Provider/Member Service Representative Resume Atlanta, GA - Hire IT People

SUMMARY:

Out - going personality with high energy level Proficient in front and back medical office procedure and protocol

Adhere to OHSA and HIPPA Safety Regulations Quality assurance/detailed oriented

Excellent communication skills (verbal/written) Operate with competency NextGen, EMR and Clearwave, CRM

PROFESSIONAL EXPERIENCE:

Provider/Member Service Representative

Confidential, Atlanta, GA

Responsibilities:

Selected as main Advisor of engagement activities for 31% of the staff of Georgia Service Center.
Receive and respond to all telephone or written correspondence inquiries from members within established timeframe.
Document all activities for reporting and resolution through the customer relationship management application (CRM)
Respond appropriately to provider issues and concerns, and provide trending feedback to improve the customer experience
Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations’ team for claim adjustment
Educate provider on health plan initiatives during interactions with providers via telephone
Identify any trends related to incoming or outgoing calls that may provide policy or process improvements to support excellent customer service, quality improvement and call reduction
Assist members with plan benefits and eligibility via telephone, in writing, in person or make referral to outreach representative as appropriate.
Utilize current reference materials to assist and resolve any member inquires.
Assist providers with claims information, member eligibility and benefits and web site assistant.

Front Office Assistant

Confidential, Atlanta, GA

Responsibilities:

Perform a variety of non-clinical duties supporting a very busy Vascular, Cardio Vascular and Thoracic Surgery office
Accurately complete clerical duties associated with the Front Office, including but not limited to Check-in/Check-out duties, updating patient demographics, conflict resolution and problem solving: greeting patients and others
Make appointments for patients via in person or phone for office visits, lab work and other procedures
Communicate effectively with staff members, doctors, patients, vendors and others
Assist patients and non-patients (in person or over the telephone) with various types of matters including, but not limited to, directions, paperwork, routine questions and ensures the needs of patients and non-patients are met by direct and/or indirect means
Verify patient insurance with third party insurance companies

Confidential

Clerk

Responsibilities:

Provided customer service to patient via personal contact at greeter desk and by telephone
Assisted with the operation of the front desk
Supported doctors and staff by pulling charts and acquiring information on patient through NEXTGEN
Accurately scan documents into EMR
Completed record request from other healthcare facilities, attorney offices and patients. Provide other assistants as needed
Pickup and delivered mail to appropriate person/department

Patient Placement Assistant

Confidential, Stockbridge, GA

Responsibilities:

Responsible for appropriate placement of inpatients and outpatients requiring beds
Assessed the patients diagnosis and needs to determine the correct placement
Confirmed and accepted reservations from physicians, physician’s offices, emergency department or other healthcare facilities and acted on requests in a timely manner
Performed all functions of registration, inpatient, outpatient, transfers and discharges as necessary
Assisted Case Manager in performing level of care screenings for specific payer requirements, confirmation that admitting physicians is in payer network, referral to financial counselors when financial screening is required, determination of resources availability
EMTALA screened for medical transfer stability

Medicaid Eligibility Specialist

Confidential, Atlanta, GA

Responsibilities:

Provided case management to eligible person for Medicaid. Gathering data for completion of applications. Data entry, problem solving and conflict resolution.
Engage in monthly or weekly meetings with Provider office to inform of any changes to government policies in regards to healthcare.
Involved in Health Fairs in the community providing outreach services to the communities of people with different cultures and backgrounds.
Answered multi-line phone responding to client questions and concerns
Completed monthly reports; purchase order and maintain office supplies
Sorted and distributed incoming mail