City & County of San FranciscoHospital Eligibility Worker 2903 | San Francisco, CA | April 2009 - CurrentI perform eligibility, clerical, and administrative duties. Provide customer service to the general public. Interview patients, their relatives and other sources to obtain financial and demographic information, to determine eligibility for coverage of medical care under various federal, state, or county programs to secure a maximum reimbursement. I preform insurance verifications, secure authorizations, transfer agreements, admitting and registration duties for clinical and hospital services. Initiate referrals for acute care patients in addition to patients in skilled nursing facilities. Coordinate patient transfers between ZSFGH medical staff and other medical facilities. Explain eligibility programs, qualification standards, policy and procedures and assist patients in the completion of applications forms and reports as necessary. Review and evaluate applications for completeness and accuracy. Prepare records related to patient eligibility information and financial assistance receive. Update demographics and submit required reports. Corroborate statements information received from applicants through the use of telephone, written verification, and or several databases; in addition , I investigate and resolve patient questions and concerns regarding clinic and hospital bills. Review cases with the supervisor in assessing the quality of the payment source and medical facilities. I am the liaison with the sessions of outside providers and transferring facilities. Explain eligibility programs, policy and procedures to patients. Assist patients in the completion of applications forms and reports as necessary. Prepare records related to patient eligibility information and financial assistance received. Update demographics submit required reports investigate statements and information received from the applicants through the use of telephone or written verification. Furthermore, I investigate and resolve patient questions and concerns regarding clinic and hospital bills. Review cases with the supervisor in assessing the quality of the payment source determination process and procedure. I compose and compare correspondence to patients references and state agencies gathering statistical data and preparing reports. I am a Power User (Administrator Controller) for department's insurance verification websites. I participate in special projects, studies, work assignments, committees; in addition, to other duties as assigned. Lastly, I have the ability and willingness to effectively communicate orally or written with individuals from diverse social and economic and cultural backgrounds.
UCSF, Pediatric Cardiothoracic Surgery Analyst I | San Francisco, CA | February 2003 - March 2009Clinical coordinator for the Children's Heart Center for Pediatric Cardiothoracic Surgery Division. Register patients for outpatient and/ or pre- admitting services in conjunction with the pre-surgical evaluation(s). Public relations adapted my care and communication style to the needs of clients from diverse socioeconomic and cultural backgrounds and different age groups. Pediatric Cardiothoracic Surgery Scheduler. Insurance verification and authorization specialist. Serve as liaison with physicians, outside providers, hospitals and international agencies in order to facilitate treatment plans. Patient referral for Medical-Cal, CCS, other government and county reimbursement programs. Secured maximum reimbursement from insurance companies (HMO, PPO, EPO, POS, Medicaid, Medicare, HDHP, and self payments) prior to patient's cardiothoracic surgery, cardiac catherizations, and/or pacemaker implants. Performance Improvements consistently looked for department systems, protocols, and self improvement opportunities. Coordinated cardiothoracic surgery in conjunction with Cardiac Catherization and Electrophysiology Departments. Daily maintenance and Power User (Administrator Controller) of physicians clinical and surgical schedules. RAI Report Processer collaborated with internal and contracted billing vendors to expedite collection of physicians professional fees. Provided Spanish interpreting services for cardiothoracic surgery, telephone consults, surgical follow up, and pre- operative appointments.
