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hospital care investigator resume example with 10+ years of experience

Jessica Claire
Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Professional Summary
Currently an MBA Student, who is a detailed oriented and who is a reliable financial professional with over 5 years of experience working in the medical industry. Areas of specialization include Customer Service, interviewing, and financial reporting. I have computer skills that include: MS Word, Excel, PowerPoint, Access, Epic, Epaces, Omni, Availity, Lotus Notes, NaviNet, Oam, Edm, facets, HHS connect, and GroupWise.
Skills
  • Works well under pressure
  • Forecasting and planning
  • Driving continuous improvement
  • Fast Learner
  • Works well with teams

 

 

Work History
11/2014 to Current
Hospital Care Investigator Harlem Hospital Center City, STATE,
  • Developed monthly reports.
  • Lower Bad Debt cases by 40%. Therefore, Revenue increased by 40%. 
  • Evaluate and investigate fraud, complaints, and billing discrepancies
  • Inform patient of hospital rates; performs in-depth interviews with patients, families, relatives and friends in an office setting or the hospital, during field investigations, and/or by telephone to determine patients’ and/or legally responsible relatives ability to pay for services rendered
  • Efficiently performed insurance verification, pre-certification and pre-authorization functions for hospital billing
  • Provide excellent Customer Service to patients
06/2012 to 11/2014
Fianancial Care Investigator Brookdale Hospital And Medical Center City, STATE,
  • Efficiently performed insurance verification, pre-certification and pre-authorization functions for hospital billing
  • Served as liaison with social services and home care agencies
  • Handled billing and payments
  • Evaluated and investigated fraud, complaints, and billing discrepancies
06/2010 to 06/2012
Eligibility Associate Fidelis Care NY City, STATE,


  • Reviewed and Submitted 30+ Medicaid, CHP and FHP applications daily
  • Processed Access New York and Child Health Plus applications according to New York State Guidelines
  • Assisted Supervisors and senior associates with generating reports, researching applications and retrieving information using FACETS
  • Reviewed and analyzed suspicious and potentially fraudulent insurance claims.


Education
Expected in Current
MBA:
Adelphi University - Garden City, NY
GPA:
  • Current GPA 3.75
  • Course work includes Finance, Technology and Operations Management, Leadership, Accounting, Statistics, Negotiations , Team building , Entrepreneurship and Investment Analysis and Building Shareholders Values
Expected in 2010
Bachelor of Science: Business Management Concentration HR Management
Fairleigh Dickinson University - Teaneck, NJ
GPA:

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Resume Overview

School Attended

  • Adelphi University
  • Fairleigh Dickinson University

Job Titles Held:

  • Hospital Care Investigator
  • Fianancial Care Investigator
  • Eligibility Associate

Degrees

  • MBA
  • Bachelor of Science

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