Sr Complex Advocate Resume Example

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Jessica Claire
  • , , 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:

Proficient Senior Service Advocate successful at delivering thorough, compassionate, and knowledgeable support to patients, geriatricians, nurse practitioners and external clients. Highly organized award-winning healthcare professional with 20 years of customer service experience. 6 years relevant experience as a liaison for providers, patients, and social service agencies with dedication to enhance strategies and optimize assistance.

  • Coordination skills
  • Effective customer communication
  • Client satisfaction
  • Administrative support specialist
  • Organizational skills
  • Proper phone etiquette
  • Case management experience
  • Compassionate client care
  • Schedule management
  • Relationship building
  • Customer support and assistance
  • Community outreach
  • Patient advising
  • Resource advocacy
  • Issue and conflict resolution
Sr. Complex Advocate, 02/2018 to Current
CelligentSpartanburg, SC,
  • Promoted after seven months from Advocate4Me to Healthcare Advisor and currently working from home in Milwaukee, Wisconsin. The, newest promotion started December 2020 to current role. Received multiple award letters for exceeding performance & compassion quality metrics in every role that I've serviced.
  • Researched routine and complex issues across multiple databases assisting customers’ needs involving benefits, eligibility, claims, prior authorizations and financial spending accounts. Also, collaborated with internal resources to resolve customer inquiries or escalated issues.
  • Educated and guided customers about topics such as, managing their health and well-being options and choosing quality care providers. Also, intervened with billing providers on behalf of the customers to resolve complex issues. Provided education and status on prior authorizations or predetermination requests and submissions.
Intake Review Coordinator, 07/2016 to 07/2017
Medica HealthCare PlansCity, STATE,
  • Performed intake duties, examined incoming faxes from hospitals, (SNF) Skilled Nursing Facilities, Home Health Agencies, Mental/Behavioral Health Facilities, and Rehabs, (DME) Durable Medical Equipment, applied and processed Inpatient Notification request, and prior authorizations for Outpatient services, triaged calls, & coordinated cases ensuring clinical criteria is met for Case Management.
  • Approved and denied pharmaceutical pre-authorization through Magellan Rx Management. Collaborated with the department supervisor in the development and revision of existing workflows and the (SOP) Standard Operating Procedures.
  • Recognized by management for providing quality and exceptional service in case management.
Sr Authorization Coordinator, 07/2013 to 07/2016
Hennepin County Medical CenterCity, STATE,
  • Worked daily imaging reports and work queues with DSN (Decision Support Number) info for prior authorization processing. Performed telephonic support for online benefits verification of services regarding utilization, authorizations, and referral activities. Prepared patient assessment packets in hospital settings.
  • Verified and entered patient demographics, using electronic health record (EHR) databases, maintained a master patient index while processing and scanning charts, communicating with healthcare providers, implementing hospital standards, maintaining patient information confidentiality, and acquired patient admissions consent forms.
  • As the sole contributor for Radiology, Cath Lab, Hyperbaric, & OB Testing Unit work queues, I accurately processed and cleared requests in a timely and efficient manner. Collaborated with the Inpatient team and coordinated notification for non-complex services regarding Inpatient Care in a timely manner.
  • Interpreted and submitted clinical documentation pertaining to the specific services requiring prior authorization to support medical necessity reviews by the payer. Obtained and documented pre-certification of services and prior authorization approval from insurance companies for procedures and hospital stays. Notified Physician’s office when authorization is not obtained and/or benefits are inadequate.
  • Maintained all authorization/notification-related faxes and other documentation in order to support the appeals process in case a claim’s denial is received. Resolved claim denials related to the prior authorization process including appeal preparations and submission.

Lead Patient Coordinator Float

  • Promoted to lead trainer for the outperformance of 20 floats, due to consistency in ranking number one with productivity in audits and quality standards. As the lead trainer coached, mentored, and oversaw all on-the-job training for 16 new employees.
  • Conducted monthly and 60 day audits on new trainees, regarding registration & insurance quality performances. Traveled as a Patient Service Coordinator Float in approximately 26 ancillary clinics throughout the hospital and metro area.
  • Registered patients in Epic system, scheduled appointments, prepared documents, verified third-party reimbursement, authorization for care, and billing.
  • Requested regularly by the Senior Care Clinic Staff due to demonstrating integrity, compassion, and patient demeanor with patients who were treated with memory problems, chronic illness, falls, & complex drug regiments.
Patient Services Coordinator, 08/2009 to 10/2012
Smile Center-We Care DentalCity, STATE,
  • Facilitated patient registration and scheduling referrals and appointments in-person and by multi-line phone system, in a fast-paced dental office. Also, collected patient data, maintained filing systems, stored charts/records manually and by electronic health record database, and retrieval of patient medical records when required.
  • Recognized for showing the most compassion and tact dealing with disabled, elderly, and emotional customers.
  • Investigated and verified member eligibility and benefits for Medicaid by using the State's system MN-ITS on a daily basis. Also verified third-party commercial dental payer's via telephone and by fax including Delta Dental, Metlife, Blue Cross Blue Shield, United Healthcare, CIGNA, Aetna.
  • Utilized working knowledge of claims processing and accurately identified and applied payments, patient responsibility portions, contractual write offs, adjustments, and timely follow-up for claim denials.
  • Received the most "Going the Extra Smile" awards & bonuses, voice mails, gifts, and hand-written notes out of 45-50 staff members in the clinic.
Education and Training
Licensed Pharmacy Technician: Pharmacy Technology, Expected in 10/2004
TLD Institute Of Technology - Chicago, IL,
High School Diploma: , Expected in 06/1997
Thomas Edison High School - Minneapolis, MN,

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Resume Overview

School Attended
  • TLD Institute Of Technology
  • Thomas Edison High School
Job Titles Held:
  • Sr. Complex Advocate
  • Intake Review Coordinator
  • Sr Authorization Coordinator
  • Patient Services Coordinator
  • Licensed Pharmacy Technician
  • High School Diploma

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