Experience

Devoted Health

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Member Outreach Specialist

  • Sep 2022 - Present

  • Medicare advantage plan • Conduct outreach via telephone and SMS to educate and inform members of available clinical programs or important screenings relevant to them • Schedule medical appointments, D2ME, follow-up visits and addressing STARs gap for members • Supporting members in finding a physician or specialist that's aligned with their values and preferences. • Listen to members and identify instances when higher levels of support through our clinical partners is… Show more • Medicare advantage plan • Conduct outreach via telephone and SMS to educate and inform members of available clinical programs or important screenings relevant to them • Schedule medical appointments, D2ME, follow-up visits and addressing STARs gap for members • Supporting members in finding a physician or specialist that's aligned with their values and preferences. • Listen to members and identify instances when higher levels of support through our clinical partners is needed • Create cases to support member needs, such as care on demand, financial assistance, food, and transportation. • Scheduling medical appointments for members • Support the team with daily task • HRAs • Abide by HIPAA and compliance regulations • Document accurate information about member needs in Orinoco within protocol outreaches, calls and cases • EMR: Orinoco, Orinoco Knowledge, Looker, Calabrio, TalkDesk, Slack, Google Applications Show less • Medicare advantage plan • Conduct outreach via telephone and SMS to educate and inform members of available clinical programs or important screenings relevant to them • Schedule medical appointments, D2ME, follow-up visits and addressing STARs gap for members • Supporting members in finding a physician or specialist that's aligned with their values and preferences. • Listen to members and identify instances when higher levels of support through our clinical partners is… Show more • Medicare advantage plan • Conduct outreach via telephone and SMS to educate and inform members of available clinical programs or important screenings relevant to them • Schedule medical appointments, D2ME, follow-up visits and addressing STARs gap for members • Supporting members in finding a physician or specialist that's aligned with their values and preferences. • Listen to members and identify instances when higher levels of support through our clinical partners is needed • Create cases to support member needs, such as care on demand, financial assistance, food, and transportation. • Scheduling medical appointments for members • Support the team with daily task • HRAs • Abide by HIPAA and compliance regulations • Document accurate information about member needs in Orinoco within protocol outreaches, calls and cases • EMR: Orinoco, Orinoco Knowledge, Looker, Calabrio, TalkDesk, Slack, Google Applications Show less



Rainbow Housing Assistance Corporation

• United States
• Non-profit Organization Management
• 1 - 100 Employee

• Resident Services Coordinator

  • Nov 2019 - Mar 2020

  • Support the needs of low-income individuals and families • Deliver educational workshops to residents • Coordinate and provide resident social activities • Provide quality customer service • Provide resources and connect residents to opportunities to bridge social and economic barriers to goals and advancement • Report program outcomes to the Rainbow Resident Services Division • Maintain the Resource Center in a clean and presentable condition • Establishe new youth and… Show more • Support the needs of low-income individuals and families • Deliver educational workshops to residents • Coordinate and provide resident social activities • Provide quality customer service • Provide resources and connect residents to opportunities to bridge social and economic barriers to goals and advancement • Report program outcomes to the Rainbow Resident Services Division • Maintain the Resource Center in a clean and presentable condition • Establishe new youth and interact with existing youth residents by explaining the resident services program, provide information and support in assisting residents enrolling in the Youth Enrichment Program. • Identify and assess youth needs when appropriate; informs the parent of available resources and provides support in accessing services successfully. • Plan, implement, promote, and administer youth/adult activities and programs. • Provide quality customer service and ensure a safe, fun, and positive environment within the youth program. • Organizes and oversees all volunteers for the Youth Enrichment Program. Show less • Support the needs of low-income individuals and families • Deliver educational workshops to residents • Coordinate and provide resident social activities • Provide quality customer service • Provide resources and connect residents to opportunities to bridge social and economic barriers to goals and advancement • Report program outcomes to the Rainbow Resident Services Division • Maintain the Resource Center in a clean and presentable condition • Establishe new youth and… Show more • Support the needs of low-income individuals and families • Deliver educational workshops to residents • Coordinate and provide resident social activities • Provide quality customer service • Provide resources and connect residents to opportunities to bridge social and economic barriers to goals and advancement • Report program outcomes to the Rainbow Resident Services Division • Maintain the Resource Center in a clean and presentable condition • Establishe new youth and interact with existing youth residents by explaining the resident services program, provide information and support in assisting residents enrolling in the Youth Enrichment Program. • Identify and assess youth needs when appropriate; informs the parent of available resources and provides support in accessing services successfully. • Plan, implement, promote, and administer youth/adult activities and programs. • Provide quality customer service and ensure a safe, fun, and positive environment within the youth program. • Organizes and oversees all volunteers for the Youth Enrichment Program. Show less



