Medical Receptionist/Referral Coordinator

• Oct 2021 - Present

Reception duties, referrals, back up Medical Assistant (when needed) Reception duties, referrals, back up Medical Assistant (when needed)

Assistant Manager of Eyeglasses

• May 2018 - Oct 2021

Assistant Manager, Contact Lens

• May 2016 - May 2018

Train and supervise employees.Collect patient medical/pharmaceutical/ocular histories, collect vitals, perform doctor order testing, pharmaceutical ordering/refills, charting, provide information to patient regarding healthcare/treatment plan, coordinate invoice coding with insurers, excellent patient relations, understanding of community resources, patient scheduling, records management, doctor order testing/results reporting. Greet patients, high quality patient service, presentation of lens treatments & types based on patient needs & lifestyle. Fitting of eyeglass frames with proper face fit, pupillary distance, and vertex distance. Show less

Medical Billing/Eligibility Specialist

• Jan 2010 - Oct 2017

Proficient in the use of ICD-9, ICD – 10 – CM. Procedure and CPT/HCPC codes and guidelines. Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.Prepares and submits clean claims to various insurance companies either electronically through company approved clearinghouse or by paper. Answers questions from patients, clerical staff and insurance companies. Identifies and resolves patient billing complaints. Prepares, reviews, and gives patients’ statements to fiscal manager for final review. Performs various collection actions including correcting and resubmitting claims to third party payers as instructed by the fiscal manager. Processes payments from insurance companies.Assists with the identification and reporting of potential quality management issues. Participates in educational activities and attends weekly staff meetings. Conducts self in accordance with CYFS employee manual. Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations. Verifies eligibility of members and participating status of providers for relevant contracted payer source. Determines member benefit coverage utilizing clearinghouse or other resource access as determined by contract. Data enters insurance, Medicaid, or other payer information detail once verified into patient account. Performs support for on-line authorization of routine services. Provides support to providers regarding utilization, authorization, and referral activities. Assists in gathering information needed to determine continued authorization. Contacts providers with authorization, denial and appeals process information as necessary. May receive pended claims reports on claims received without prior authorization to research and review eligibility and benefit coverage. Upon decision of claim payment status, generates the appropriate referral with notification and exchange of information to the service organization for proper adjudication of claim payment. Show less

Mental Health Contracting Specialist

• Sep 2015 - Jun 2016

Assigned responsibilities involving highly responsible work as a liaison between CYFS and Oregon Medicaid CCO Carriers. This includes responsibilities related to establishing and maintaining an effective and viable network of mental health providers with the Oregon Medicaid CCO carriers and CYFS. Performs network provider services and liaison duties between the state insurance program and participating providers in the health care provider network; provides assistance in resolving problems with claims; explains allowable benefits, coverage provided, fee schedules and other aspects of the program; coordinates problems with other agency divisions and/or third party administrators as required. Responds to phone requests from providers on a variety of concerns, problems and issues; conducts necessary research and analysis and responds verbally or by correspondence as appropriate. Attends meetings, seminars and other training related to the insurance and health care industries; reviews a variety of publications concerning health coverage and treatments to stay informed of changes; adheres to all HIPAA guidelines/regulations. Show less

Mental Health Credentialing Specialist

• Sep 2015 - Jun 2016

Responsible for all aspects of the credentialing, recredentialing and privileging processes for all mental health providers who provide client care . Responsible for ensuring providers are credentialed, appointed, and privileged with Oregon Medicaid, Oregon Medicaid CCO Carriers, and commercial health plans. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications and adheres to all HIPAA guidelines/regulations.. Show less

Administrative Assistant

• Nov 2009 - Dec 2009

Records and data entry of employees medical tests into all electronic databases; adhered to all HIPAA guidelines/regulations. Records and data entry of employees medical tests into all electronic databases; adhered to all HIPAA guidelines/regulations.

Clinical Receiptionist

• Mar 2009 - Apr 2009

Answer multi - line telephone system. Directed internal and in - coming calls to the appropriate departments or personnel. Provide patient relations for in - coming calls; adhered to all HIPAA guidelines/regulations. Answer multi - line telephone system. Directed internal and in - coming calls to the appropriate departments or personnel. Provide patient relations for in - coming calls; adhered to all HIPAA guidelines/regulations.

Library Helper

• Jan 2009 - Feb 2009

Sorting & Shelving Library Books & media by Alpha - Numeric & dewy decimal systems

Greeter at Verizon Wireless Keizer Station

• Sep 2008 - Dec 2008

Greet Customers in friendly, helpful manner, direct customers to the correct people for the proper assistance for their wireless and account needs. Answer multi - line telephone system; directed phone calls to the appropriate associate for proper customer assistance.

Assistant Eyeglass Manager

• Nov 2000 - Sep 2008

Train and supervise employees. Employee evaluations. Run Weekly P & L Reports. Meet weekly and monthly benchmarks for store. Collect patient medical/pharmaceutical/ocular histories, collect vitals, perform doctor order testing, pharmaceutical ordering/refills, charting, provide information to patient regarding healthcare/treatment plan, coordinate invoice coding with insurers, excellent patient relations, understanding of community resources, patient scheduling, records management, doctor order testing/results reporting. Greet patients, high quality patient service, presentation of lens treatments & types based on patient needs & lifestyle. Fitting of eyeglass frames with proper face fit, pupillary distance, and vertex distance. Show less