KATIRIA SANTOS
Newark,NJ
Summary
Compassionate Patient Coordinator with a proven track record in coordinating patient care and optimizing scheduling processes. Demonstrates expertise in managing patient information with a focus on accuracy and confidentiality. Recognized for effective communication skills and resilience under pressure, leading to enhanced patient satisfaction levels. Aiming to leverage these skills to further improve healthcare delivery and patient experiences.
Overview
20
20
years of professional experience
Work History
Non-Clinical Case Management Coordinator
Robert Wood Johnson Barnabas Health
Belleville, NJ
04.2023 - Current
- Managed transitions for patient discharges from acute to post-acute and home settings.
- Facilitated prompt communication with patients regarding care plans.
- Worked closely with Hospitalists, Discharge Planners, Social Workers, and Physical Therapists.
- Scheduled discharge-related appointments to ensure continuity of care.
- Managed referrals to relevant service providers within the community.
- Partnered with cross-functional teams to develop comprehensive patient care strategies.
- Coordinated with management to streamline aspects of patient care, focusing on both clinical and administrative efficiencies.
- Actively participated in staff meetings discussing best practices in patient care coordination.
Outreach and Enrollment Specialist
Strive Health
Denver, CO
10.2020 - 04.2023
- Provided telephonic insurance healthcare consultation to CKD and ESRD patients.
- Collected payments, processed receipts and informed policyholders of outstanding balances.
- Processed enrollment requests, including data entry into system database.
- Assisted new policyholders with processing claims.
- Responded to patient inquiries regarding enrollment processes in a timely manner.
- Collaborated with other departments to ensure accurate processing of enrollments.
- Generated letters, emails, and other correspondence related to enrollments.
- Delivered essential administrative assistance in appointment scheduling, record management, and report creation.
Patient Registration Specialist
Actify Neurotherapies
Princeton, USA
07.2019 - 03.2020
- Conducted insurance eligibility verifications to ensure coverage of services provided.
- Reviewed benefit plans for accuracy of coding changes when necessary.
- Met needs of physicians and other treating team members with timely retrievals of patient medical records.
- Followed up with insurance companies regarding denials of claims or incorrect reimbursements amounts.
- Entered data into the computerized registration system to update patient demographics records.
- Collaborated closely with clinical staff members regarding scheduling conflicts or cancellations due to unforeseen circumstances.
- Verified insurance benefits prior to patient visits to maximize reimbursement potential.
- Verified insurance and collected critical data elements to properly identify and bill patients.
Patient Account Representative
Prime Healthcare Business Services CBO
Newark, USA
08.2017 - 04.2019
- Initiated collection activities on delinquent accounts while adhering to HIPAA guidelines and regulations.
- Engaged in outreach to recover payments from patients with outstanding balances.
- Communicated frequently with healthcare providers regarding payment status updates on their claims submitted.
- Evaluated denied claims from third-party payers to identify reimbursement solutions.
- Drafted appeals for denied claims using evidence gathered from extensive research.
- Monitored overdue accounts using automated information systems.
- Analyzed inconsistencies in patient accounts and identified solutions.
- Worked closely with insurance companies to obtain authorization for services rendered.
- Managed payment posting while ensuring timely updates to account records.
Personal Lines Account Analyst
AIG Financial
Berkeley Heights, USA
11.2015 - 06.2016
- Gained in-depth knowledge of financial and insurance products, services, and industry best practices.
- Executed policy modifications including cancellations, endorsements, reinstatements, and renewals.
- Delivered customer support, addressing inquiries and solving problems.
- Tracked renewal dates for all personal lines accounts and provided timely reminders to customers prior to expiration date.
- Explained coverage options to potential policyholders, answering questions or concerns.
- Counseled prospects and policyholders on coverage, limits and regulations.
- Identified potential risks associated with policyholders and offered appropriate solutions.
- Calculated premiums and established payment methods, receiving customer payments and issuing receipts.
Account Services Representative
Plymouth Rock Assurance
Berkeley Heights, USA
09.2013 - 11.2015
- Generated appointments and quotes through proactive outbound prospecting and lead activity management.
- Responded quickly to customer inquiries via phone or email.
- Served as primary contact and support for maintaining account information and opening and closing accounts.
- Maintained accurate and complete records on past due accounts and collection actions.
- Counseled prospects and policyholders on coverage, limits and regulations.
- Identified potential risks associated with policyholders and offered appropriate solutions.
- Performed regular audits of account files to ensure accuracy of information.
- Monitored clients' insurance coverages to ensure changing needs were met.
Disability Claims Specialist
Prudential Financial
Roseland, USA
03.2005 - 06.2008
- Received patient inquiries or complaints and directed to appropriate medical staff members.
- Explained various admission forms and policies, acquiring signatures for consent.
- Maintained accurate records and files containing detailed information on each claim processed.
- Investigated medical records and gathered evidence in support of approved or denied claims.
- Maintained confidentiality of patient information in compliance with HIPAA regulations.
- Scanned documents into electronic medical records system.
- Prepared and reviewed insurance-claim forms and related documents for completeness.
- Reviewed and analyzed disability claims to determine eligibility for benefits.
Education
Associate of Applied Science - Office Administration/Legal Concentration
Gibbs College
Montclair, NJ03.2002
Skills
- Case assessment
- Case management
- Proficient in EPIC systems
- EMR management
- Discharge coordination
- Patient communication
- Healthcare system navigation
- Time management
- Effective communication
- Organizational skills
- Analytical skills
- Claims processing
- Insurance verification
- Patient scheduling
- Billing statement processing
- HIPAA protocol adherence
- Patient registration
- Medical data collection
- Patient education
- Patient outreach and Follow-up
Timeline
Non-Clinical Case Management Coordinator
Robert Wood Johnson Barnabas Health
04.2023 - Current
Outreach and Enrollment Specialist
Strive Health
10.2020 - 04.2023
Patient Registration Specialist
Actify Neurotherapies
07.2019 - 03.2020
Patient Account Representative
Prime Healthcare Business Services CBO
08.2017 - 04.2019
Personal Lines Account Analyst
AIG Financial
11.2015 - 06.2016
Account Services Representative
Plymouth Rock Assurance
09.2013 - 11.2015
Disability Claims Specialist
Prudential Financial
03.2005 - 06.2008
Associate of Applied Science - Office Administration/Legal Concentration
Gibbs College
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