Medical Quality Assurance Specialist resume example

• Generated, posted and attached information to claim files.
• Modified, updated and processed existing policies.
• Assured timely verification of insurance benefits prior to patient procedures or appointments.
• Reviewed outstanding requests and redirected workloads to complete projects on time.
• Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
• Checked documentation for accuracy and validity on updated systems.
• Maintained confidentiality of patient finances, records and health statuses.
• Made contact with insurance carriers to discuss policies and individual patient benefits.
• Carried out administrative tasks by communicating with clients, distributing mail and scanning documents.
• Prepared insurance claim forms or related documents and reviewed for completeness.
• Notified insurance agents and accounting departments of policy cancellations and changes.
• Verified client information by analyzing existing evidence on file.

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• Worked with multidisciplinary team to carry out successful treatment plans for diverse acute and chronic conditions.
• Responded to patient requests with appropriate clinical and personal assistance.
• Performed arterial cut-downs, inserted central lines and inserted endotracheal tubes as part of trauma team.
• Prepared patients for surgery, educating patients and family members on surgical procedures.
• Documented patient vitals, behaviors and conditions to communicate concerns to supervising nurse.
• Took samples to complete diagnostic and routine assessment tests.
• Assessed patients' temperature, pulse and blood pressure and recorded in electronic medical records.
• Monitored, tracked and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.
• Managed patient care through closely monitoring respiration, blood pressure and blood glucose levels.
• Cared for wounds, provided treatments and assisted with procedures.
• Delivered updates in patient status to charge nurse, recording changes in medical records.
• Used aseptic techniques to provide sterilized wound care and dressing applications.
• Evaluated patients to identify and address wounds, behavioral concerns and medically relevant symptoms.
• Collaborated with interdisciplinary team of healthcare and social service providers to address patients' needs through effective intervention and care planning.
• Supported physicians during examinations and scans to assist with diagnostic procedures.
• Offered immediate assistance in emergency and routine paging situations to evaluate needs and deliver care.
• Performed routine evaluations of each patient's status, needs and preferences.
• Answered incoming phone calls from patients to provide basic assistance and triage medical concerns.
• Comforted and counseled patients and families throughout care process.
• Managed appointment calendar for scans, lab tests, and evaluations.
• Performed functional assessments for admission and discharge.
• Obtained biological specimens for ordered tests and prepared for laboratory transport.
• Gathered lab specimens, ordered testing and interpreted results to diagnose patients.
• Educated patients and caregivers on medical diagnoses, treatment options, chronic disease self-management and wound management.
• Obtained patient vital signs and input/output measurements from inpatients.
• Documented accurate and complete patient information to address patient problems and expected outcomes.
• Collaborated with supervisor to assess patient needs, plan and modify care and implement interventions.
• Administered controlled narcotics, inserted IVs and performed catheterizations.