Senior Patient Services Advocate Resume

PROFESSIONAL EXPERIENCE

Confidential

Senior Patient Services Advocate

Responsibilities:

Daily, weekly and monthly auditing to ensure appt.’s are scheduled within providers preferred parameters
Training new hires on all operating systems and SMA protocols
Reviewing all actions taken by new hires to ensure appt.’s are scheduled in accordance with SMA guidelines
Processing and documenting interpreter billing for SMA providers
Processing and documenting deceased pt. report
De - escalating and assisting pt.’s dissatisfied with SMA providers and/or procedures
Taking complaint calls, documenting them appropriately and notifying the correct parties
Communicating with clinic management
Facilitating interdepartmental communications
Processing and submitting Impanelment change requests in conjunction with scheduling appt.’s in accordance with SMA guidelines
Providing support and guidance to all employee’s, but especially employee’s under my purview
Completing and submitting daily Adherence and Idle Slips to employee’s under my purview
Reviewing and reassigning tasks in accordance with SMA protocols

Confidential

Patient Services Advocate

Responsibilities:

Answering 75 or more calls per day
Participating in pilot programs to review and analyze new software programs
Transcribing and relaying messages between providers, patients, and third party representatives as needed and appropriate with accordance to HIPPA laws
Scheduling, rescheduling and cancelling appointments for Primary Care, OB/GYN, Pediatric, Radiological and Specialty Providers
Reviewing, verifying, programming and scheduling Stat Radiology Exams
Receiving and transcribing refill requests on Controlled Substances in accordance with provider guidelines
Processing and submitting Impanelment change requests for patients as needed and when appropriate
Utilizing Centricity, Touchwork, AS400, Outlook, Excel, Word, and Wrapper as needed and in accordance with company guidelines
Reviewing referrals and relaying relevant information to appropriate parties in accordance with HIPPA laws
Relaying relevant Prior Authorization details to appropriate parties in accordance with company guidelines and HIPPA laws

Confidential

Training Agent / Customer Care Crew

Responsibilities:

Creating and Maintaining Excel spreadsheets for daily accountability
Creating training documents for Payment Solutions Team member responsibilities
Training Payment Solutions Team Members
Providing detailed and timely member communications while remaining HIPAA compliant
Taking escalated calls and Lead Calls as requested / needed
Providing guidance to Payment Solutions Team members
Providing guidance to InsureMonkey Care Crew team members related to Payment Solutions and Research inquries
Monitoring Payment Solutions Team members when leadership is unavailable or when otherwise instructed
Assisting Members and / or Providers with Claim Inquiries
Reading and explaining overall as well as itemized claims
Quoting Benefits & Eligibility to Members and / or Providers
Assisting with Network Inquiries

Confidential

Data Resolution Team / HICS Specialist

Responsibilities:

Researching Enrollment Details and Status for Healthcare.Gov Policies
Facilitating and Managing Healthcare.Gov calls with members
Customized Daily follow up with Brokers, Members and Healthcare.Gov
Reviewing and processing enrollment applications for off exchange policies, with broker outreach as needed
Reviewing and processing payments for new applicants with follow up as needed
Providing detailed and timely member communications while remaining HIPAA compliant
Cross-referencing 834’s, PA’s and supplemental data sources to verify and validate enrollment status’
Researching and processing monthly premium payments for members and clients and reconciling membership accounting to provide an accurate and concise billing history
Assisting NHC HICS and NHC Compliance team with member outreach for HICS cases
Creating and Maintaining Excel spreadsheets for special projects and daily accountability
Creating training documents for Data Resolution Team and Payment Solutions Team member responsibilities
Monitoring and addressing emails for the Data Resolution Team box
Assisting NHC EDI with member outreach and account research
Training existing and new Data Resolution Team members
Taking escalated calls and Lead Calls as requested / needed
Providing guidance to fellow Data Resolution Team members
Providing guidance to InsureMonkey Care Crew team members related to Data Resolution and Research inquries
Monitoring Data Resolution Team members when leadership is unavailable or when otherwise instructed
SalesForce Beta-testing, Data Entry and Programming
Numerous special projects including locating and addressing payment issues, cross-checking accounts between SalesForce and Javelina, and failed roll-over accounts

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