Consumer Access Representative resume example with 11+ years of experience

Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000,
Professional Summary

Results-driven employee with excellent problem-solving, analytical and organizational abilities and strong focus on collaborating with employees to resolve business, customer and vendor issues quickly. Works alone or as part of team to manage high volumes of work in fast-paced environments.

  • Calm and Effective Under Pressure
  • Patient Confidentiality and Data Security
  • Insurance Company Knowledge
  • HIPAA Regulations
  • Quality Assurance
  • Explaining Policy and Procedures
  • Team Leadership
  • Software Applications
  • Customer Service
  • Critical Thinking
  • Multitasking and Organization
  • Time Management
  • Risk Management Assessments
  • Knowledge of Community Services and Programs
  • Training Coordination
  • Resolving Problems
  • Detailing Skills
Work History
04/2021 to Current Consumer Access Representative Cedar Valley Medical Specialists | Waterloo, IA,
  • Contact insurance companies by phone, online portal, and other resources to obtain and verify insurance eligibility and benefits
  • Obtaining pre-authorizations from third-party payers in accordance with
  • Accurately enters required authorization information in Advent Health systems to include length of authorization
  • Ensures patient accounts are assigned the appropriate payor plans
  • Ensures all financial assessments, eligibility, and benefits are updated to support financial needs
  • Thoroughly documents all conversations including payer decisions
  • Creates accurate estimates to maximize up-front cash collections and adds collections documentation where required
  • Calculates patients' co-pays, deductibles, and co-insurance
  • Provides personalized estimates of patient financial responsibility based on their insurance coverage or eligibility for government programs prior to service for both inpatient and outpatient services.
08/2018 to 04/2021 Cath Lab Inventory Control Par Technician Advent Health Celebration | City, STATE,
  • Performs inventory management for the Cath Lab
  • Evaluates the appropriate Min/Max par levels in Peoplesoft and WaveMark systems
  • Manages time and equipment effectively, performs and assigns activities related to maintaining a clean, safe and efficient environment, compliant with DNV regulations
  • Inspects package integrity and rotates stock to reduce expiration of products
  • Adheres to routine cleaning and inspection schedules for all inventory locations
  • Completes daily responsibilities according to established procedures
  • Responsibilities include inventory reconciliation, generating requisitions for special orders, and ordering select stock items
  • Tracks and receives special and stock items along with restocking designated inventory areas; researches status of open orders as necessary
  • Tags and registers high-spend items into point of use (POU) or RFID system(s) as applicable
  • Manages inventory by adjusting par levels when necessary and manage accuracy of bin locations and cost center expense codes
  • May work with clinical systems to charge patients, synchronize data, and/or perform inventory management functions
  • Generates and validates reports for the purpose of maintaining PAR levels ensuring accuracy and completeness
  • Initiates return of defective and recalled products to vendors, understanding urgent recall issues and responding appropriately and in a timely manner to all patient orders
  • Returns items that are overstocked to the warehouse or suppliers per procedures
  • Performs department product catalog (DPC) maintenance regularly
  • Maintains accuracy of master product catalog (MPC) numbers and bin locations at the par cart level
  • Contributes to the development and execution of action plans for supply cost savings and management
  • Keeps supervisor and/or managers informed while communicating appropriately and professionally with clinical and medical personnel
  • Effectively and expeditiously researches and communicates changes in inventory and/or incidences of unavailable inventory to the clinical team
  • Collaborates with lead and supervisor on special projects and special requests as situations dictate
  • Responsible and accountable for participation in quality and performance improvement activities with a goal to improve patient or departmental outcomes
  • Supports quality standards and initiatives set by the department and performs additional tasks as needed within Support Services
  • Processes returns appropriately per approved policy
  • Ensure items have the appropriate barcodes, and cross referenced in WaveMark system
  • Work with Sales Rep to strategize our used of inventory in our consignment and purchased items.
06/2016 to 12/2017 Medical Risk Adjustment and Quality Analyst Physician Partners | City, STATE,
  • Support Medicare Advantage and Commercial Risk Adjustment programs though the end-to-end processes of data management and data submissions
  • Perform clinical validation audits and interpretation of medical documentation to capture all Medicare Risk codes in coordination with Providers
  • Provide formal report(s) on audit findings; create and generate reports with summary of findings to practices
  • Evaluate, track, and monitor risk adjustment data, address progress towards optimal performance
  • Create risk adjustment dashboards for internal and external review and use
  • Analyze findings of completed audits to determine coding error trends; present recommendations for process improvements to prevent reoccurrence
  • Prepare quantitative analysis data-driven by HCC ICD-10 CM and HCC category count
  • Develop HCC category tools and resource materials using evidenced-based criteria and guidelines
  • Perform initial audits for new practices and provide input on how Providers can best be supported
  • Perform ongoing prospective and retrospective chart reviews
  • Maintain an up-to-date knowledge of all risk adjustment programs and the quality metrics in which the company participates with health plans and other payer incentive programs that may develop over time
  • Ensure all providers are continuously updated to meet the needs of the risk adjustment program
  • Participate in various special projects stemming from results of previous audits and report any improvement or nonengagement
  • Assist Coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes
  • Work directly with Leadership on the continued development and enhancement of risk adjustment programs intended to improve the capture of HCC chronic conditions
  • Stay abreast of primary care practice standards, e.g., STARS, HEDIS, and RAF
  • Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and federal and state regulations; research regulatory guidelines for supporting documentation
  • Participate in departmental and organizational quality management activities
  • Ensured proper coding guidelines and other IPA protocols are followed
  • Conducted training programs to Primary Care Providers and other Clinic Care Providers.
08/2010 to 06/2016 Front Desk Specialist Community Health Centers Inc | City, STATE,
  • Obtain pre-authorizations for medical and dental services
  • Provided financial counseling
  • Processes medical and dental claims
  • Assisted in training new hire

Expected in 2010 Associate Degree | Business and Administration University of Phoenix, Orlando, FL GPA:
Native or Bilingual
Native or Bilingual

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Resume Overview

School Attended

  • University of Phoenix

Job Titles Held:

  • Consumer Access Representative
  • Cath Lab Inventory Control Par Technician
  • Medical Risk Adjustment and Quality Analyst
  • Front Desk Specialist


  • Associate Degree

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