Alice Swenson

• Conduct patient insurance education
• Identify and effectively communicate opportunities to better the insurance status of patient to help reduce or alleviated financial risk and burden
• Provided information to patients to help them find and/or secure options for insurance coverage and other financial assistance programs as necessary.
• High-level customer service to patients across multiple DaVita Dialysis facilities to ensure educational needs are met and to ensure patient questions or issues are addressed effectively.
• Complete insurance assessments/evaluations for patients to accurately document patient education sessions.
• Acted as a liaison between patients, facility teammates, billing office and corporate office to resolve patient insurance issues and/or concerns.
• Build and maintain relationships with field partners (e.g. Home Program Departments, Facility Administrators, Social Workers, Administrative Assistants) to ensure seamless patient support.
• Worked closely with supervisor/manager to meet objectives, deadlines, and reporting requirements as they pertain to patient education.
• Provide monthly reporting and analysis on key metrics related to patient education and advocacy as well as actively participate in monthly operations reviews on assigned patient portfolio.
• Find opportunities for continued process improvement and review ideas with team and operational leadership.
• Assisted with onboarding and training of new teammates.

• Provided all secretarial support for Regional Operations Director.
• Coordinate and arrange conference calls and gather data and prepare DeNovo information as needed.
  • Coordinate new facility open houses
  • Prepare Monthly Facility Report Calendar and follow through with facilities
  • Arrange travel plans for ROD
  • Proactively monitor and manage office supplies and equipment needs
  • Manage calendar and coordinate meetings with facility directors, administrators, and corporate personnel

Reconcile and track expense reports
• Assist with creating presentations as requested
• Act as facility and customer liaison for ROD
• Attend education activities, in-services, and staff meetings
Handle special projects on an as-needed and sometimes urgent basis

• Received incoming calls and gathered information for potential Physical Medicine and Rehab inpatient admits.
• Obtained verification of insurance and referral authorizations. Tracks and inputs client data into database.
• Critical thinking and able to manage multiple assignments in a fast paced environment.

• Acted as liaison between the patient/member and Kaiser Permanente in providing general assistance and education on how to utilize multiple Kaiser system, resolve member complaints and grievances as efficiently as possible, and answer Health-Plan related questions.
• Partnered with other departments in the organization, such as Marketing and Health Education, and attends community, employer and KP events to ensure accurate information is provided to various clientele regarding KP services, benefits, and protocols.
• Research, resolve and communicate Health Plan/coverage/benefit-related issues for members.
• Maintain current comprehensive knowledge of Health Plan benefits, eligibility and exclusions.
• Educate providers, staff and individual members on Health Plan benefits and services, explaining the details of specific member plans.
• Participate in research or resolution of the organizations complaint and grievance process.
• Appropriately interview member/patient (or authorized representative of patient) in person or via phone regarding benefit, service, and medical care issues, document, and triage all case information to correspondence center. Accountable for investigation of issues, including collection and documentation of appropriate data.
• Effectively handle and attempt to resolve member issues that are received from numerous sources.
• Appropriately transfer all applicable cases and accompanying documentation after initial resolution effort in keeping with all regulatory requirements and internal policies and procedures.
• Assist non-English or limited-English speaking customers in the use of interpreter services.
• Responsible for communicating with members or their authorized representative(s), regarding the Health Plans response and grievance/ complaint process.
• Ensure that complaints and grievances are processed in accordance with regulations, compliance standards, policies and procedures. Regulators include, but are not limited to: Center for Medicare/Medicaid (CMS), California Department of Managed Healthcare (DMHC), Department of Health Services (DHS), Department of Labor, Department of Consumer Affairs, the National Committee for Quality Assurance (NCQA).
• Ensure integrity of departmental database by thorough, timely and accurate entry, consistent with regulatory protocols and applicable P&Ps and effectively manages case resolution inbox everyday.
• Research and resolve, to the extent possible, member/system conflicts to obtain member satisfaction and minimize health plan risks.
• Interpret and communicate Health Plan benefits/contracts to internal and external clients.
• Responsible for the written and verbal interpretation of the Health Plan service agreement. Educate members/patients about their rights and responsibilities, medical center services, policies and procedures.
• Identifies member - system conflict in an effort to prevent professional liability, minimize financial penalties to the organization, and retain satisfied members.
• Communicate continually with a diverse set of internal and external clientele to achieve excellent results in the areas of complaint and grievance handling, compliance, documentation, benefit/contractual information, and enhancement of the member experience.
• Collaborate with internal staff, managers and physicians, to identify opportunities to advocate for the member and resolve issues as quickly as possible.

• Supported pharmacist in preparing daily prescriptions.
• Answered customer questions about prescribed and OTC medications.
• Confirmed prescriptions for patients by placing calls and conferring with physicians' office staff.
• Greeted customers to determine wants or needs.
• Assisted customers by answering questions, locating items or referring to pharmacist for medication information.
• Assisted pharmacist in daily operations tasks and administrative tasks.
• Stocked shelves and supplies and organized displays to focus customer attention on specific items.
• Counted and balanced cashier drawers.
• Responded to customer issues to provide immediate resolution and improve retention.