Medicaid Representative Ii Resume Example

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(555) 432-1000,
, , 100 Montgomery St. 10th Floor
Professional Summary

Talented Intake Specialist offering 10 years of experience in conducting intake interviews and summarizing data with speed and efficiency. Connects with clients easily to provide thoughtful and compassionate assistance. Manages client files and prioritizing tasks to achieve optimal productivity. . Gifted in working with stressed, confused and upset individuals in need of benefits information and supportive guidance to navigate systems. Effective at operating within state and federal regulations and department guidelines to manage telephone calls, emails, letters and in-person requests for assistance.

  • Eligibility review
  • Benefits investigation
  • Consultation and advisory
  • Intake assessment
  • Application assessments
  • Critical thinking skills
  • Case management
  • Progress reporting
  • Group and individual instruction
  • Crisis Intervention
  • Scheduling
  • Customer Service
University Of Phoenix Tempe, AZ, Expected in : Clinical Psychology - GPA :
  • Majored in Psychology
Arkansas State University - Beebe Beebe, AR Expected in : Health Administration - GPA :
Jacksonville High School Jacksonville, AR, Expected in 05/1989 High School Diploma : - GPA :
  • Certified Pharmacy Technician (CPhT )Process of recertifying
Work History
Adventist Health System - Medicaid Representative II
Los Angeles, CA, 11/2020 - Current

• Screens adult and newborn in-patients on floors via alpha-split for Medicaid.
• Screens in-patients on floors via alpha-split for FAP if patient does not qualify for Medicaid.
• Note accounts in EPIC for appropriate application taken or screened out.
• Review patients in payer databases for Medicaid and/or commercial coverage.
• Note accounts for Medicaid and commercial coverage.
• Add Medicaid coverage if needed.
• Works rotating 8 hour shift on weekends covering all alpha-splits for adults and newborns.
• Effectively communicates with AIG to add private coverage to patient accounts.
• Effectively communicates and assist patients and/or care providers, RN's and social workers with counseling and assisting self-pay in-patients.
• Other duties as assigned.

Country Meadows Retirement Communities - Care Coordinator Benefits Investigation Specialist
Bethlehem, PA, 10/2017 - 05/2020
  • Contacted insurance companies to determine levels of coverage and benefits information for patients.
  • Reviewed each step of patient care and made proactive adjustments to avert issues.
  • Established rapport and relationships with patients and external partners to cross-train and support medical staff.
  • Updated documentation and reports detailing patient activities, care actions and hospital determinations.
  • Supported patient care excellence via planning and interpretation of programs.
  • Measured effectiveness with team and implemented recommendations for long term improvements
  • Administration of all client accounts including, but not limited to: updating client contact information, completion and processing of account paperwork, following up with client Cross-trained to support other medical staff with emphasis on establishing patient rapport and developing relationships with external partners.
  • Lead 20 employees across multiple locations achieving targeted KPI metrics. Supervised hiring, onboarding, scheduling (including daily, short term disability, vacation and sick leave), performance, development, training and retention.
  • Facilitated and maintained support log for Vendor partners with 98% complete within 2-day turn-around time
  • Cross-trained to support other medical staff with emphasis on establishing patient rapport and developing relationships with external partners.
  • Maintained patient records and paperwork while observing company protocols for data confidentiality.
Unitedhealth Group - Patient Advocate
San Diego, CA, 03/2016 - 04/2017
  • Communicated directly with individuals and families to provide information about eligibility requirements, application details, payment methods and applicants' legal rights during intake assessment.
  • Offered compassionate and attentive guidance to patients during moments of crisis and trauma.
  • Completed intake assessment forms and filed clients' charts.
  • Interacted kindly with insurance providers via phone, email and written correspondence to obtain necessary documents to complete registration.
  • Bolstered customer retention by creating and offering unique discount options and inspiring interest in new product lines.
  • Provided accurate information about promotions, customer programs and products, helping drive high customer retention.
  • Investigated and resolved accounting, service and delivery concerns
Maximus - Scheduler Coordinator
City, STATE, 06/2015 - 02/2016
  • Successfully scheduled patient appointments and placed reminder calls to deliver exceptional customer experience.
  • Verified insurance coverage and obtained pre-authorizations.
  • Expertly managed all surgery services, including planning, scheduling and coordination, determination of procedures and procurement of supplies and equipment.
  • Checked patients in and out and collected payments.
  • Reviewed medical histories and current information to provide accurate information to surgeons.
  • Received, recorded and addressed incoming and outgoing communication via telephone and email.
  • Supported providers in outpatient medical office through coordinating all administrative operations.
  • Completed skilled administrative work to support all office staff and operational requirements.
United Healthcare - Clinical Administrative Coordinator
City, STATE, 01/2007 - 10/2009
  • Kept team on track by assigning and supervising their activities and giving constructive feedback.
  • Worked successfully with diverse group of coworkers to accomplish goals and address issues related to products and services.
  • Reviews EOB/EOMB's for proper reimbursement
  • Performed site evaluations, customer surveys and team audits
  • Developed highly-efficient administrative team through ongoing coaching and professional development opportunities.
  • Verified and reconciled service charges with insurance companies and payment providers.
  • Drafted letters for government and commercial clients, providing verification of specific diagnoses and clinical results.
  • Assisted patients in adhering to prescribed care models via phone and email communications.
  • Investigated claims to check billing status.
  • Performed patient census operations, collecting data to generate comprehensive profile of practice's performance.
  • Maintained knowledge of standardized medical billing codes.
  • Coordinated schedules with patients and facility calendar.
  • Reviewed cases to determine need for escalation.
  • Provided comprehensive administrative support to department staff.
  • Coordinated, monitored, assigned and documented patient and clinical care activities.

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Resume Overview

School Attended
  • University Of Phoenix
  • Arkansas State University - Beebe
  • Jacksonville High School
Job Titles Held:
  • Medicaid Representative II
  • Care Coordinator Benefits Investigation Specialist
  • Patient Advocate
  • Scheduler Coordinator
  • Clinical Administrative Coordinator
  • Some College (No Degree)
  • Some College (No Degree)
  • High School Diploma

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