LiveCareer-Resume

provider intake coordinator resume example with 20+ years of experience

Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
:
Summary

Healthcare Industry/Insurance with over twenty-four years' experience as a Customer Service Specialist and Claims Processor. Strong customer services skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for customers.

Skills
  • Consulted Marketing, Enrollment Services, Provider Relations and Medical Review Departments to obtain required information.
  • Full knowledge of the HMO, PPO, Capitated Plans, Self-Funded Accounts (TPA), AHCCCS, Medicare and Dental Plan Coverages.
  • Familiar with system networks, HSR/ICUE (Precertification System Application), IEX, Tops, Unet, iSet (Eligibility & Benefits System Application) & NDB (INN/OON Provider Contract Research) GE Centricity/IDX Flowcast (Physicians Schedules and Patients Appointments System Application). C
  • Commercial software such as Vista, Windows, 95/98/M.E./XP, Word Perfect, MS Excel, PowerPoint, Group-wise Mail, Lotus Notes and Cisco Jabber.
  • Accounts Receivables & Payables
  • Attention to Details
  • Benefits & Eligibility
  • Call Center (Incoming & Outgoing Calls)
  • Medical & Dental Claims Coding & Processing Guidelines
  • Computer Literacy
  • Strong Customer Service
  • Coordination of Benefits (COB)
  • HIPPA Compliance Guidelines
  • ICD9/ICD10 Coding, CPT/HPCCS Coding
  • Maintaining Records
  • Medical & Dental Terminology
  • Ordering Supplies/Materials
  • Organizational & Problem Solving
  • Postage Meter Maintenance
  • Receiving Deliveries
  • Reporting Discrepancies
  • Scheduling of Physicians
  • Stocking of Materials
  • Sort & Distribute Mail
  • Subrogation with Other Insurance
  • Type 50-65 w.p.m.
Education and Training
DeVry Institute of Technology Phoenix, AZ Expected in 1996 C.I.S.M : Computer Information Systems & Management - GPA :
Cook County GED Records Office 100 W Randolph St., Suite#2010, Chicago, IL 60601, Expected in 1989 G.E.D (High School Equivalency Certificate) : General Studies - GPA :
Certifications
Scheduling of Physicians Full Knowledge of Medical Insurance Plans Ordering of Materials Receiving Deliveries Familiar with System Networks Microsoft Office Reporting Discrepancies Benefits & Eligibility Stocking of Supplies Medical & Dental Terminology HIPPA Compliance Guidelines Maintaining Records Attention to Details Medical & Dental Claims Processing Sort & Distribute Mail Coordination of Benefits (COB) Projects (Booklets, Reading Materials) Subrogation
Experience
Wipfli Llp - Provider Intake Coordinator
Milwaukee, WI, 05/2013 - 08/2019
  • Responsible for initial triage of members, administrative intake of members or information post-notification, working with hospitals and the clinical team.
  • Managed incoming calls, manage providers/members, providing information on available network services and transferring members as appropriate to process, processes incoming and outgoing referrals, and prior authorizations.
  • Resolve customer service inquiries which could include, enter notifications, providers' status of an existing notification and determining if notification is required.
  • Take calls and questions from members and/or providers regarding case status.
  • Also, determine member eligibility.
  • Determine whether authorizations are required for requested medical services.
  • Provide/explain benefit and authorization information to members/providers.
  • Communicate with clinical team to ensure provider receives a response when necessary.
  • Provide excellent customer service to both providers and enrollees.
  • Review and advise member/provider of status of a request (e.g., notification, authorization).
  • Constantly meet established productivity, schedule adherence, and quality standards.
Cvs Health - Administrative Assistant
Dallas, TX, 05/2007 - 04/2013
  • Performs diverse administrative duties and provides logistical support to the Leveraged Team in support of the achievement of program and business objectives.
  • Assists in meeting planning and coordinates and distributes agendas and materials for meetings and conferences.
  • Assists in the development of materials for various meetings and special projects, as well as preparing and distributing meeting packets as appropriate.
  • May attend meetings to organize and transcribe minutes and operate video conference equipment.
  • Assists in monitoring items that require action and follow-up.
  • Composes correspondence and documents from verbal instruction.
  • Reviews materials prepared by others to ensure procedural, grammatical, and typographical accuracy.
