Knowledgeable Hospital Eligibility Worker skilled in data collection, analysis and providing superior customer service. Works well under pressure and consistently meets deadlines and targets while delivering high quality work.
Skills
Self motivated professional
Dependability
Multitasking
Interpersonal skills
Bilingual- English and Spanish
Adoptable and effective communication skills
Conscientious and Analytical
Meticulousness attention to detail
Initiative and problem-solving abilities
Ability to thrive in fluid environments while remaining pragmatic and focused
Work History
Hospital Eligibility Worker 2903, 03/2009 - Current Jones Lange Lasalle Inc. – Mill Valley, CA, I 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.
Analyst I, 01/2003 - 02/2009 UCSF, Pediatric Cardiothoracic Surgery – City, STATE, Clinical 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.
Additional Information
Business/ Clinical Coordinator, Medical Biller- CPT/ICD-9, Medical terminology, Knowledgeable of government programs (procedures, rules, and regulations, private and third party insurances), Insurance authorization and verification specialist (UCSF certification) IDX, IMF, Medipac, and STOR
Active Member & Mentor: Cure Autism Now and Support for Families of Children with Disabilities
Education
Graduate courses taken towards completion of BA: Business Management , Expected in 6/1992-1-1993 - University of Texas El Paso - El Paso, Texas GPA:
High School Diploma: , Expected in - Austin High School - El Paso, Texas GPA:
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