Motivated Care Connector FC with understanding of customer relations and multi-line telephone systems. Positive and upbeat team player with exceptional clerical knowledge and hardworking mentality.
Creates and updates records and databases with personnel, financial and other data. Serves as primary administrative and operational liaison with external and internal functions between practitioners (clinical staff), physicians, and financial services of the company. Verify benefits with insurance carriers to obtain coverage information for items prescribed. Calculates a patient's deductible and co-insurance. Enter patient demographics, insurance information, work order, prescription, notes and scan documents. Ensure the patient's chart is in compliance to be sent to billing. Answer daily telephone calls from practitioners/patients regarding patient balances/payments, patient appointments, and paperwork deliveries. Follow up on pending authorizations and on custom deliveries. Provides high level administrative support to the executive team. Answers all incoming calls and direct these to appropriate staff as needed. Schedules patient appointments using software; ensure appropriate resources are booked and appointment types are accurate. Receives and forward faxes for referrals and medical records. Maintains accurate medical records clients. Educates clients on the treatment process including pre- and post- care guidelines. Observes all federal requirements of a medical office including HIPAA, OSHA and client confidentiality. Performs other medical and office tasks as needed.
Built sustainable relationships of trust through open and interactive communication. Identified and assess customers' needs to achieve satisfaction. Handled complaints and provide appropriate solutions and alternatives within the time limits. Performed specialized clerical work of processing customer applications for services, setting up and maintaining customer accounts. Exercised independent judgment and initiative in completing assignments. Assisted in managing the overall operations of the facility. Worked with the facility manager in overall facility and teammate management and/or acting as the manager in his/her absence. Supported customer service functions to retrospective claims review, referral/auth. entry, research which may include but not limited to claims, provider contracts and data entry report generation. Provided claims follow up as indicated. Documented in multiple computer applications timely and according to unit policy and regulations. Documented appropriate codes and claims payment information to ensure accurate claims payment. Liaison with providers and facilities telephonically, include problem solving regarding member needs. Responded to incoming calls routed through skill-based technology to meet quality standards and performance measurements. Conducted outbound calls as required and meet established quality/quantity guidelines supporting initiatives and/or programs. Contributed toward the overall development of programs and services to provide for the needs of members. Assisted Administrator in providing strategic leadership to management to ensure staff is in accordance with goals, objectives, policies, and applicable regulatory agency rules and regulations. Contributed to effective and accurate communications, operations, and planning by conducting studies and reporting findings, and participating in special committees and/or projects. Established and maintained operational and performance standards.
Institute reserve rationales to cover the financial exposure incurring on the file. Maintained direct communication with defense and necessary personal to negotiate settlements/mitigate legal cost and allocate proper vendors to assist with cost containment. Inspected personal injury claims to determine how much the insurance company should pay for the loss. Interviewed the claimant and witnesses and accomplished additional research. Consulted with other workers, lawyers, and physicians, who offered a more expert evaluation of a claim. Gathered information—including photographs and statements, either written or recorded on audio or video compiled the report for claims examiners to negotiate. Analyzed and processed complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Negotiated settlement of claims within designated authority. Calculated and assigned timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. Calculated and paid benefits due; approved and made timely claim payments and adjustments; and settled claims within designated authority level. Prepared necessary state fillings within statutory limits. Managed the litigation process; ensured timely and cost effective claims resolution. Reported claims to the excess carrier; responds to requests of directions in a professional and timely manner. Communicated claim activity and processing with the claimant and the client; maintains professional client relationships. Ensured claim files are properly documented and claims coding is correct. Referred cases as appropriate to supervisor and management.
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