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Patient Care Coordinator Resume Example

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PATIENT CARE COORDINATOR
Summary

IT Professional with background in Health Care. Strong technical proficiency with work history in health insurance. In-depth knowledge of Oracle coupled with trouble shooting and customer support capabilities. Proven history of strong work ethic, leadership and flexibility.

Skills
  • Solid leadership and management skills along with the ability to build professional working environment for both office patients, and medical teams
  • Strong analytical skills along with the ability to research, evaluate, and solve complex administrative and operational problems
  • Excellent organizational and time-management skills with the ability to handle multiple priorities within specific deadlines
  • Proficiency with MS Office Suite, EMR/PM system, database application and Internet, including knowledge of using office equipment
  • Strong reporting and documentation skills with the ability to handle and maintain confidentiality of medical records
  • Project Management
  • Records maintenance
  • Regulatory requirements
  • Schedule management
  • Health information systems
  • Claims processing
  • Organizational skills
  • Performance metrics
  • Providing customer support
  • Mac and PC proficiency
  • Technical Troubleshooting
  • Call center experience
  • Recording support tickets
Experience
Patient Care Coordinator06/2018 to CurrentCompany NameCity, State
  • Served as advisory resource by providing patient and family care expertise in form of educational materials, videos and latest information from CDC.
  • Liaised effectively with patients, doctors and staff members, assessing medical charts and promoting high level of communication and interaction.
  • Submitted various medication requests electronically.
  • Improved patient feedback by 60% in 2 years.
  • Implemented new hire training to further develop skills and initiate discussions on task prioritization.
  • Worked closely with store manager to maintain day-to-day operations.
  • Ordered all supplies needed for pharmacy and kept tabs on inventory levels.
  • Created and maintained facility documents and records, maintaining accuracy while managing sensitive data.
  • Drove process, efficiency and quality improvements, resulting in 36% increase in patient discharge times.
  • Added more than 82% in revenue between 2018 and 2019.
Provider Claim Analyst03/2015 to 06/2018Company NameCity, State
  • Service areas of: CA, MO, KY, OH, GA, FL, IN, IL Coordination.
  • Spearheaded claims negotiations up to $200K and contributed to litigation processes for unsuccessful settlements.
  • Based payment or denials of medical claims upon well-established criteria for claims processing.
  • Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
  • Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.
  • Documented file notes clearly and concisely in Oracle, Athena, and Kareo.
  • Stayed current on HIPAA regulations, benefits claims processing, medical terminology, and other procedures.
  • Efficiently and effectively processed a large volume of medical claims on a daily basis.
  • Gathered and documented evidence to support authorization denials.
  • Created master spreadsheet to record procedures, denials and approvals.
  • Led training initiatives to optimize productivity.
  • Worked closely with employees and managers at all levels.
  • Handled and processed variety of claims, including Medical and Dental.
  • Maintained 97% accuracy rate when preparing weekly spreadsheets and project reports for management based on data from various sources.
  • Achieved high quality marks on quality assurance evaluations through 2018.
Health Information Specialist08/2014 to 03/2015Company NameCity, State
  • Indiana Medicaid eligibility review via Manage Care.
  • Vision, Dental, Pharmacy Benefit Coordination.
  • Reimburse customers for payments made that should have been covered.
  • Help with member appeals for denied claims, authorizations, and pharmacy authorizations.
  • Explain coverage or denial of claim to inquiring members.
  • Coordinating with Care Coordination, to schedule appointment and home visits.
  • Upgraded medical record documentation system to meet federal and state regulations, continually monitored medical records and contacted physicians for deficient or delinquent data.
  • Facilitated document import into electronic health records using variety of applications and workflows, executed scanning and indexing and organized patient records for quick reference.
  • Addressed customer information requests promptly and courteously, maintained strict confidentiality and respect and identified potential improvements to inquiry response processes.
  • Streamlined day-to-day office processes to meet long-term goals.
  • Took part in meetings and committees to discuss such topics as electronic health records and communicate best ways to improve workflows.
  • Entered patient insurance, demographic and health information into software and confirmed records.
  • Set up patient charts and documented information in various company software.
  • Pulled patient records and transferred information to appropriate parties.
  • Logged all requests for medical records into spreadsheets.
  • Assessed departmental operations to determine areas for customer service improvement and support.
  • Drove quality customer experiences by leading retention strategy development and conflict resolution to improve overall support delivery.
  • Trained new hires on relationship building, benefit-oriented sales presentations, sales processes and protocol, product knowledge, customer needs analysis and overcoming objections.
Pharmacy Technician03/2012 to 08/2014Company NameCity, State
  • Verified insurance benefits to refill medications by examining formularies and calling insurance companies for exceptions.
  • Used 8-point check system to verify labeled prescriptions.
  • Teamed with peers, technicians and other pharmacists to prioritize and complete orders.
  • Efficiently responded to voicemails from healthcare providers and customers.
  • Reviewed and monitored patient medication files and lab data in hospital setting.
  • Trained new technicians to provide excellent customer service which resulted in higher customer satisfaction scores.
  • Managed medication stocks, including conducting counts, labeling products and maintaining controls.
  • Interpreted and processed medication orders under supervision of pharmacist.
  • Improved drug inventory management procedures to reduce overhead and eliminate backorders or overstock.
  • Received and verified daily incoming drug inventories, reported discrepancies and logged items into inventory system.
Education and Training
High School Diploma03/2012Pike High SchoolCity
  • English/ Language Arts 8 credits Including a balance of literature, composition and speech.
  • Mathematics 6 credits 2 credits: Algebra I 2 credits: Geometry 2 credits: Algebra I
  • Science 6 credits 2 credits: Biology I 2 credits: Chemistry I or Physics I or Integrated Chemistry-Physics 2 credits: any Core 40 science course Social Studies 6 credits 2 credits: U.S. History 1 credit: U.S. Government 1 credit: Economics 2 credits: World History/Civilization or Geography/History of the World
  • Directed Electives 5 credits World Languages
Certificate: Covid-19 Contract Tracing01/2021Johns Hopkins UniversityCity
  • Bloomberg School of Health and courtesy of Bloomberg Philanthropies., the natural history of SARS-CoV-2 and case investigation: Johns Hopkins
  • Coursework in Public Health, Epidemiology
  • Volunteered at Julian Center
Certificate: Google IT Professional01/2021Coursera
  • Course in: CompTIA A+, Network+ and Cyber Security+
  • Professional Certificate is licensed under a Creative Commons Attribution 4.0 International License
  • American Council on Education (ACE) ACE CREDIT®
  • At&t Believe Scholarship Recipient 2020
Certificate: Network +Expected in 05/2021CompTIA
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Resume Overview

School Attended

  • Pike High School
  • Johns Hopkins University
  • Coursera
  • CompTIA

Job Titles Held:

  • Patient Care Coordinator
  • Provider Claim Analyst
  • Health Information Specialist
  • Pharmacy Technician

Degrees

  • High School Diploma 03/2012
    Certificate : Covid-19 Contract Tracing 01/2021
    Certificate : Google IT Professional 01/2021
    Certificate : Network + Expected in 05/2021

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