Case Management Assistant Resume Example Company Name

CASE MANAGEMENT ASSISTANT

Experience

Case Management Assistant, 04/2016 to Current
Company Name – City, State

Provides assistance to the case management staff, including but not limited to, creating and faxing referral packets, organizing admission and discharge patient records, making phone calls, obtaining signatures, or any other assistance needed determined by the DCM Assists the case management team in scheduling family conferences.
Assists the case management team by making necessary arrangement for post-discharge follow up care.
Forwards the necessary patient clinical information for all admission, concurrent, and retrospective insurance reviews to payers for the completion of medical necessity reviews.
Monitors, documents, and tracks payer responses/requests of completed clinical reviews, including approvals, appeals, and denials, and communicates these to the appropriate personnel [hospital staff, physician, DCM, Claims Management, and Centralized Business Office (CBO).
Monitors and tracks the total hospital certified days of the patient for payers (commercial, managed care, and Medicaid) and communicates missing certifications to the DCM and CBO.
Initiates and completes insurancepre-certification for patients lacking certification, due to pre- admission issues, concurrent insurance changes, or outgoing hospital planned procedures.
Communicates pre-authorization outcomes to appropriate personnel (hospital and CBO).
Organizes and prepares the necessary clerical elements for the weekly Interdisciplinary Team Meeting to function timely and efficiently.
Performs general daily operational tasks/clerical support (i.e.
Phone calls, emails, faxes, copies, etc.) for the Case Management Department and as determined by the Director of Case Management (DCM).
Performs additional duties to assist the Case Management Department staff, support the revenue.

Patient Advocate, 05/2011 to 05/2016
Company Name – City, State

I assist in care coordination and provide welfare information to eligible participants who are diagnose with cancer and others as needed, in order to ensure optimum outcomes.
I help identify, communicate with and follow up with these participants, helping to identify available medical provider resources and community resources as well as Fund services that will help meet participants' needs.
I also help patients make appointments, accompany them during their clinical visits.

CAER RepresentativeCompany Name – City, State

Contribution Accounting Enrollment Representative is a new roll that the fund created as of June 01, 2013.
The position is a combination of both contribution and enrollment representative.
I am responsible for collecting contributions from employers, processing participant and dependent enrollment and eligibility.
New employer/employee orientation.
This also COBRA, STD/ADD, LIFE and FMLA processing and applying cash by participants through Self-Pay.

Contribution Accounting RepresentativeCompany Name – City, State

Responsible for collecting contributions from employers based on their Collective Bargaining Agreements with the various Local Unions.
Based on the Collective Bargaining Agreements, enrollments and elections are essential to the process of inputting work history for each of our participants which provides eligibility for health care coverage.
This also includes processing applications for COBRA and processing and applying cash by participants through Self-Pay and/or COBRA.

Customer Service Representative/Care Coordinator, 09/2011 to 10/2011
Company Name – City, State

Customer service representative is responsible for inbound/outbound calls providing benefits as well as the terms of eligibility for members and providers.
When significant changes in insurance coverage like increased co-payments or new limitations on treatment or prescription drug coverage occur, we are bound to promptly inform workers of the new restrictions.
Assisting participant on how to elect a (PCP) Primary Care Physician, Biometrics.
Assisting potential patients on scheduling appointments.
Recording potential patients information on VPA (Virtual Physicians Assistant).
Verifying insurance information with potential patients HMO/PPO.
Assisting with building new online applications.

Customer Support Specialist, 11/2010 to 09/2011
Company Name – City, State

CSS Daily tasks in customer support include troubleshooting customer inquiries, recording issues in an Incident tracking database, providing status updates on known issues, and continually building Online applications.
Troubleshooting customer inquiries.
Recording issues in an incident tracking database.
Providing status updates on known issues.
Continually building proficiency in our online applications.

International Sales Coordinator, Representative, 11/2007 to 01/2010
Company Name – City, State

Providing sales and administrative support involving efficient handling of top and confidential agreements.
Supporting the company's product by troubleshooting or answering and questions or concerns regarding the company's products.
Process inquiries by phone, fax, email in relation to company business.
Resolve and average of 200 inquiries in any given week and consistently met performance benchmarks in all areas (speed, accuracy, volume).
Work with new customers and update them on order status and inquiry.
Conveyed in a reassuring manner step by step instructions to resolve application issues.
Put customer at ease by acknowledging their need for explanation and information.
Provide client support and technical issue resolution via E-Mail, phone and other electronic medium.
Identify and correct or advise, on operational issues in client computer systems.

Enrollment RepresentativeCompany Name – City, State

Responsible for processing and maintaining all aspects of participant and dependent enrollment and eligibility, for assigned plan units between the Regional Offices, Contribution Accounting and, as needed, other internal teams and departments.

