Amy Drake
Lockport,NY
Summary
Obtain a career utilizing my experience and skills to assist a company with their goals.
Overview
19
19
years of professional experience
Work History
Patient Service Representative
General Physician, P.C.
09.2022 - Current
- Responsible for scheduling patients, managing phone calls, triaging Docotors/Nurses, banking/managing of daily money intake, filing, copying, scanning, work with Medent, verify insurance and eligibility.
Elite Health Advocate
UHC United Healthcare
09.2021 - 09.2022
- Inbound/Outbound calls from/to members regarding their benefits/claims
- Create commitments to address client issues and follow up
- Investigate claims for errors and send for review and correction as needed
- Handled Medical, behavioral Health and Pharmacy claims
- Worked with ISET, Excel, Word, Knowledge Central, Knowledge Library and Teams.
Social Services Worker
Niagara County Department of Social Services
09.2020 - 08.2021
- Assist clients with eligibility requirements and determining eligibility for Public Assistance, Medicaid and SNAP benefits
- Inbound and outbound phone calls
- Client interviews
- Following up with various departments
- Referrals
- Completion of paperwork
- Opening cases when complied with eligibility requirements.
System Resolution Coordinator
Fidelis Care
01.2017 - 09.2020
- Review appeals sent in by providers and provide outcome and rationale for upholding or overturning claims
- Review and process invoices for payment
- Follow up with responses from various departments for finalization of appeals
- Proficient in Facets, Excel, Cotiviti Edits, and Webstrat
- Investigate claims and payment denials
- Investigate Contracts.
Claims Review Analyst
Fidelis Care
12.2015 - 01.2017
- Detailed review of processed claims for corrections
- Work with XC reports, IHT edits, 3C reports, Excel, and Facets
- Follow up with responses from various departments by maintaining my personal route que
- Work various reports as requested by supervision.
Claims Processor
Fidelis Care
10.2014 - 12.2015
- Processed claims according to regulation
- Worked pend reports to ensure correct processing of claims
- Assisted supervisor with any tasks as asked
- Sorted various claims for appropriate processing.
Managed Long Term Care Service Coordinator
Fidelis Care Of New York
03.2013 - 10.2014
- Coordinate homecare services for MLTC members
- Set up and extend authorizations
- Caseload of 175+ members
- Assist supervision with special projects
- Advocate for the members
- Work closely with the nurse care managers.
Provider Call Center Associate
Fidelis Care Of New York
06.2010 - 03.2013
- Assisted providers with resolution on claims
- Completed appropriate documentation and forwarded to appropriate department for completion
- Follow up with providers on outcomes of reviews
- To date I have received several thank you letters from providers for assisting with different issues.
Client Service Supervisor
Niagara Cerebral Palsy
04.2005 - 12.2008
- Effectively maintained operations of ten bed ICF for developmentally disabled adults
- Provided all aspects of supervision to the residential staff
- Maintained and updated files of residential staff and consumers as required by state regulations
- Investigations of possible abuse/neglect cases
- Effectively followed company policies and procedures
- Worked as part of the Incident Reporting committee on Investigations.
Education
High School Diploma -
Starpoint Central High School
01.1995
Skills
- Facets
- Microsoft Office
- Microsoft Word
- Datanet
- Cotiviti Edits
- Web Strat
- EDI
- Developmental Disabilities Experience
- Communication skills
- Computer literacy
- Document review
- Documentation review
- ICD-10
- Medical Terminology
- Medical Records
- CPT Coding
- Medical Billing
- ICD Coding
- ICD-9
- Employee evaluation
- Triage
- Insurance Verification
- Medical Scheduling
- MEDENT
- Customer Service
- HIPAA Compliance
- Eligibility Determination
- Scheduling appointments
- Payment Collection
- Patient Intake
- Data entry proficiency
- Healthcare industry understanding
- Office Administration
- Medical insurance
- Reception Management
- Problem-Solving
- Multitasking and Organization
- Team Collaboration
- Relationship Building
- Regulatory Compliance
- Team Leadership
- Attention to Detail
- Punctual and Hardworking
- Caring and Empathetic
- Reliability and Dedication
- Calm and Effective Under Pressure
- Insurance Authorizations
Additional Information
Over four years of supervisory experience, Proven record as a "fast learner" who admires challenges, Highly oriented to detail and well organized, Motivated to multi-tasking
Timeline
Patient Service Representative
General Physician, P.C.
09.2022 - Current
Elite Health Advocate
UHC United Healthcare
09.2021 - 09.2022
Social Services Worker
Niagara County Department of Social Services
09.2020 - 08.2021
System Resolution Coordinator
Fidelis Care
01.2017 - 09.2020
Claims Review Analyst
Fidelis Care
12.2015 - 01.2017
Claims Processor
Fidelis Care
10.2014 - 12.2015
Managed Long Term Care Service Coordinator
Fidelis Care Of New York
03.2013 - 10.2014
Provider Call Center Associate
Fidelis Care Of New York
06.2010 - 03.2013
Client Service Supervisor
Niagara Cerebral Palsy
04.2005 - 12.2008
High School Diploma -
Starpoint Central High School
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