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Healthcare and Benefits Advocate Resume Example

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KIONNA
POSLEY
Professional Summary

Empathetic Case Coordinator with more than 11 years of experience in Social Service case coordination. Adept at structuring effective treatment plans around each patient's strengths. Committed to providing the highest level of care with outstanding abilities in community services and eligibility. Ready for new professional challenges with a growth-oriented organization.

Skills
  • Client Engagement
  • Business Development
  • Value-based Care Programs
  • Admitting processes
  • Assessing needs
  • Visiting patient homes
  • EMR / EHR
  • Interdisciplinary collaboration
  • Working knowledge of Windows , Novell, Data Point, Cisco IPICS Phone Client, Prime, NC Fast, CaMSS, Insite, CRM, Genesys Systems, and SharePoint
  • Written and verbal communication
  • Relationship building and retention
  • Conflict Resolution
  • Decision making
  • Care Planning
  • Patient education
  • Documentation
  • Insurance practices
  • Profit improvements
  • HIPAA and confidentiality
  • Performance metrics
Education
University of Maryland Global UniversityCity12/2020Master of Science:Health Care Administration
Indiana University NorthwestCity, State06/2016Bachelor of Science:General Studies

25 Credit Hours Earned in Social Work

Work History
Company Name - Healthcare and Benefits Advocate
City, State11/2019 - Current
  • Analyze and complete extensive research with each solution for clients to find methods of saving money and improving efficient healthcare.
  • Work in partnership as a healthcare advocate to assist with a wide range of key areas, including healthcare benefits, cost estimates, bill reviews, prescription reviews, and appeals, to determine the client's best outcome for five states which include NC, SC, Georgia, Virginia, and Florida clients.
  • Make practical recommendations for alternative practices that will bring greater efficiency to the clients' healthcare needs.
  • Educate clients and assist them in understanding the effectiveness of their healthcare plans.
  • Empower healthcare clients across private and public sectors through delivery of comprehensive support services.
  • Juggle multiple projects and tasks to ensure high quality and timely delivery.
  • Demonstrated self-reliance by meeting and exceeding workflow needs.
Company Name - Elderly and Disability Care Coordinator
City, State08/2018 - 08/2019
  • Managed a caseload of 85-95 clients which included providing case management services, including health assessments, care planning, client empowerment to low income, elderly, and disabled individuals to prevent nursing facility placement through the Medicaid Waiver program.
  • Ensured each client received services rendered through their providers, caregivers, and home health agencies.
  • Made weekly visits to clients' homes and assisted living facilities for appointments and determined the level of care for daily living and personal care needs.
  • Determined need for special assessment activities for complex cases, effectively handling care plans.
  • Monitored and assisted residents through individual service plans.
  • Updated policies and procedures, leading continuous improvement of resident assessments and care.
  • Supported patient care excellence via planning and interpretation of programs.
  • Provided excellent service and attention to customers when face-to-face or through phone conversations
Company Name - Economic Services Case Manager
City, State05/2015 - 08/2018
  • Maintained a patient caseload of 100 clients which including Medicaid and Medicare Part D eligibility.
  • Planned, implemented, and evaluated actions required to meet the client's and community centers' needs.
  • Provided case management service by completing an assessment and determining initial and on-going eligibility for Medicaid, NC Health, and CHIP programs.
  • Reduced care costs without sacrificing quality through effective service coordination and multidisciplinary collaboration.
  • Educated patients and loved ones about different treatment options and outside care approaches, reducing burden on hospital resources.
Company Name - Adult and Nursing Home Case Manager
City, State05/2009 - 12/2015
  • Interviewed clients, authorized representatives, power of attorneys, and lawyers regarding new nursing home applications that have been filed by clients in nursing homes or long-term care facilities.
  • Helped determine eligibility for Medicaid, Medicare, and Nursing Home Medicaid.
  • Demonstrated leadership by making improvements to work processes and helping to train others.
  • Motivated and encouraged team members to communicate more openly and constructively with each other.
  • Managed 95-105 caseloads which included ongoing changes and determining continuous eligibility.
Accomplishments
  • Documented and resolved Bill Reviews which led to a 2020 client's savings of $303,583.
  • Documented and resolved elderly abuse concerns with the state which led to several clients removal from unhealthy living environment and restored to quality care living.
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Resume Overview

School Attended

  • University of Maryland Global University
  • Indiana University Northwest

Job Titles Held:

  • Healthcare and Benefits Advocate
  • Elderly and Disability Care Coordinator
  • Economic Services Case Manager
  • Adult and Nursing Home Case Manager

Degrees

  • Master of Science : Health Care Administration
    Bachelor of Science : General Studies

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