Nazam Healthcare Services Inc

• Houston, Texas, United States

• Community Outreach Specialist

  • Oct 2018 - Nov 2019

  • Responsible for interaction in the community and promoting company services • Analyze the company’s organization to determine its strengths and weakness • Analyze past and current marketing data • Completes an analysis of the company’s product line • Analyze patient/company relationships • Develops a marketing plan, identifying priorities and sets a reasonable timetable • Implements marketing plan staying within established timetable • Reviews and evaluates the analyses… Show more • Responsible for interaction in the community and promoting company services • Analyze the company’s organization to determine its strengths and weakness • Analyze past and current marketing data • Completes an analysis of the company’s product line • Analyze patient/company relationships • Develops a marketing plan, identifying priorities and sets a reasonable timetable • Implements marketing plan staying within established timetable • Reviews and evaluates the analyses and plan on an established basis • Home Health Care • Work closely with children and adults with disabilities Show less • Responsible for interaction in the community and promoting company services • Analyze the company’s organization to determine its strengths and weakness • Analyze past and current marketing data • Completes an analysis of the company’s product line • Analyze patient/company relationships • Develops a marketing plan, identifying priorities and sets a reasonable timetable • Implements marketing plan staying within established timetable • Reviews and evaluates the analyses… Show more • Responsible for interaction in the community and promoting company services • Analyze the company’s organization to determine its strengths and weakness • Analyze past and current marketing data • Completes an analysis of the company’s product line • Analyze patient/company relationships • Develops a marketing plan, identifying priorities and sets a reasonable timetable • Implements marketing plan staying within established timetable • Reviews and evaluates the analyses and plan on an established basis • Home Health Care • Work closely with children and adults with disabilities Show less



Conifer Health Solutions

• United States
• Hospitals and Health Care
• 700 & Above Employee

• ACO- Clinical Care Coordinator

  • Jan 2018 - Oct 2018

  • Responsible for conducting care transitions, initiating member education and facilitating improvement on ACO quality measures. • Assess barriers to advocate for members & ensure their care needs are met through collaboration with ACO Nurses, ACO Practices as well as internal & external clinical programs available to the member. • Daily review discharge data, patient’s medical record information, case management notes to initiate member outreach • Initiate proactive member education… Show more • Responsible for conducting care transitions, initiating member education and facilitating improvement on ACO quality measures. • Assess barriers to advocate for members & ensure their care needs are met through collaboration with ACO Nurses, ACO Practices as well as internal & external clinical programs available to the member. • Daily review discharge data, patient’s medical record information, case management notes to initiate member outreach • Initiate proactive member education at each touch-point with members to ensure preventive & condition-specific care gaps are addressed • Schedule & meet with practice manager regarding quality measures to ensure the practice is adhering to the ACO market per contract guidelines. • Educate practice manager on Care Gabs & advise ways to improve metrics. • Identify gaps and opportunities to strengthen systems of care within the member’s community and assists members in utilizing community services, including scheduling appointments with social services agencies, (including transportation vendors), and assisting with completion of applications for eligible programs. • EMR: ALLSCRIPTS, POP HEALTH, CARE CONTINUITY, RIGHTFAX, SYNAPSE MOBILITY Show less • Responsible for conducting care transitions, initiating member education and facilitating improvement on ACO quality measures. • Assess barriers to advocate for members & ensure their care needs are met through collaboration with ACO Nurses, ACO Practices as well as internal & external clinical programs available to the member. • Daily review discharge data, patient’s medical record information, case management notes to initiate member outreach • Initiate proactive member education… Show more • Responsible for conducting care transitions, initiating member education and facilitating improvement on ACO quality measures. • Assess barriers to advocate for members & ensure their care needs are met through collaboration with ACO Nurses, ACO Practices as well as internal & external clinical programs available to the member. • Daily review discharge data, patient’s medical record information, case management notes to initiate member outreach • Initiate proactive member education at each touch-point with members to ensure preventive & condition-specific care gaps are addressed • Schedule & meet with practice manager regarding quality measures to ensure the practice is adhering to the ACO market per contract guidelines. • Educate practice manager on Care Gabs & advise ways to improve metrics. • Identify gaps and opportunities to strengthen systems of care within the member’s community and assists members in utilizing community services, including scheduling appointments with social services agencies, (including transportation vendors), and assisting with completion of applications for eligible programs. • EMR: ALLSCRIPTS, POP HEALTH, CARE CONTINUITY, RIGHTFAX, SYNAPSE MOBILITY Show less



Dean's Professional Services, Inc.

