Member Outreach Care Specialist II Resume Example Beaumont Hospitals

MEMBER OUTREACH CARE SPECIALIST II

CAREER OVERVIEW

Overview of my whole career

I offer 10 years of healthcare experience PG HOSPITAL, MEDSTAR, ANTHEM

YEARS OF EXPERIENCE

University of Maryland Prince George's Hospital
Medstar Washington Hospital Center
Anthem Inc.
COVID 19 RELIEF EFFORTS
Outreach to over 5,000 Amerigroup members
Coached members through mental health crisis
Resolved life threatening prescription during the global pandemic
Promoted to manage entire state of the art surgery Pavillion
Apart of emergency staff stayed at hospital on duty for 48 hours straight in level II Trauma center 2018
High profile VIP patients/ speaking in family in trauma crisis
Provided live-in-home SIDS training to young new mothers •
Completed over 200 home visits to members in margenilized communites to provide coaching and training.

RELATED SKILLS

Compassionate
Positive outlook
Health coaching

Patient education
Conducting assessments
Project organization

Experience

Member Outreach Care Specialist II | 01/2020 to Current
Beaumont Hospitals - Berkley , MI

Counsel and coach members who are non compliant and fail to meet Hedis metrics and requirements gathered from quarterly reports.
Assist the pharmacy account management team, prescribing physicians, and members to rectify and diffuse complaints about insurance rejections, medication requests, and prior authorizations.
Administer various health risks assessments to measure member needs and address barriers and gaps in care.
Schedule patient appointments and transportation for members and send out alerts or reminders as needed.
Refer member requests to appropriate case management or quality insurance team and act as a liaison between external and internal departments.
Provide training and workshops to educate members on health concerns such as; sudden infant death syndrome, diabetes, asthma, heart disease, high blood pressure, postpartum depression, etc.
Produce and distribute brochures, flyers and packets covering topics such as infant mortality risk factors, domestic violence, substance abuse, child abuse or neglect, therapy, respiratory therapy, physiology, and chronic disease management.
Establish and maintain positive relationships with members to provide coaching and education that motivates the member to improve health and behavioral choices.
Updates member tracking databases to provide accurate data for reports and documents.
Complete a large volume of daily incoming and outgoing calls according to assigned campaign lists.
Follow-up with members and provide action plans and goals to create a sense of accountability for the member.
Provide Covid-19 relief outreach calls to members, who are deemed among the top 10% most vulnerable population in the community, to check on needs such as food, housing, financial support, insurance benefits, mental health support, medications, and other resources during this global crisis.
Conduct member satisfaction, welcome, and retention surveys to provide data to operation, promotion, and management teams.

Financial Clearance Rep | 02/2012 to 01/2020
MedStar Washington Hospital Center - City , STATE

Distributed health & financial education materials to identified patients and family members in the emergency room, ICU, & trauma center.
Enrolled eligible patients in "myMedstar"patient portal with explanation of benefits, disease management, and preventative programs.
Coordinated with the DECO medical assistance eligibility team to identify and coach self pay patients that are in need of emergency Medicaid and the financial assistance program.
Helped patients enroll in health education programs and resources.
Provided verification assistance to patients traveling internationally in need of medical care.
Worked along with the Sexual Assault Nurse Examiner Program to collect patient data and inform patients about the federally funded program at no cost to them.
Completed registration activities and documents results in the Amalga database using correct insurance codes.

Pre Op Patient Access Rep | 03/2010 to 02/2012
University Of Maryland Prince George's Hospital - City , STATE

Conducted patient interviews prior to surgery.
Educated patients and families on treatments, procedures, medications, continuing care and community resources.
Obtained patient signatures on Consent forms, HIPAA, Observation Notice, Insurance Waiver, Important Message from Medicare and other important forms as required within the Hospital's policies.
Work with insurance team specialist to maintain patient flow while resolving financial issues.
Communicates effectively with service areas when unresolved financial issues threaten appointment schedules and request from physicians that service be rescheduled when payment from insurance or patient is doubtful.
Educated and coached patients on at-home surgery preparation requirements and post-operative care process.
Reported patients' status to doctors and monitored completion of treatment plans.

Education and Training

Washington Adventist University - City, State

Some College

Counseling Psychology/ Public Health

Pursuing a Bachelor of Science degree

Institute For Integrative Nutrition - City

Certification

Health And Wellness Coach Certification

Program completion date: April 6, 2021

Activities and Honors

WAU Academic Excellence Award, 2018
Medstar Health Service Award, 2019

Resume Overview

School Attended

Washington Adventist University
Institute For Integrative Nutrition

Job Titles Held:

Member Outreach Care Specialist II
Financial Clearance Rep
Pre Op Patient Access Rep

Degrees

Some College
Certification

Member Outreach Care Specialist II Resume Example

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