Customer Service Representative, 01/1999 to 01/2007
Company Name – City, State

Answered inbound calls in support of customer needs.
Conveyed in a reassuring manner step by step instructions to resolve application issues.
Reviewed and issued audits on account information and processes.
Performed queries in multiple databases.
Answer phones and respond to customer requests.
Transfer customer calls to appropriate staff.
Identify, research, and resolve customer issues using the computer system.
Follow-up on customer inquiries not immediately resolve.
Complete call logs and reports.
Research billing issues, misapplied payment.

Work History

Assistant, 05/2016 to Current
Company Name – City, State

Provides assistance to the case management staff, including but not limited to, creating and faxing referral packets, organizing admission and discharge patient records, making phone calls, obtaining signatures, or any other assistance needed determined by the DCM Assists the case management team in scheduling family conferences.
Assists the case management team by making necessary arrangement for post-discharge follow up care.
Forwards the necessary patient clinical information for all admission, concurrent, and retrospective insurance reviews to payers for the completion of medical necessity reviews.
Monitors, documents, and tracks payer responses/requests of completed clinical reviews, including approvals, appeals, and denials, and communicates these to the appropriate personnel [hospital staff, physician, DCM, Claims Management, and Centralized Business Office (CBO).
Monitors and tracks the total hospital certified days of the patient for payers (commercial, managed care, and Medicaid) and communicates missing certifications to the DCM and CBO.
Initiates and completes insurance pre-certification for patients lacking certification, due to pre- admission issues, concurrent insurance changes, or outgoing hospital planned procedures.
Communicates pre-authorization outcomes to appropriate personnel (hospital and CBO).
Organizes and prepares the necessary clerical elements for the weekly Interdisciplinary Team Meeting to function timely and efficiently.
Performs general daily operational tasks/clerical support (i.e.
Phone calls, emails, faxes, copies, etc.) for the Case Management Department and as determined by the Director of Case Management (DCM).
Performs additional duties to assist the Case Management Department staff, support the revenue.

Patient Advocate, 05/2011 to 05/2016
Company Name – City, State

I assist in care coordination and provide welfare information to eligible participants who are diagnose with cancer and others as needed, in order to ensure optimum outcomes.
I help identify, communicate with and follow up with these participants, helping to identify available medical provider resources and community resources as well as Fund services that will help meet participants' needs.
I also help patients make appointments, accompany them during their clinical visits.

CAER Representative,

Contribution Accounting Enrollment Representative is a new roll that the fund created as of June 01, 2013.
The position is a combination of both contribution and enrollment representative.
I am responsible for collecting contributions from employers, processing participant and dependent enrollment and eligibility.
New employer/employee orientation.
This also COBRA, STD/ADD, LIFE and FMLA processing and applying cash by participants through Self-Pay.

Contribution Accounting Representative,

Responsible for collecting contributions from employers based on their Collective Bargaining Agreements with the various Local Unions.
Based on the Collective Bargaining Agreements, enrollments and elections are essential to the process of inputting work history for each of our participants which provides eligibility for health care coverage.
This also includes processing applications for COBRA and processing and applying cash by participants through Self-Pay and/or COBRA.

Enrollment Representative,

Responsible for processing and maintaining all aspects of participant and dependent enrollment and eligibility, for assigned plan units between the Regional Offices, Contribution Accounting and, as needed, other internal teams and departments.

Customer Service Representative/Care Coordinator, 09/2011 to 10/2011
Company Name – City, State

Customer service representative is responsible for inbound/outbound calls providing benefits as well as the terms of eligibility for members and providers.
When significant changes in insurance coverage like increased co-payments or new limitations on treatment or prescription drug coverage occur, we are bound to promptly inform workers of the new restrictions.
Assisting participant on how to elect a (PCP) Primary Care Physician, Biometrics.
Assisting potential patients on scheduling appointments.
Recording potential patients information on VPA (Virtual Physicians Assistant).
Verifying insurance information with potential patients HMO/PPO.
Assisting with building new online applications.

Customer Support Specialist, 11/2010 to 09/2011
Company Name – City, State

CSS Daily tasks in customer support include troubleshooting customer inquiries, recording issues in an Incident tracking database, providing status updates on known issues, and continually building Online applications.
Troubleshooting customer inquiries.
Recording issues in an incident tracking database.
Providing status updates on known issues.
Continually building proficiency in our online applications.