• United States
• Staffing and Recruiting
• 1 - 100 Employee

• Financial Clearance Associate

  • Dec 2015 - Feb 2017

  Obtain authorization and document verification of patient benefits for oncology diagnostic imaging. • Timely manage work que list for cases requiring pre-authorization and work directly with the payor or assigned third party vendor to obtain all required pre-authorizations. • Provide financial counseling to patients which includes reviewing cost estimates, assistance with calculating expected patient liability, discussions regarding payment requirements, collection of financial amounts… Show more Obtain authorization and document verification of patient benefits for oncology diagnostic imaging. • Timely manage work que list for cases requiring pre-authorization and work directly with the payor or assigned third party vendor to obtain all required pre-authorizations. • Provide financial counseling to patients which includes reviewing cost estimates, assistance with calculating expected patient liability, discussions regarding payment requirements, collection of financial amounts dues, provide information regarding available payment plan options, and provide information regarding patient financial assistance opportunities when applicable. • Financial counseling also includes reviewing ABN. • EMR: EPIC, Third party verification systems Patient Access Representative III • Perform cashiering functions, ensuring that all hospital accounts are secure, through the collection of the required co-pay, deductibles and co-insurance, and post payment. • Duties may include charge entry, registration, scheduling surgeries, outpatient and inpatient and direct admit appointments, insurance verification, pre-authorizations, and check in and check out, explains all required forms to the patient or guarantor and obtains the necessary signatures. Float Pool: Orthopedics, OBGYN, Neurology, Cardiology, Pediatrics, Radiology, Internal Medicine. • ICD-10, ICD-9, CPT codes • EMR: EPIC, ATHENA Patient Access Services- EPIC Implementation • ASAP/OPTIME/CADENCE • Updating patient demographics, registration, and insurance information. • Customer service expert to ensure all patient records are updated before appointments. • Patient access conversion prelude team: converted patient PHI from CARE SYSTEM to ONE CONNECT (EPIC) Show less Obtain authorization and document verification of patient benefits for oncology diagnostic imaging. • Timely manage work que list for cases requiring pre-authorization and work directly with the payor or assigned third party vendor to obtain all required pre-authorizations. • Provide financial counseling to patients which includes reviewing cost estimates, assistance with calculating expected patient liability, discussions regarding payment requirements, collection of financial amounts… Show more Obtain authorization and document verification of patient benefits for oncology diagnostic imaging. • Timely manage work que list for cases requiring pre-authorization and work directly with the payor or assigned third party vendor to obtain all required pre-authorizations. • Provide financial counseling to patients which includes reviewing cost estimates, assistance with calculating expected patient liability, discussions regarding payment requirements, collection of financial amounts dues, provide information regarding available payment plan options, and provide information regarding patient financial assistance opportunities when applicable. • Financial counseling also includes reviewing ABN. • EMR: EPIC, Third party verification systems Patient Access Representative III • Perform cashiering functions, ensuring that all hospital accounts are secure, through the collection of the required co-pay, deductibles and co-insurance, and post payment. • Duties may include charge entry, registration, scheduling surgeries, outpatient and inpatient and direct admit appointments, insurance verification, pre-authorizations, and check in and check out, explains all required forms to the patient or guarantor and obtains the necessary signatures. Float Pool: Orthopedics, OBGYN, Neurology, Cardiology, Pediatrics, Radiology, Internal Medicine. • ICD-10, ICD-9, CPT codes • EMR: EPIC, ATHENA Patient Access Services- EPIC Implementation • ASAP/OPTIME/CADENCE • Updating patient demographics, registration, and insurance information. • Customer service expert to ensure all patient records are updated before appointments. • Patient access conversion prelude team: converted patient PHI from CARE SYSTEM to ONE CONNECT (EPIC) Show less



