Healthcare Resume
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Resume:
O/PPO, and Tricare Programs .Demonstrate competent knowledge of healthcare insurance and able to adapt to complex and demanding situations. Strong organizational skills and an excellent record of completing projects according to deadlines. Proficient in Medical Insurance Billing, Medical Terminology, and Medical Coding
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EXPERIENCE
CASE MANAGER
PATIENT ADVOCARE HAMPTON,VA
PRESENT
Maintain contact with clients on a scheduled basis that is appropriate to their particular status and needs. Perform outreach to agencies and organization pertinent to potential residents and/or supportive services. Assist clients’ to achieve goals as outlined in their Individual Wellness Plan. Maintain outreach to agencies and organization pertinent to potential residents and/or supportive services. Provide clients training in the areas of, accessing community resources, medical adherence, household management or other needs as outlined in the clients’ Individual Wellness Plan
HUMAN RESOURCE
IAP (WALTER REED) WASHINGTON, DC
JUL -OCT
Compose citations and prepare certificates and awards in final form for government review and signature. Book appointments on department’s on-line calendar and prepare monthly and weekly reports. File documents and memos in accordance with DA system. Scan documents into PDF format, prepare Power Point presentations, and conduct literature searches as requested by government.
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MEDICAL RECORDS REFERRAL COORDINATOR
WALTER REED (IAP) WASHINGTON, DC
MAR -JUL
Receives and process all Right of First Refusal request from Tricare as they are received and within defined timelines. Determine appropriate medical documentation is available to analyze requested care. Research and communicate with requesting providers, HNFS, and others as needed to make informed decisions about RORF. Enter consults into CHCS to facilitate MTF appointing when the care is available. Review and develop processes to improve the ROFR process upon government review.
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SECRETARY
COLUMBIA HEALTHCARE SERVICE
GAITHERSBURG, MD
APR TO MAR
Worked as an administrative/secretary in the health unit at the National Institute of Standard Technology (NIST). Schedule appointments for physical examinations, health screenings, and other health testing. Prepare and type unit correspondence, reports, and purchase orders. Assist employees involved in work related injuries and illness in the completion compensation forms; serves as staff liaison with NIST injury specialist to ensure effective/efficient of workers compensation cases/claims. Maintain all administrative files and medical records.
CLIENT SERVICE COORDINATOR
SUBURBAN HOSPITAL BETHESDA, MD
JUL -APRI
Assist callers in obtaining and interpreting technical information about all test performed in the laboratory and other reference laboratories. Give results for all test performed in the laboratory. Process and send out reports by entering all results in Meditech and maintain files on all results. Review reports for acceptability as well as completion of results. Responsible for completion of Department Quality Assurance program on a monthly basis.
REIMBURSEMENT SPECIALIST
ROBERTS HOME MEDICAL GERMANTOWN, MD
SEPT -JUN
coding principles, governmental regulations, protocols and third party requirements regarding billing and billing documentation. Assure that all services documented in the patient’s chart are coded with appropriate CPT- and ICD- codes. Followed up on unpaid or denying claims for their status, heavy data entry tasking, answering the phones and files, faxing and copying documents.
BENEFITS/MEDICAL REFERRAL COORDINATOR
SIERRA MILITARY HEALTH SERVICE ROCKVILLE, MD
APR - AUG
Responsible for receiving, processing, investigating, answering beneficiary and providers request for services and information on Tricare Programs. Assist the TSC staff with providing effective services and accountable for providing timely, accurate, and complete responses to Tricare program beneficiaries and providers. Schedule appointments, process claims and clinical orders for consults.
PROVIDER AND MEMBER SERVICE REPRESENTATIVE
APS HEALTHCARE BETHESDA, MD
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SEPT -MAR
Served as a front-end for providers, PCP’s accessing their mental health/substance abuse benefits, provide members with outpatient referrals. Handle inquires from members, providers, and PCP\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\'s nationwide concerning their insurance benefits and claims, policy and procedures. Triage calls to special departments as needed. Process and make adjustments to claims using the correct ICD- codes.
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EDUCATION
PRESENT-UNIVERSITY OF PHOENIX (HEALTHCARE ADMINISTRATION)
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