Driven Program Coordinator seeking to utilize advanced leadership and decision-making abilities in an Healthcare position.
12 week contract focused on HEDIS Data Collection efforts for 2015. Performs duties as assigned by UHC Clinical Quality Manager(s), HEDIS Project Managers, or Regional HEDIS Managers for market specific annual data collection efforts. Demonstrates proficiency in Microsoft Office – Outlook, Excel, and Word & similar applications. Managed various data organization within Excel spreadsheets
Possesses the ability to separate & combine PDF medical records in Adobe Acrobat. Conducted Claims Research, determining correct service location or verifying member history.Performed Provider Outreach, verifying and confirming provider demographics & medical record requests, both written and verbally.Requested medical records and performs follow up of requests within HEDIS database tools. Maintained HIPAA standards and confidentiality of protected health information.
Accurately applied payments to patients accounts. Researched and resolve incorrect payments. Strong ability to interact and communicate with people over the telephone, often in stressful situations. In-depth knowledge of medical billing procedures - submission of insurance claims, Medicare, Medicaid, and other private insurance carriers. Provided accurate and appropriate information in response to customer inquiries.Addressed customer service inquiries in a timely and accurate fashion.
Efficiently performed insurance verification and pre-certification and pre-authorization functions for MRI's and Biopsies. Entered and closed batches charges for daily clinics. Collect data for surgical billing using systems such as NextGen, EPIC, and Eagle and Microsoft Office Suite 2010.Scheduled and confirmed appointments for entire medical team in the Cancer Center and Pediatrics Department. Handled and processed confidential patient information Responsible for claim follow up for bills with insurance liability. Resolved any credit balances on accounts. In bound calls from patients to interpret E.O.B.'s and took payments for zero balances. Worked with insurance companies to resolve any questions and problems as well as staying abreast of current insurance regulations changes. Excellent understanding of CPT codes, general medical terminology, and strong written and oral communication skills. Monitored accounts receivable and took appropriate action in regards to claims submission and posting payments and write-offs.
Responsible for tracking and processing all physicians and hospital orders to coordinate with doctors and nurses to develop care plans for patients. Served as liaison between management, clinical staff and the community. Cooperated with other health related agencies and organizations in the community. Prepared prescription refills request on behalf of the patient. Evaluated the accuracy of providers charges, including dates of service, procedures, level of care, locations, diagnosis, patient identification and provider signature. Consistently informed patients of their financial responsibilities prior to services being rendered as well as gave understanding their long and short term benefits. Efficiently performed insurance verification and pre certification and pre authorization functions. Call Center Environment.
Calls from health plan members to coordinate and schedule in home health care assessments with nurse practitioners. Explained the benefits if health risks assessments to overcome objections as well explained how the assessment was a part of the benefit plan. Created and organized Excel spreadsheets to schedule and monitor all active and in active member home visits. Accurately and concisely documented customer feedback and special needs indicated during each member contact. Heavy call volume.
Inbound from providers and caretakers of patients that have been absent from the New York State Department of Mental Health agencies. Recorded physicians information in a tracking system to create a patient file. Administered, directed and coordinated the activities of the agency. Served a liaison between management, clinical staff and the community. Verified and logged in deadlines for responding to daily inquiries. Handled and processed confidential patient information. Made copies, sent faxes and handled all incoming and outgoing correspondence. Received and screened a high volume of internal and external communication, including email and mail.
Prepared loan applications and assisted with the calculations of retirement benefits, rollovers, and disbursements of employee benefits. Provided accurate and appropriate information in response to customer inquiries. Addressed customer service inquiries in a timely and accurate fashion. Maintained up-to-date records at all times. Collected customer feedback and made process changes to exceed customer satisfaction goals. Developed effective relationships with all call center departments through clear communication. Worked with upper management to ensure appropriate changes were made to improve customer satisfaction. Formulated and enforced Service Center policies, procedures and quality assurance measures. Properly directed inbound calls in phone queues to improve call flow. Call Center environment.
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