilled at coordinating busy offices and maintaining professionalism in stressful situations.

Skills

  • Microsoft Office

  • Administrative
  • Interpersonal
  • Communication skills

  • Medical terminology

  • Process improvements

  • Provider Relations

  • Medical Office Management

  • Insurance Verification

  • Medicare/Medicaid

  • Patient relationship management

  • Patient education

  • HIPAA compliant

  • ICUE proficient

Work History
12/2018 - CurrentCARE NAVIGATOR | Company Name - City, State
  • Initial triage, administrative intake of members and/or managing admission/discharge information post-notification.
  • Maintained metrics by reaching 20-30 members daily
  • Working with hospitals and clinical teams to get members seen by clinicians in home post discharge.
  • Established support by communicating complex information in understandable terms both verbally and written while critically analyzing issues from multiple angles to determine next steps and / or root cause for members.
  • Collaborate and coordinate across multiple teams and departments. Develop effective working relationships with applicable internal and external customers
  • Recognize trends with escalated issues and identity preventative action
  • Providing information on available within UHC network.
  • Managing referrals and processes incoming/outgoing referrals, and prior authorizations.
  • Take telephone messages and provide feedback and answers to patient/physician /pharmacy calls Gathers required details to inform treating Clinician of ongoing complaints.
  • Advises provider of patient's condition, complaints, compliance or adverse reactions to medication and/or treatment to medication and/or treatment.
  • Monitors delivery of care by engaging with patient to identify progress toward desired care outcomes.
09/2016 - 12/2018CARE MANAGEMENT ASSOCIATE/CERT. MEDICAL ASSISTANT | Company Name - City, State
  • Managed high volume inbound calls of 60-80 live calls daily and provide feedback and answers to patient/physician /pharmacy calls; Gathered required details to inform treating Clinician of ongoing complaints.
  • Advises provider of patient's condition, complaints, compliance or adverse reactions to medication and/or treatment to medication and/or treatment.
  • Transmit messages from patients and front office staff to physicians, practicing nurse and physician assistants.
  • Performs patient outreach, education and teaching to improve compliance with care plans, under direction of providers.
  • Monitors delivery of care by engaging with patient to identify progress toward desired care outcomes.
  • Provide support to children and youths with challenges including interpersonal relationships, social interaction, behavioral conduct, and communication skills.
  • Assist youth in DFACS system adaptive and effective coping skills that can be utilized in home, community and or educational setting under direction of provider.
  • Tracks, manages and expedites referrals, consults and orders to ensure receipt and completion.
  • Monitored status of orders including labs, DME, HHC, Imaging studies, RX etc.
  • Supports completion of medical documents requested by third party payors and other providers, as directed by clinical provider.
  • Engaged with other providers to coordinate patient care and foster compliance with plan of care, as directed by Clinician.
  • Conduct intake interviews with patients and refer patients into appropriate social programs.
  • Assists in completion of care plans and psychosocial assessments in timely fashion.
07/2014 - 09/2016CERTIFIED CLINICAL MEDICAL ASSISTANT- LAB ASSISTANT | Company Name - City, State
  • Daily patient charting of 15-20 patients daily
  • Insurance verifications along with managing billing concerns for patients.
  • Decreased wait times by assisting in patient triage and conducting intake interviews with patients and set up appropriate social program referrals prior to provider seeing patient.
  • Scheduling patient appointments.
  • Precertification.
  • Assisting in 5-10 minor joint injection procedures weekly.
  • Prepared treatment rooms for patients, including cleaning surfaces and restocking supplies
  • Collected forms, copied insurance cards and coordinated patient information for billing and insurance processing
  • Led patients to exam rooms, answered general questions and prepared patients for physician by explaining process
  • Educated patients about medications, procedures and physician's instructions
Education
Expected in 12/2021Louisiana State University At Alexandria, City, StateBachelor of Arts: Psychology
  • GPA 3.2
11/2011Remington College - Baton Rouge, City, StateMedical Assisting Diploma: Medical Assisting
Certifications
  • Medical Office Management Bookkeeping
  • HIPPA & OSHA Certified & Filing
  • Scribing for physicians
  • Lab accessioning, Certified Clinical Medical Assistant (NHA) April 2016 to August 2020
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Resume Overview

School Attended

  • Louisiana State University At Alexandria
  • Remington College - Baton Rouge

Job Titles Held:

  • CARE NAVIGATOR
  • CARE MANAGEMENT ASSOCIATE/CERT. MEDICAL ASSISTANT
  • CERTIFIED CLINICAL MEDICAL ASSISTANT- LAB ASSISTANT

Degrees

  • Bachelor of Arts : Psychology
    Medical Assisting Diploma : Medical Assisting

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