case management analyst coordinator team leader resume example with 5 years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
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Healthcare Administrator with proven to deliver exemplary level of healthcare service delivery to patients. Coordinate admission and discharge of patients. Plan and implement strategies for developing improved health care management. Proven problem solver and excellent communicator. Strong organizational skills, superb understanding of data collection and performance metrics. Recognized for staff development leading to high performing teams. Used Microsoft Excel to develop inventory tracking spreadsheets. Supervised team of 20 staff members. Self-motivated, dependable Case Management Analyst Coordinator experienced in advocating outreach and engagement services. Demonstrated clinical skills in assessing and obtaining community resources to customize care plans. Commitment and understanding of equal opportunities with diverse and multicultural environments.

  • Employee Recruitment and Hiring
  • Information Systems Development Problem Resolution
  • Employee Performance Evaluations Medical Programs Implementation
  • Employee Work Scheduling Patient Care Assessment
  • Medical Billing
  • Case Management
  • Healthcare Management
  • Medical Records
  • Project Leadership
  • Meeting Facilitation
  • Quality Assurance
  • Insurance Verification
  • Medical Terminology
  • Behavioral Health
  • Community Outreach
  • Research and Facts Collecting
  • Assistance Program Knowledge
  • Supervision & Leadership
  • Critical Thinking
  • Training & Development
  • Team Management
  • Data Management
  • Organizational Skills
Case Management Analyst Coordinator/Team Leader, 10/2019 to Current
Aetna Better Health Of Virginia, CVS CompanyCity, STATE,
  • Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations
  • Participated in professional growth programs to support special education improvement efforts
  • Increased referral rates by providing excellent service and building meaningful relationships with patients and caregivers
  • Evaluated IEP for compliance with state and federal requirements regulations and rectified non- compliance issues immediately
  • Educated patients and loved ones about different treatment options and outside care approaches to reduce burden on hospital resources
  • Developed positive relationships with parents to foster communication and encourage involvement for student growth
  • Managed support services and fostered communication among social workers, therapists, hospital staff and patients
  • Addressed delays in discharge, postponed procedures and discharge equipment unavailability
  • Partnered with physicians, social workers, activity therapists, nutritionists and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems
  • Evaluated treatment plans against individual goals and healthcare standards
  • Consulted with clinicians to devise and manage ongoing care plans for at-risk patients
  • Supervised and managed daily activities of clinical team consisting of 20+ physicians, nurses and support staff
  • Organized and facilitated 2-3 department head meetings weekly, discussing current census, admissions and discharges and residents' Medicaid applications
Patient Assistance Specialist, 12/2018 to 10/2019
PfizerCity, STATE,
  • Identified insurance payment sources and listed payers in proper sequence to establish chain of payment
  • Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy
  • Collected and entered patient demographic and insurance data into computer database to establish patient's medical record
  • Contributed to reduction of accounts receivables by adhering to predetermined policies and procedures to recover amounts due from patients
  • Determined patient financial needs and referred eligible patients to proper county, state or federal agencies to obtain financial assistance
  • Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks
  • Collected and validated patient demographics and insurance information
  • Explained estimated cost for medical treatments and answered patient questions to promote good understanding of proposed services
  • Resolved patient financial problems with guidance from documented guidelines and procedures
  • Recommended service improvements to minimize recurring patient issues and complaints.
Medical Benefits Specialist, 04/2017 to 12/2017
AnthemCity, STATE,
  • Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email and in-person interactions
  • Directed and controlled 401K, medical, dental and vision benefit packages
  • Delivered targeted advise on issues such as applicable employment regulations, compensation strategies and internal systems to help companies update antiquated or ineffective approaches
  • Trained new team members in policies and procedures and offered insight into best ways to manage job tasks and duties.
Disputes Analyst Lead, 01/2016 to 12/2016
Portfolio Recovery AssociatesCity, STATE,
  • Adhered to department processes, procedures and goal expectations for case investigations
  • Kept up to date on industry information, system changes, network rules and compliance issues
  • Used sound judgment and available resources to make well-informed decisions for case approval or denial
  • Interacted with law enforcement agencies, merchants and persons of interest to obtain and review dispute information
  • Analyzed, researched and resolved payment claims within required timeframes
  • Made decisions and recommendations about extending lines of credit
  • Controlled credit exposure by providing financial order management support to minimize risk and obtain timely payment
  • Led projects and analyzed data to identify opportunities for improvement
  • Developed team communications and information for meetings.
Education and Training
Medical Billing And Coding: , Expected in to Centura College - Norfolk, VA,
High School Diploma: , Expected in to Norview High School - Norfolk, VA
Bachelor of Science: , Expected in to Colorado Technical University - ,
  • Consistently maintained high customer satisfaction ratings.
  • Led team to achieve 97% accuracy, earning recognition from upper management and financial reward.
  • Created highly effective new program that significantly impacted efficiency and improved operations.
  • Promoted from Care Management Associate to Case Management Team Lead Subject Matter Expert, in less than 12-months.
Activities and Honors
  • 2020 Beta Theta Zeta Amicae of Norfolk

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Resume Overview

School Attended

  • Centura College
  • Norview High School
  • Colorado Technical University

Job Titles Held:

  • Case Management Analyst Coordinator/Team Leader
  • Patient Assistance Specialist
  • Medical Benefits Specialist
  • Disputes Analyst Lead


  • Medical Billing And Coding
  • High School Diploma
  • Bachelor of Science

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