International Sales Coordinator, Representative, 11/2007 to 01/2010
Company Name – City, State

Providing sales and administrative support involving efficient handling of top and confidential agreements.
Supporting the company's product by troubleshooting or answering and questions or concerns regarding the company's products.
Process inquiries by phone, fax, email in relation to company business.
Resolve and average of 200 inquiries in any given week and consistently met performance benchmarks in all areas (speed, accuracy, volume).
Work with new customers and update them on order status and inquiry.
Conveyed in a reassuring manner step by step instructions to resolve application issues.
Put customer at ease by acknowledging their need for explanation and information.
Provide client support and technical issue resolution via E-Mail, phone and other electronic medium.
Identify and correct or advise, on operational issues in client computer systems.

Customer Service Representative, 01/1999 to 01/2007
Company Name – City, State

Answered inbound calls in support of customer needs.
Conveyed in a reassuring manner step by step instructions to resolve application issues.
Reviewed and issued audits on account information and processes.
Performed queries in multiple databases.
Answer phones and respond to customer requests.
Transfer customer calls to appropriate staff.
Identify, research, and resolve customer issues using the computer system.
Follow-up on customer inquiries not immediately resolve.
Complete call logs and reports.
Research billing issues, misapplied payment.

Education

Associate: Nursing, Expected in 12/2019
Wright College - City, State

MPH Worker Training Program

Certification in Motivational Interviewing StanfordKelvyn Park High School - City, State

GEDSt Augustine College - City, State

Summary

Versatile professional with over 10 years of experience providing service. An unwavering commitment to customers, with ability to build productive relationship, resolve complex issues and win customer loyalty. Team player who sees the whole picture while focusing on primary responsibilities. Bilingual in Spanish and English. Authorized to work in the US for any employer

Certifications

CNA Patient Advocate July 2014 to Present

Languages

Bilingual in Spanish and English.

Highlights

Computer literate with the ability to learn customer service software applications. I am a professional
With verbal and written communication skills with the ability to type 45 wpm. Efficiency, exceptional
Telephone personality.
AS400
HIPPA Certification
Kronos
Lotus Notes
Microsoft Word, Excel, Access, PowerPoint, Outlook Express.
Microsoft Windows XP/Vista 32-64 bit.
Microsoft Office XP Professional
Sales Force
VPA (Virtual Physicians Assistant)
Vitech, ADS, RIMS, IMAX
Protouch
Allscripts
Accounting, Fax, Spanish
Administrative support, Faxing, Telephone
ADS, Insurance, Phone
Make appointments, Kronos, Answer phones
Scheduling appointments, Lotus Notes, Troubleshooting

AS400, Director, Type 45 wpm
Benefits, Access, Vista
Billing, Excel, Written communication skills
Cancer, Office
Case Management, Microsoft Office XP
CNA, Outlook Express
Clerical, PowerPoint
Computer literate, Microsoft Windows XP
Conferences, Microsoft Word
CSS, Monitors
Client, Organizing
Customer service, Patient Advocate
Customer support, Personnel
Client support, Primary Care
Databases, Processes
Database, Recording
E-Mail, Research
Email, RIMS
English, Sales
Faxes, Scheduling

Skills

Computer literate with the ability to learn customer service software applications. I am a professional

With verbal and written communication skills with the ability to type 45 wpm. Efficiency, exceptional

Telephone personality. AS400

HHIPPA Certification

KKronos

LLotus Notes

MMicrosoft Word, Excel, Access, PowerPoint, Outlook Express.

MMicrosoft Windows XP/Vista 32-64 bit.

MMicrosoft Office XP Professional

SSales Force

VVPA (Virtual Physicians Assistant)

VVitech, ADS, RIMS, IMAX

PProtouch

AAllscripts,

Accounting, administrative support, ADS, make appointments, scheduling appointments, AS400, benefits, billing, cancer, Case Management, CNA, clerical, Computer literate, conferences, CSS, client, Customer service, customer support, client support, databases, database, E-Mail, email, English, faxes, fax, faxing, insurance, Kronos, Lotus Notes, Director, Access, Excel, Office, Microsoft Office XP, Outlook Express, PowerPoint, Microsoft Windows XP, Microsoft Word, Monitors, organizing, Patient Advocate, personnel, Primary Care, processes, Recording, Research, RIMS, Sales, scheduling, Spanish, telephone, phone, Answer phones, Troubleshooting, type 45 wpm, Vista, written communication skills

Resume Overview

School Attended

Wright College
Kelvyn Park High School
St Augustine College

Job Titles Held:

Case Management Assistant
Patient Advocate
CAER Representative
Contribution Accounting Representative
Customer Service Representative/Care Coordinator
Customer Support Specialist
International Sales Coordinator, Representative
Enrollment Representative
Customer Service Representative
Assistant

Degrees

Associate : Nursing , Expected in 12/2019
MPH Worker Training Program
Certification in Motivational Interviewing Stanford
GED

Case Management Assistant Resume Example

DISCLAIMER

How this resume score could be improved?

Resume Overview

Create a job alert for [job role title] at [location].

Similar Resumes