Houston Methodist

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Admitting Representative

  • Jun 2015 - Dec 2015

  • Obtain and input accurate demographic and insurance information, on the Hospital Information System (HIS) on patients, presenting at the various entry points of the health Center. • Adhere to all departments, hospital, governmental and/or any other healthcare licensing agency requirements related to EMTALA and HIPAA. • Performs cashiering functions, ensuring that all hospital accounts are secure, through the collection of the required co-pay, deductibles, and co-insurance. • Perform… Show more • Obtain and input accurate demographic and insurance information, on the Hospital Information System (HIS) on patients, presenting at the various entry points of the health Center. • Adhere to all departments, hospital, governmental and/or any other healthcare licensing agency requirements related to EMTALA and HIPAA. • Performs cashiering functions, ensuring that all hospital accounts are secure, through the collection of the required co-pay, deductibles, and co-insurance. • Perform the medical necessity check, to ensure compliance with Medicare guidelines. • Train new hires in emergency room/fast track area. • Top collector in Hospital Collections. • EMR: HIS Show less • Obtain and input accurate demographic and insurance information, on the Hospital Information System (HIS) on patients, presenting at the various entry points of the health Center. • Adhere to all departments, hospital, governmental and/or any other healthcare licensing agency requirements related to EMTALA and HIPAA. • Performs cashiering functions, ensuring that all hospital accounts are secure, through the collection of the required co-pay, deductibles, and co-insurance. • Perform… Show more • Obtain and input accurate demographic and insurance information, on the Hospital Information System (HIS) on patients, presenting at the various entry points of the health Center. • Adhere to all departments, hospital, governmental and/or any other healthcare licensing agency requirements related to EMTALA and HIPAA. • Performs cashiering functions, ensuring that all hospital accounts are secure, through the collection of the required co-pay, deductibles, and co-insurance. • Perform the medical necessity check, to ensure compliance with Medicare guidelines. • Train new hires in emergency room/fast track area. • Top collector in Hospital Collections. • EMR: HIS Show less



Memorial Hermann Health System

• Hospitals and Health Care
• 700 & Above Employee

• Patient Access Representative

  • Feb 2015 - Jun 2015

  • Sports Medicine Rehabilitative • Schedule patient appointments and enter required information in the computer. • Obtain demographic, insurance and financial information from patient or guarantor. • Explain all required forms to the patient or guarantor and obtain the necessary signatures. • Verify insurance eligibility and benefits and ensures all notifications and authorizations are completed within the required timeframe. • Posts payments in the computer system and… Show more • Sports Medicine Rehabilitative • Schedule patient appointments and enter required information in the computer. • Obtain demographic, insurance and financial information from patient or guarantor. • Explain all required forms to the patient or guarantor and obtain the necessary signatures. • Verify insurance eligibility and benefits and ensures all notifications and authorizations are completed within the required timeframe. • Posts payments in the computer system and generates the appropriate patient receipts. • Monitor, review, and resolve patient account issues on assigned revenue reports. • EMR: HEALTH QUEST, APTA CONNECT, COOL REPORTS, SOVERA, FAX SERVER Show less • Sports Medicine Rehabilitative • Schedule patient appointments and enter required information in the computer. • Obtain demographic, insurance and financial information from patient or guarantor. • Explain all required forms to the patient or guarantor and obtain the necessary signatures. • Verify insurance eligibility and benefits and ensures all notifications and authorizations are completed within the required timeframe. • Posts payments in the computer system and… Show more • Sports Medicine Rehabilitative • Schedule patient appointments and enter required information in the computer. • Obtain demographic, insurance and financial information from patient or guarantor. • Explain all required forms to the patient or guarantor and obtain the necessary signatures. • Verify insurance eligibility and benefits and ensures all notifications and authorizations are completed within the required timeframe. • Posts payments in the computer system and generates the appropriate patient receipts. • Monitor, review, and resolve patient account issues on assigned revenue reports. • EMR: HEALTH QUEST, APTA CONNECT, COOL REPORTS, SOVERA, FAX SERVER Show less



