CAROL BROWN

• HHSC Medicaid Chip Services (MCS) AS Contract Specialist IV work on HIGH PRIORITY ASSIGNMENTS
• Reports to Health Plan Manager located in Managed Care Contracts and Oversight (MCCO)
• Coordinates development and evaluation of MCCO policies as affect MCO contracts and makes recommendations for changes as need
• Contract Specialist work under limited direction with considerable latitude for use of initiative and independent judgment and perform other duties as may be assigned or required
• Generated regular reports on project progress utilizing spreadsheet software applications like MS Excel and Access
• Developed and maintained filing systems for confidential documents and records
• Participate in training and mentoring of team members, responsible to ensure compliance, evaluate MCO performance and manages corrective actions, shows initiative to take on new projects, is team-oriented and committed outstanding customer service, and focuses on promoting efficiencies and accountability
• Maintained files and filing, keeping sensitive information confidential. Created maintained and entered information into databases

Job duties consist of verify all documents HCS (Home & Community Based Services) & TxHml (Texas Home Living Waiver) agency account & Component Code, WCA (Wavier Contract Area) Scanning, verify all documents before using SCOR (System of Contract Operation and Reporting) to provide one system to records for Management and Reporting, Compliance for all HHSC (Health and Human Services Contracts)

• H.I.M.(Health Information Management) Retrieve/Reconcile medical records and loose documentation from ancillary departments, facilities, vendors, etc. (ER-Emergency Room, IP-Inpatient Admit in Hospital, SD-Same Day Procedure/Outpatient
• Responsible for monitoring, maintaining organizing record filing room
• Responsible for reporting lost chart and spacing to Director
• Assists Hospital Staff with requests for information on discharged and active patients
• Utilizes, perform daily routine data entry of clinical services, clinical charges to maintain patient charts consist of daily admissions
• Maintained up-to-date knowledge of HIPAA regulations related to the protection of PHI
• Retrieved requested medical records in a timely manner while maintaining confidentiality of protected health information
• Assists Hospital Staff with requests for information on discharged and active patients
• Utilizes, perform daily routine data entry of clinical services, clinical charges to maintain
• Assembling patient charts with necessary documents for physician review, including lab results, imaging reports, and progress notes.
• Inputting patient demographics, medical history, diagnoses, procedures, and medications into electronic health record system. patient charts consist of daily admissions

Job duties consist of *Responsible for monitoring, maintaining *organizing the record filing room *Responsible for reporting lost chart and spacing to the Director * Assists Hospital Staff with requests for information on discharged and active patients. Utilizes, perform daily routine data entry of clinical services, clinical charges to maintain patient charts *consist of daily admissions *maintain confidential files *filing *purging chart *preparing's on EMR *scanning documents *indexing documents different *Daily Request *Medical Records Request for Patients Records from All Healthcare Providers & Recipient need to
submit Medical Release Form (need to be scanned & faxed to CIOX)

• Texas Health and Human Services Commission (HHSC) Access and Eligibility Services (AES) . Performs case reviews to determine validity and accuracy of eligibility determinations made by other staff. Initiates, monitors, and manages service improvement projects and reports on activities.
• Maintained a high level of confidentiality when dealing with sensitive information related to clients' cases
• AES provides customer service to clients and stakeholders
• Interviewed applicants to obtain and verify information to determine eligibility
• Initiates, monitors, and manages service improvement projects and reports on activities
• Approved or denied applications, informing applicants within required time frames.
• Performed data entry tasks accurately and in timely manner.
  
• Interviews clients, verifies financial and other information, and determines/re-determines eligibility for SNAP (Food Stamps), Temporary Assistance for Needy Families (TANF), Medicaid and/or Medicaid for Elderly and People with Disabilities (MEPD) programs
• Completes formal reports and narratives for management
• Provides general information and assistance to clients regarding programs and application process

Job duties consist of *Interviews clients, verifies financial and other information, and determines/re-determines eligibility for SNAP (Food Stamps), Temporary Assistance for Needy Families (TANF), Medicaid and/or Medicaid for Elderly and People with Disabilities (MEPD) programs. Completes formal reports and narratives for management. • Provided exceptional customer service to ensure customer satisfaction

• DSHS Laboratory Recorded Line provides Customers Service to All Healthcare Providers, Hospital, Public Health Department and Colleges and Schools in the State of Texas
• DSHS Laboratory, healthcare providers must first enroll and obtain an active "Submitter ID number," which is essentially a unique identifier required to submit specimens and access test results
• HIPPA Medical Release Form Required from Recipient and Universal
• Performed data entry tasks accurately and in a timely manner
• Responded to customer requests for products, services, and company information.