  • Receives and screens visitors, telephone calls and electronic mail.
  • Uses initiative and independent judgment by responding to requests, providing information, and resolving issues.
  • Maintains meeting room calendars/schedules.
  • Coordinates events and meetings e.g., schedules speakers, coordinates meeting rooms, food service, attendance, and audio/visual equipment.
  • Sets up and maintains data files.
  • Maintains records, may processes purchase requisitions.
  • IDX Master Scheduler.
  • Develops, maintains and updates accurate templates in IDX for all physicians.
  • Responsible for managing the templates and ensures patients are rescheduled in a timely fashion.
  • Main support for clinical staff when overbooking a physician is required.
  • Runs reports as needed.
  • Trains and orients new staff to front office procedures.
  • Claims/Coordinator.
  • Customer Service, Take incoming calls from providers/physicians regarding claims status and denials.
  • Responsible for check run every week, printing of all explanation of benefits (denials & resubmits).
  • Handled all checks printed number of claims paid ranging from $100,000 to $500,000 every week) from finance and mailed to all providers.
  • Responsible of all mail that comes in everyday and date stamped all claims submissions (1500 forms & UB92s).
Aetna Healthcare - Care Management Associate
City, STATE, 01/2001 - 04/2007
  • Support comprehensive coordination of medical services including Care Team intake.
  • Screening and supporting the implementation of care plans to promote effective utilization of healthcare services.
  • Responsible for initial review and triage of Care Team tasks.
  • Identifies principle reason for admission, facility and member product to correctly apply intervention assessment tools.
  • Screens patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan.
  • Monitors non targeted cases for entry of appropriate discharge date and disposition.
  • Identifies and refers outlier cases to clinical staff (e.g.
  • Length of Stay).
  • Identifies triggers for referral into Aetna's Case Management, Disease Management, Mixed Services and Other Specialty Programs.
  • Utilizes e-TUMS and other Aetna systems to build, research and enter member information, as needed.
  • Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate expense by identifying opportunities for the patient to utilize participating providers and services.
  • Promotes communication, both internally and externally to enhance effectiveness of medical management services.
  • Performs non-medical research pertinent to the establishment, maintenance and closure of open cases.
  • Provides support services to team members by answering telephone calls, taking messages, researching information and assisting in solving problems.
Blue Cross Blue Shield Of Arizona - Claims Specialist/Customer Service Representative Supervisor
City, STATE, 06/1995 - 01/2001
  • Processed complex Institutional and Physician claims for all types of services and lines of business.
  • Handled suspended claims and corrected edits, auditing when necessary the entry of the claim to ensure accuracy.
  • Made certain amount of medical review contract determinations based on manual procedures and current coding/procedural guidelines and memos.
  • Processed any adjustments needed on line and do necessary research.
  • Meet standards for quality and quantity, is familiar with all systems, procedures, forms and manual.
  • Handled claims on a current daily basis.
  • Explained to subscribers, group representatives, and others, a variety of information concerning the organization's services, including benefits, changes in coverage, etc.
  • Give information regarding claims payment or rejects to contracting hospitals, professional offices and subscribers.
  • Received and answered correspondence related to special groups.
  • Does research and updates on-line worksheets on a current daily basis.
  • Maintains manuals on a daily basis.
  • Displays working knowledge of systems, procedures, forms and contract types.
  • Participated in the corporation's Excellent through Quality Program.
Activities and Honors

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Resume Overview

School Attended

  • DeVry Institute of Technology
  • Cook County GED Records Office

Job Titles Held:

  • Provider Intake Coordinator
  • Administrative Assistant
  • Care Management Associate
  • Claims Specialist/Customer Service Representative Supervisor

Degrees

  • C.I.S.M
  • G.E.D (High School Equivalency Certificate)

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