Allied Health Professional
- Successful Allied Health representative with expertise in Patient Administration. Performs tasks, with a high degree of accuracy, performance and efficiency.
- Results-proven operations with 10 years of experience and track record of success in improving business development, profitability, service, and quality for a global medical technology company business. Strong and decisive leader with excellent analytical, team building, and planning abilities. Additional knowledge/skill areas include:
- Build relationships with customers across multiple areas, including placement. Familiar with MCO and MDC medical policies for product coverage.
- Escalates concerns regarding these policies and makes suggestions for improvements.
- Solutions-Orientated with clinical documentation obtained to determine medical necessity. Requests additional documentation/clarification as required.
- Resourcefulness between customer and team and business office when there are questions regarding authorization.
- Collaborations with customers and case managers in obtaining additional documentation/clarification and facilitates communication with internal and external parties until placement is resolved.
- Communicates concerns regarding authorizations for prescribed patients to the proper areas.
- Participates in any and all reasonable work activities as may be deemed suitable and assigned by management.
- Conforms to, supports and all company policies and procedures.
- Support and serve a team as well as lead from the front
- Boldness with wiliness to shoulder responsibility
- Demonstrates expertise in excellent customer relation skills members
- Diverse knowledge of Medicare compliance
- Proactive, hands on style extensively team orientated in administrative, and clinical
- Adept at training employees
- Able to support and serve as a leader
- Identify patients transitioning between care settings e.g., Acute to Home .
- Superior communication, interpersonal, and negotiation skills
- Consistent history of working effectively on teams and independently.
- Maintain excellent attendance and punctuality record.
- Comply with Standard Operating Procedures, particularly HIPAA.
- Prioritize, Focus, and execute to bring results
Order Fullfillment Team Leader
- Provide timely quality customer service and accurate team member assistance on the Lead Line
- Monitor Ship-Pending Log and release orders as needed
- Identify system access barriers and initiate resolution through local sources or the I.S. Help Desk
- Coordinate and initiate regular coaching and development and daily communication with all team members
- Monitor and review team member quality results using C/C database to meet monthly goal requirements
- Resolve escalated and more complex customer and service center issues
- Assist supervisors in monitoring schedule adherence and other Advantage related activities
- Provide instructional guidance, coaching and feedback to CSRs in support of individual CSR Development Plans
- Monitor Backlog to ensure teams are assigned appropriately, and achieving optimal performance
- Participate in any and all reasonable work activities as assigned and deemed appropriate by management
- Motivate and inspire team members to increase job satisfaction, agent performance and overall team productivity
- Escalates team member issues/disatisfiers to immediate supervisor for assistance
- Facilitate team meetings
- Ability to achieve and maintain an average rating of 3 or above on the Team Lead MBO Performance Matrix
FIELD COPA/Claims Specialist lll
- Ensure seamless transition of product placement.
- Review recertification information and documentation for payers as required
- Code Diagnoses for Product Authorization and Coverage Determination
- Correlate the transitioning between care settings
- Developing and managing relationships with Discharge Planners, Case Managers, and others involved in the VAC Therapy transition process
- Communicating with customer personnel and educating them on the VAC authorization process
- Proactively managing the transition process in a HIPAA-compliant manner, including paperwork and coordination with Advantage Center
- Recovering lost assets and handling inventory management
- Monitor Ship Pending report, and maintain Bizflow reports
- Supporting account paperwork credit, collection, invoice matters
- Monitor Unbilled Documents Issues report, and collection to a resolution
- Maintain compliance with Medicare
- Provide clinical resolutions of treatment beyond authorization date of Negative Pressure Wound Treatment
- Provide training and direction to internal/external customers to ensure timely and accurate processing
- Communicate both orally and in writing, pertain to planning, assigning and supervising the work of staff, and providing status reports to senior management
- Track cases until payer and internal requirements are met for billing
- Notify personnel of billing, pricing, negotiations
- Solutions oriented in the absence of management, exercises initiative and judgment in responding to client problems or complaints promptly, courteously and in accordance with established policies and procedures or, if unable or unqualified to assist, promptly refers to the appropriate party or department and follows-up to ensure problem resolution
- Complies and completes reports, statistical data, charts, graphs and tables reviews and analyzes reports to determine appropriate action or refers to management for review.
- Rapidly edits and types a variety of confidential correspondence and documents effectively composes other routine correspondence, forms and charts.
- Accurately maintains calendar makes necessary arrangements for appointments, meetings, seminars, conferences or travel in a timely manner