Intake Specialist Resume Example
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INTAKE SPECIALIST
Professional Summary
Motivated customer service specialist with over 5 of experience in a fast-paced, team-based healthcare environment.
Skills
Customer service skills. Knowledge of HIPPA and OSHA guidelines. | Strong knowledge of Microsoft Office, specifically Excel, Word and Outlook Exchange, proficient in Internet Explorer. |
Work History
Apex SystemsIntake Specialist | Augusta , GA | July 2015 - Current
- Answer incoming calls to the KKI central referral line; reply to written requests for information and /or appointments from patients, families, and external referral sources.
- Obtain and document patient clinical, demographic, and insurance information in AS400, intake form and KKI intranet.
- Search for and document previous appointments or requests for services by internal/external referral sources.
- Communicate with appropriate staff and complete all documentation.
- Finalize the intake by communicating disposition to family and/or referral source.
- Create appropriate referrals for appointments to be scheduled in IAMS.
- Schedule appointments with the Care Center and/or Clinic Coordinators based on Clinic Policy.
- Notify Clinical Care Associate of any critical information regarding appointments, insurance, referrals, Letters of Guarantee, etc., as needed.
- Check all documentation for grammar, spelling, accuracy, and completeness.
- Maintain daily log of intakes done including: number of calls, types of callers, number of referrals created, referral source, etc.
Marco TechnologiesAccounts Receivable Representative | Lancaster , PA | March 2015 - July 2015
- Access client files if necessary to verify information.
- Respond to verbal and written client or responsible party inquiries regarding account status within policy and procedure timeline.
- Research accounts and document follow up appropriately.
- Resolve account discrepancies and prepare adjustments and refunds for approvals as necessary.
- Maintain accurate and complete records concerning billing activity on all accounts.
- Document in the system records.
- Address problems as they occur.
- Keep supervisor advised of area or compliance issues which may lead to untimely or inaccurate completion of invoice or claim submission.
- Complete all reports according to schedule.
- Prepare, edit and submit account billing in accordance with client contract or payer guidelines.
- Ensure all invoices are submitted accurately and timely per policy guidelines.
- Utilize several systems to research, document or verify information.
- IDX, Emdeon, Availity, Navinet, Passport etc.).
Unitedhealth Group Inc.Quality Assurance Enrollment Auditor | Newington , CT | August 2014 - January 2015
- Review processed enrollment for accuracy in accordance with established policies and procedures.
- Processes updates directly into systems.
- Audit daily work as assigned and communicate quality errors to Enrollment technicians for correction to be completed in a set time frame.
- Communicate errors with tact and diplomacy, using positive feedback as a training tool in an effort to improve quality results.
- Document all processing errors for feedback to processors and record results in the QA Error Database for matrix reporting.
- Perform quality audits with a goal of 99% accuracy based on MTM (Member Touchpoint Measures) quality program administered by Carefirst Blue Cross Blue Shield of Maryland.
- Prepare documentation for monthly audits required by carriers, which includes all election forms, supporting documentation or respond to Carrier inquiries.
- Adhere to timeframes established by carriers for completion of audits.
- Adhere to transmission timeframes to ensure completion of QA review prior to transmission of data to carrier.
- Keep abreast of current trends and regulatory issues surrounding carriers plan design and administration.
- Additional projects as assigned.
Cigna HealthspringProvider Services Representative | City , STATE | July 2012 - June 2014
- Answered an average of 60-90 calls per day by addressing customer inquiries, solving problems and providing benefit information.
- Developed reputation as an efficient service provider with high levels of accuracy.
- Assisted providers with authorization, referral, and credentialing status.
- Provided claims payment and denial status to providers.
- Performed investigative tasks to find payment retractions and reviewed processed claims to ensure that they were billed correctly.
- Responded to all emails and calls in a timely fashion.
- Used various claims viewing systems such as QNXT, Emdeon, Claims Vision Suite, MHC, CCMS)
- Trained on-coming reps on QNXT, Laserfisch, Emdeon, and Availity.
Education
Associate of ScienceNursingCommunity College of Baltimore CountyCity, State | Current
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Resume Overview
School Attended
- Community College of Baltimore County
Job Titles Held:
- Intake Specialist
- Accounts Receivable Representative
- Quality Assurance Enrollment Auditor
- Provider Services Representative
Degrees
- Associate of Science Nursing
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