Barbara Elder
Kingston,MA
Summary
Organized and motivated employee eager to apply time management and organizational skills in various environments. Seeking opportunities to expand skills while facilitating company growth.
Overview
18
18
years of professional experience
Work History
Inter-plan Host Associate
Blue Cross Blue Shield of Massachusetts
Hingham, MA
02.2023 - Current
- Reviewed and processed incoming claims for accuracy and completeness.
- Analyzed claim information to determine the appropriate course of action.
- Provided assistance in developing new processes and policies related to claim processing.
- Followed up on denied or rejected claims to resolve issues quickly.
- Managed multiple tasks simultaneously while meeting tight deadlines.
- Identified areas of improvement within existing processes and proposed solutions.
- worked Union accounts
- Hospital Credit Balance
- Out of Balance
- worked multiple projects
- Trained associates on Union chat & Union processes
- Collaborated with Support staff to update workflows
- DRG validation
- GI's & follow-up to resolve any claims issues
- Met or exceeded and maintained all Metrics
- Trained to become a Complex associate
Provider Service Representative
Blue Cross Blue Shield
Hingham, MA
10.2021 - 02.2023
- Investigated and resolved Provider Inquires and concerns related to Claims/ Benefits & Eligibility
- Claims processing
- Appeals processing
- Mentored new hires
- Maintained and exceeded all call metrics
- Use of Systems such as Blue View, NASCO, MHK & Payspan
- OTL/Appeals/Benefits & Eligibility/ Professional and Facility Claims.
Home Support Coordinator
South Shore Support Services Inc.
09.2006 - 05.2020
- Dressed, groomed and fed patients with limited physical abilities to support basic needs
- Helped transition patients between bed, wheelchair and automobile to provide safe mobility support
- Delivered a high level of assistance with cooking, meal preparation and shopping
- Maintained patient hygiene by administering bedpans, urinals, baths and shaves
- Planned optimal meals based on established nutritional plans
- Provided entertainment and companionship through conversation, reading and board games
- Maintained updated records and safeguarded patient privacy in accordance with HIPAA
- Administered prescribed medications under direction from physicians
- Transported individuals to medical appointments and assisted with errands
- Documented patient status and reported changes in care needs
- Worked successfully with diverse groups of coworkers to accomplish goals and address issues related to our products and services
- Worked closely with team members to deliver project requirements, develop solutions and meet deadlines
- Prioritized and organized tasks to eciently accomplish service goals
- Juggled multiple projects and tasks to ensure high quality and timely delivery
- Demonstrated self-reliance by meeting and exceeding workow needs
- Demonstrated leadership by making improvements to work processes and helping to train others
- Motivated and encouraged team members to communicate more openly and constructively with each other
- Communicated with patients with compassion while keeping medical information private
- Created and maintained facility documents and records, maintaining accuracy while managing sensitive data
- Directed daily operations at a facility caring for ve individuals
- Headed clinical oversight to devise and establish policies, procedures and best practices in alignment with regulatory requirements
- Ordered all supplies needed for pharmacy and kept tabs on inventory levels
- Oversaw clinical administration, including nancial management, recruitment and human resources
- Trained and qualied staff per board requirements as well as national, state and local regulations
- Improved patient outlook and daily living through compassionate care
- Tracked and reported clients' progress based on observations and conversations
- Supervised medication administration, personal hygiene and other activities of daily living
- Followed a care plan and directions to administer medication
- Aided with mobility and independence for disabled individuals and continually monitored safety
- Assisted clients with personal hygiene needs, including bathing, dressing and incontinence care
- Managed various dailyjob tasks, including patient transportation and appointment scheduling
- Organized and administered medications on schedule to alleviate symptoms and improve quality of life
- Trained employees on best practices and protocols while managing teams to maintain optimal productivity.
Education
CNA/HHA Certications -
Massasoit Community College
06.2021
GED -
Quincy High School
12.2002
Skills
- Case management Experience
- Communication
- Data entry
- Medical terminology
- Client care & Safety
- HIPPA regulations
- Product knowledge
- Communication & documentation skills
- Adhering to Association guidelines
- Trained Associates
- Team Collaboration
- Strong interpersonal skills
- Quick learner
Languages
English
Timeline
Inter-plan Host Associate
Blue Cross Blue Shield of Massachusetts
02.2023 - Current
Provider Service Representative
Blue Cross Blue Shield
10.2021 - 02.2023
Home Support Coordinator
South Shore Support Services Inc.
09.2006 - 05.2020
CNA/HHA Certications -
Massasoit Community College
GED -
Quincy High School
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