Texas Orthopedic Hospital

• United States
• Hospitals and Health Care
• 100 - 200 Employee

• Registrar

  • Jan 2014 - Oct 2014

  • Responsible for greeting patients and visitors • Answer telephones, schedule appointments, register patients, obtain insurance and demographic information. • Verify Insurance • Obtain and update patient electronic medical records with registration forms, other forms related to visit and most recent imaging, labs, pathology and referring physician reports. • Register patients into the hospital system and obtain referrals and prior approvals for visits/procedures prior to the… Show more • Responsible for greeting patients and visitors • Answer telephones, schedule appointments, register patients, obtain insurance and demographic information. • Verify Insurance • Obtain and update patient electronic medical records with registration forms, other forms related to visit and most recent imaging, labs, pathology and referring physician reports. • Register patients into the hospital system and obtain referrals and prior approvals for visits/procedures prior to the patient being seen. • Post & reconciles patient copays, deductible, and coinsurance. • Radiology, Pre-Admit, Pain Management • Hospital Collections • EMR: MEDITECH, PASSPORT, FOS, E-DOCK United Health. Show less • Responsible for greeting patients and visitors • Answer telephones, schedule appointments, register patients, obtain insurance and demographic information. • Verify Insurance • Obtain and update patient electronic medical records with registration forms, other forms related to visit and most recent imaging, labs, pathology and referring physician reports. • Register patients into the hospital system and obtain referrals and prior approvals for visits/procedures prior to the… Show more • Responsible for greeting patients and visitors • Answer telephones, schedule appointments, register patients, obtain insurance and demographic information. • Verify Insurance • Obtain and update patient electronic medical records with registration forms, other forms related to visit and most recent imaging, labs, pathology and referring physician reports. • Register patients into the hospital system and obtain referrals and prior approvals for visits/procedures prior to the patient being seen. • Post & reconciles patient copays, deductible, and coinsurance. • Radiology, Pre-Admit, Pain Management • Hospital Collections • EMR: MEDITECH, PASSPORT, FOS, E-DOCK United Health. Show less



UnitedHealthcare

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Customer Service Representative

  • Nov 2010 - May 2013

  Provide excellent customer service inbound and outbound to complex customer calls. • Resolve customer service inquiries which could include: • Insurance Verification, Billing and Payment issues, Process/ Reprocess claims, Explanation of Benefits (EOB), Coordination of Benefits (COB) • Authorizations for EAP, I/O, O/P mental health and substance abuse treatment • Behavioral Health Claims: Medicare, Medicaid, Public Sector, Employer Division • Out of Network Provider… Show more Provide excellent customer service inbound and outbound to complex customer calls. • Resolve customer service inquiries which could include: • Insurance Verification, Billing and Payment issues, Process/ Reprocess claims, Explanation of Benefits (EOB), Coordination of Benefits (COB) • Authorizations for EAP, I/O, O/P mental health and substance abuse treatment • Behavioral Health Claims: Medicare, Medicaid, Public Sector, Employer Division • Out of Network Provider Loading • Appeal Status • Compiles and maintains current and accurate data for all providers. • Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed. • Maintains copies of current state licenses, DEA certificates • Maintains knowledge of current health plan and agency requirements for credentialing providers. • Track license and certification expirations for all providers to ensure timely renewals. • Document conversations with members and providers to track requests, problems, and solutions. • EMR: FACET, UNET, HP DEMO, CITRIX, CBS, IBAAG, COSMOS, TOPS, ISET, CAQH, LINX, IBM, WAND, KANA, EPUF, SURF, FEO, MACROS, IEX, MY METRICS, NDB Show less Provide excellent customer service inbound and outbound to complex customer calls. • Resolve customer service inquiries which could include: • Insurance Verification, Billing and Payment issues, Process/ Reprocess claims, Explanation of Benefits (EOB), Coordination of Benefits (COB) • Authorizations for EAP, I/O, O/P mental health and substance abuse treatment • Behavioral Health Claims: Medicare, Medicaid, Public Sector, Employer Division • Out of Network Provider… Show more Provide excellent customer service inbound and outbound to complex customer calls. • Resolve customer service inquiries which could include: • Insurance Verification, Billing and Payment issues, Process/ Reprocess claims, Explanation of Benefits (EOB), Coordination of Benefits (COB) • Authorizations for EAP, I/O, O/P mental health and substance abuse treatment • Behavioral Health Claims: Medicare, Medicaid, Public Sector, Employer Division • Out of Network Provider Loading • Appeal Status • Compiles and maintains current and accurate data for all providers. • Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed. • Maintains copies of current state licenses, DEA certificates • Maintains knowledge of current health plan and agency requirements for credentialing providers. • Track license and certification expirations for all providers to ensure timely renewals. • Document conversations with members and providers to track requests, problems, and solutions. • EMR: FACET, UNET, HP DEMO, CITRIX, CBS, IBAAG, COSMOS, TOPS, ISET, CAQH, LINX, IBM, WAND, KANA, EPUF, SURF, FEO, MACROS, IEX, MY METRICS, NDB Show less