Hospital Care Investigator Resume Example
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HOSPITAL CARE INVESTIGATOR
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
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Work History
Hospital Care InvestigatorHarlem Hospital Center - City , STATE12/2014 - Current
- 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
Fianancial Care InvestigatorBrookdale Hospital And Medical Center - City , STATE07/2012 - 12/2014
- 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
Eligibility AssociateFidelis Care NY - City , STATE07/2010 - 07/2012
- 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
MBA: Adelphi University - City, StateCurrent
- 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
Bachelor of Science: Business Management Concentration HR ManagementFairleigh Dickinson University - City, State2010
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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 : Business Management Concentration HR Management
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