Job duties consist of *Responds to request by phone, fax or email from health care professionals requesting confidential. Assist with other Laboratory Reporting Group duties as needed. New Submitter Form is required due to any changes company new name w/address. Providers need to Enroll w/TMHP w/NPI/TPI ID # Varies LAB are requested NBS-(newborn screen) test 1, 2 THS-(Tx Health Steps) lead, hemoglobin, etc. HP-TB, culter,etc

H.I.M.(Health Information Management) Retrieve/Reconcile medical records and loose documentation from ancillary departments, facilities, vendors, etc. (ER-Emergency Room, IP-Inpatient Admit in Hospital, SD-Same Day Procedure/Outpatient

• Responsible for monitoring, maintaining organizing record filing room
• Responsible for reporting lost chart and spacing to Director
• Assists Hospital Staff with requests for information on discharged and active patients
• Utilizes, perform daily routine data entry of clinical services, clinical charges to maintain patient charts consist of daily admissions
• Maintained up-to-date knowledge of HIPAA regulations related to protection of PHI
• Retrieved requested medical records in timely manner while maintaining confidentiality of protected health information
• Assists Hospital Staff with requests for information on discharged and active patients
• Utilizes, perform daily routine data entry of clinical services, clinical charges to maintain
• Assembling patient charts with necessary documents for physician review, including lab results, imaging reports, and progress notes.
• Inputting patient demographics, medical history, diagnoses, procedures, and medications into electronic health record system. patient charts consist of daily admissions

Job duties consist of *Responsible for monitoring, maintaining *organizing record filing room *Responsible for reporting lost chart and spacing to the Director * Assists Hospital Staff with requests for information on discharged and active patients. Utilizes, perform daily routine data entry of clinical services, clinical charges to maintain patient charts *consist of daily admissions *maintain confidential files *filing *purging chart *preparing on EMR *scanning documents *indexing documents different *Daily Request *Medical Records Request for Patients Records from All Healthcare Providers & Recipient need to submit Medical Release Form (need to be scanned & faxed to CIOX)

• Customer Service Representative Recipients Health Care Provider All Incoming/Outgoing Calls
• Verify Austin Gastro documents Super bill Procedure Orders Procedure Codes Diagnoses
• Verify Recipient Health Plan eff date deductible coinsurance copay amount out of pocket
• Call Recipient DOS of Procedure & Time Estimate fee Copay Amount Offer Payment Plan
• Obtain Authorization/Referral Verify Austin Gastro website Call Recipient Health Plan always provide procedure/diagnoses code & get Representative Name w/reference Number
• Evaluated adequacy and competitiveness of current pricing models for personal insurance products.
• Performed benefit calculations for retirement and terminated vested.

Job duties consist of Obtain Authorization/Referral *Verify Austin Gastro website *Call Recipient Health Plan always provide procedure/diagnoses code & get Representative Name w/reference.*Call Recipient- *DOS of Procedure & Time *Estimate fee *Copay Amount **Offer Payment Plan

• Customer Service Representative Recipients Health Care Provider All Incoming Calls Claim Status
• EOB Information Insurance Paid Patient Responsible Patient Previous Paid Patient Owes Refund
• Set up Payment Plan monthly payment W/Amount Email Receipt 20% discount
• Recipients Request for Insurance Itemization Statement Copy of Estimate Fee Resubmit Claim
• Call Recipient Health Plan Verify Eligibility for DOS Authorization Required Claim Status
• Work on Bad Debt Account Resubmit Denied Claims Claim Rejection
• Responded to customer requests for products, services, and company information.
• Trained new personnel regarding company operations, policies and services.
• Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.

• Customer Service Representative Recipients Health Care Provider All Incoming/Outgoing Calls
• Verify Recipient Health Plan Various Health Plan Eligibility
• Obtain Authorization/Referrals-Review Procedure Note/Orders Procedure code Diagnostic Code Call Recipients PCP to get Referral status Right fax Request to PCP Submit Request/Call Recipient Health Plan
• EPIC WORKQUEUE Workflow Administration Recipients demographics Provider
• Linked families to relevant community support to meet non-medical needs.
• Scheduled appointments with specialists on behalf of clients.
• Called insurance companies to get precertification and other benefits information on behalf of patients.
• Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
• Coordinated with medical staff and patients to find cost-effective options for services.
• Answered telephone calls to offer office information, answer questions, and direct calls to staff.

• Customer Service Representative Recipients Health Care Provider All Incoming/Outgoing Calls
• Verify Recipient Health Plan Various Insurance online (Medicare & TMHP Medicaid) Eligibility
• Contact Recipient Inactive benefits Update Demographics Provide dos & time
• EPIC WORKQUEUE Workflow Administration Recipients demographics Provider
• Misys Scan documents Right Fax Submit request for Records & Auth/Referral
• General Medical Records job duties: Scan document to different category such as Doctor Notes Labs HIPPA FORM RELEASE OF INFORMATION Auto fax records on EMR Daily Request from Healthcare Provider & Patients Daily Mail Request from DADS, DARS, VA HOSPITAL & SOCIAL SECURITY DEPARTMENTS
• Prepared medical records for chart audits according to front desk and charge entry audit policy.

• Customer Service Representative Recipients Health Care Provider All Incoming/Outgoing Calls
• Verify Recipient Health Plan Various Insurance online (Medicare & TMHP Medicaid) Eligibility
• Contact Recipient Inactive benefits Update demographics Provide dos & time
• EPIC WORKQUEUE Workflow Administration Recipients demographics Provider
• Misys Scan documents Right Fax Submit request for Records & Auth/Referral
• General Medical Records job duties: Scan document to different category such as Doctor Notes Labs HIPPA FORM RELEASE OF INFORMATION Auto fax records on EMR Daily Request from Healthcare Provider & Patients Daily Mail Request from DADS, DARS, VA HOSPITAL & SOCIAL SECURITY DEPARTMENTS Records are mailed out Stamp w/Date & Time Employee Initial
• Provided clerical support to company employees by copying, faxing, and filing documents.
• ALL MEDICAL REQUEST FOR RECORDS DOCUMENTED IN TIMELY, ACCURATE, LEGIBLE MANNER