Experience

Nathan Adelson Hospice

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

• Patient Service Representative

  • Oct 2021 - Present

  • Understanding death and dying and promoting comfort care to the dying as an active• Knowledge of hospice palliative eligibility and local coverage determinations (LCD).• Great interpersonal relationships with patients, families, co-workers, and other health team members.• Utilizing medical records and other electronic devices to their fullest potential.• Working in inpatient, ICU, and Acute care setting• Responding to referrals that are provided by Admissions office• Creating internal referrals from friends, families, and hospital providers for hospice• Scheduling transportation from hospital to Inpatient unit, or patients’ home• Ensuring medical insurance information is entered correctly• Adding the basic tabs such as first last name, and insurance payer• Assisting patients with completing consents forms• Obtaining external medical records as required by medical professionals• Determining eligibility utilizing local coverage determination guidelines• Participating, supporting and adapting organizational initiative to maximize admissions• Explaining hospice services and philosophy at bedside with patient and patient’s family



CenterWell Senior Primary Care

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

• Senior Care Management Support Assistant

  • Sep 2020 - Oct 2021

  • Greeting patients• Registering patients according to established protocols• Assisting patients to complete all necessary forms and documents• Ensuring patients information is accurate including billing information• Informing patients of medical office procedures and policies• Maintaining and managing patient’s record• Assisting with HIM/Medical Records entering into system• Scheduling visit transportation• Answering incoming call and making outbound calls • Scheduling patients appointments• Collecting co-payments and past due balances• Reporting statistics• Making Excel sheets with new patients information for marketing• Scheduling hospital admissions, test, scans and outside appointments for patients• Obtaining external medical reports as required by medical professionals• Responding and complying to requests for information• Offering and providing tours of the center when needed



Hill Health

• Call Center Manager

  • Nov 2018 - Aug 2020

  • Greeting patients and others entering the department in a courteous and professional manner in accordance with performance standards.• Enter registration and billing information into computer application system following specific guidelines and instructions• Retrieve data and prepare variety of reports related to patient census, patient insurance, and financial status.• Check-in and checking insurance eligible and benefits• Registration and Pre-registration for Ambulatory Care Services• Interview patients to obtain necessary information for billing purposes,• Financial screening of patients and process documents to establish source of payment• Preparation of registration packets and patient visit.• Appointment scheduling in person, and/or on the phone with excellent customer service.• Checkout patients providing after visit summary, labs, referral to other offices• Billing troubleshooting and outgoing calls to collect outstanding payments• Cash handling skills taking copayments and coinsurance payments in person and over the phone• Prescription Prior Authorization (Cover My Meds)•Ability to multitask and remain calm under pressure, especially during peak hours or intense situations.•Exceptional interpersonal, customer service, problem-solving, verbal and written communication, and conflict resolution skills.•Knowledge of management principles and familiarity with company products, services, and policies.•Strong coaching and leadership skills, ability to motivate employees.•Decisiveness and attention to detail.•Proficiency with the necessary technology, including computers, software applications, phone systems, etc.•Polite, professional phone voice.



Stanford Health Care

• Hospitals and Health Care
• 700 & Above Employee

• Utilization coordinator

  • Sep 2016 - Nov 2018

  Urgent approved authorization phone calls to members, and providers• Using established UM guideline pathways for screening, authorizing, and finalizing authorization (Inpatient, Outpatient, Retrospective) referral request• Data Entry Face sheets and Clinic records in EPIC (electronic records)• Checking members coverage and eligibility• Communicate effectively and interact with the utilization review nurse and health plans daily or as indicated regarding UM and referral authorization issues.• Data entry via EPIC software• Process request that are approved, denied or deferred and in accordance with utilization management policy and procedure.• Responsible for Deferred authorization maintenance, tracking and follow up.• Responsible for the EIOD process, including log maintenance; and member notifications• Returns phone calls to members, physicians and health plans and follows up with requests.• Maintain turnaround time compliance in all aspects of the UM process.



Aetna

• Call Center Supervisor

  • Jun 2013 - Jun 2016

  • Monitor productivity of call center agents • Review and monitor call queues • Generate regular and reports • Monitor individual and team results against revenue and performance goals. • Take calls and acts as an escalation point for customer issues. • Plans and conducts meetings, coordinating and supporting other teams as needed.• Perform disciplinary actions, attendance notifications, performance improvement plans, and maintain • Document on agent progress. • Create and maintaining a motivating and positive working environment • Perform other duties as assigned. • Experienced in ICD-9 ICD-10, HCPCS, and CPT medical codes • Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Microsoft OneNote • Inbound and outbound calls to patients (members) and doctors (providers) • Collaborate with Supervisor to come up with goals to improve performance for team or induvial• Regular data entry transaction processes