Patient Care Specialist resume example with 5+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:

Focused Patient Service Representative with 5 years of experience supporting patients in healthcare settings. Extensive knowledge of medical record organization and patient advocacy. Successful at helping patients through care and treatment process. Attentive Patient Service Representative skilled in managing patient charts, processing payments and scheduling procedures. Detailed team player with strengths in communication, customer service and multitasking.

  • Handling Customer Complaints
  • Appointment Scheduling
  • Multitasking and Organization
  • Schedule Coordination
  • Regulatory Compliance
  • Customer Service
  • Patient Scheduling
  • Phone and Email Etiquette
  • Attention to Detail
  • Remote Work Coordination
Patient Care Specialist, 01/2021 to 12/2022
Lehigh Valley Hospital & HealthTrexlertown, PA,

• Serves NCMS patients over the phone with initial order of diabetes testing supplies and related products.

• Maintains a high call volume per day (80+ combined inbound and outbound calls per day).

• Provides effective customer service while obtaining patient demographics, verifying and updating patient accounts.

• Determines patients’ needs and offers products and services as applicable.

• Manages an average of 150+ patient accounts per month.

• Ships an amount of product to patients greater than or equal to the set monthly goal (department and individual goals are communicated daily).

• Works closely with other departments and physician support teams to confirm patient orders are eligible for shipment.

• Complies with HIPAA rules, appropriately safeguarding PHI or other private & confidential information.

• Maintains accurate and detailed notes in the company system.

• Adapts quickly to frequent process changes and improvements.

• Is reliable, engaged, and provides feedback to improve processes and policies.

• Attends all department, team, and company meetings as required.

• Appropriately routes incoming calls when necessary.

• Meets patient service quality standards.

Member Engagement Specialist, 01/2020 to 01/2021
Ymca Of Central Stark CountyNorth Canton, OH,
  • Responsibilities include scheduling patient appointments and coordinating cancellations, reschedules, and additions to schedules. Obtains demographic and insurance information, verifies insurance coverage, and may collect co-pays, deductibles, and previous balances. Ensures insurance and patient information obtained is complete and accurate, updating information if necessary, applying acquired knowledge of government and third-party payer requirements. Updates financial responsibility and other data when changes or additions occur and communicates to patients as appropriate.
  • Provides referrals to physicians/providers. Completes all essential forms, obtains necessary information, such as patient demographic and insurance information. Verifies and updates the medical record with customer information.
    Identifies emergent calls based on information provided by caller and department guidelines. Follows the process for immediate transfer to Registered Nurse for triaging or appropriate more experienced staff for resolution. Responsible for competency in and adherence to guidelines for emergency situations and critical call handling.
  • Determines the level of care needed by patients calling the call center which results in routing patients for triage, scheduling, rescheduling, and canceling appointments, submitting medication refill requests for evaluation, and paging providers and facilities as appropriate.
  • Provides customer service per established departmental standards as measured by patients on post call survey. Asks clarifying questions, presents options or solutions, and understands the level of complexity of the call, escalating only those situations necessary for resolution.
  • Assists with organizational marketing efforts by providing associated information and referral to customer, while maintaining appropriate records for documentation. Conducts regular reporting and updating of the provider and marketing databases.
  • Performs additional duties based on department needs such as faxing, updating medical records, logs, and reports, managing files/databases, assisting with entering, gathering, organizing, and compiling data for reports.
Healthcare Customer Service Representative, 02/2017 to 01/2020
Cvs HealthConroe, TX,
  • Respond to and resolve, on the first call, customer service inquiries and issues from several sources (Provider, Member, Customer)
  • Research complex issues using multiple UMR proprietary applications and databases and work with appropriate internal support resources to resolve customer issues and/or partner with Supervisor to resolve escalated issues
  • Help members locate providers, understand their benefit plan and answer questions related to processed claims
  • Collaborate effectively with multiple internal partners to ensure issues are resolved and thoroughly communicated to providers, members, and customers in a timely manner.
  • Research and dissect complex prior authorization and claim issues and take appropriate steps to resolve identified issues to avoid repeat calls, escalations, and provider dissatisfaction.
  • Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures to adjudicate complex claims (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates)
  • Strong multitasking to effectively and efficiently navigate more than XX systems to extract necessary information to resolve and
Education and Training
High School Diploma: , Expected in 06/2011
Forest Brook - Houston,Texas ,

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

Your data is safe with us

Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.

Resume Overview

School Attended

  • Forest Brook

Job Titles Held:

  • Patient Care Specialist
  • Member Engagement Specialist
  • Healthcare Customer Service Representative


  • High School Diploma

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

*As seen in:As seen in: