Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Crystal Bogan

Chicago,IL

Summary

To seek and maintain a position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.

Overview

15
15
years of professional experience
1
1
Certification

Work History

Patient Advocate

Zion B Advocates LLC
Chicago, IL
06.2019 - 04.2022
  • Followed document protocols to safeguard confidentiality of patient records.
  • Worked with patients to ascertain issues and make referrals to appropriate specialists.
  • Entered details into computer systems and managed database of information.
  • Helped patients file appeals to insurance denials and worked with insurance companies to resolve disputes.
  • Maintained documentation on patient activities, coverage issues and hospital actions.
  • Reviewed patient claims, bills and medicolegal documents for accuracy.
  • Assisted patients in understanding individual rights and responsibilities in regards to care, coverage and payment.
  • Utilized knowledge of available resources to help patients select appropriate courses and obtain relevant support.
  • Connected individuals with available and relevant resources.
  • Conducted community workshops to promote different programs and educate public on available services.
  • Referred families to shelters, legal resources and educational programs.
  • Coordinated individual referrals to obtain community services, advocate for client needs and resolve roadblocks.

Provider Services Associate

Magellan Health
Maryland Heights, MO
09.2015 - 06.2019
  • First call resolution to a specified set of customers
  • Managed over 60 to 100 incoming calls for new and existing authorizations per day
  • Responsibilities include documenting in the appropriate systems and ensuring high quality and accurate information is provided to callers
  • Meet or exceed operations production and quality measures
  • Confirm billing codes for each procedure to ensure appropriate billing.
  • Maintained confidentiality of patient finances, records and health statuses.
  • Communicated verification and authorization status updates with the specialist department to facilitate decision-making for patient admissions and insurance coverage.
  • Checked documentation for accuracy and validity on updated systems.

Referral Specialist

BJC Medical Group Communication, Answering Service
02.2014 - 07.2015
  • Responds to and routes calls appropriately for all subscribed physicians and customers, including After Hours Service, Barnes Care, ACO patient alerts, and patient admission and discharge notifications
  • Maintains accountability for accurate data entry and thorough knowledge of all contact center software applications and other support systems
  • Confirms patient demographic and insurance information, makes appointments and obtain proper information for referral requests
  • Provide insurance and physician referrals for specialists
  • Performed per day about 80 120 insurance precertification for radiology, gastro and surgery procedures Researches new technologies and methods for improving patient care coordination and physician communication
  • Coordinates telephonic and application-based support for complex, medically fragile, and chronic patients by facilitating communication between services, monitoring communications to primary care physicians, and working with Washington University pediatric specialists to coordinate outpatient appointments for physicians.

Forms Processor Mail Room Clerk

Citrix
02.2010 - 01.2015
  • Data Entry
  • Collecting Confidential Data for Statistical Purposes
  • Obtains location of records using various databases to reply to customer inquiries
  • Correcting Data Before Submitting
  • Setting Appointments
  • Census of Agriculture
  • Customer Service
  • Answers customer requests via telephone, e-mail, fax, and mail
  • Making Outbound Calls
  • Receiving Inbound Calls
  • Software
  • Analyzing inquiries related to Government confidential records
  • Preparing responses to requests
  • Communicating with all levels of customers
  • Prism
  • Uses a telephone operated by an automated call distribution system, and other basic office equipment, Use a computer and 10-key pad to enter data into a database
  • Edit questionnaires and surveys by assigning appropriate codes
  • Perform data entry verification
  • Use a guillotine machine to prepare documents for scanning
  • Scan documents using scanning equipment
  • Receive, open and sort incoming mail
  • Prepare crop samples for data entry

Prior Auth Representative

Express Scripts
Saint Louis, MO
08.2013 - 10.2014
  • Processing pharmacy claims, insurance verification, chart-noting, MD, patient and insurance calls, and other projects
  • Handle inbound telephone and written inquiries from pharmacists and doctors regarding prior authorization by screening and reviewing requests based on benefit plan design, client specifics and clinical criteria
  • Provide information to clients, participants, pharmacists and doctors regarding participants pharmacy benefit, drug coverage and provide accurate procedures for medication exceptions
  • Facilitate resolution of drug coverage issues and pro-actively address, research and resolve issues while maintaining accurate and complete documentation of all inquires for continuous improvement
  • Work collaboratively with other associates and supervisor to ensure that best practices are shared
  • Followed-up on warm Internet leads and responded to customer questions about vehicle availability, price and options while fielding inquiries from various marketing websites.

Customer Service

Macys.com
10.2012 - 12.2012
  • Seasonal
  • Process Orders
  • Update Private Information
  • Resolve Issues
  • Approve Credit Line
  • Track Orders
  • Concern Listening
  • USDA - Nass Call Center Enumerator Telephone Interviewer, Greeting Customers Coming and Going

Project- Extraction Operator

Randstad IRS
04.2012 - 05.2012
  • Open and Sorting Tax Forms
  • Processing Checks and IRS Forms with Proper Stamping
  • Making Sure Tax and IRS Forms Have Proper Supporting Documents

Greeter

Wal-Mart Door
10.2011 - 03.2012

Education

Diploma - Computer Applications

Morton Senior HS
06.2007

Business Technology/ Administration Certification Hammond - Business Administration And Management

Hammond Area Career Center
Hammond, IN
06.2005

Skills

  • Patient Confidentiality and Data Security
  • Registration and Scheduling
  • Providing Information and Resources
  • Documenting and Recording Information
  • Administrative and Office Support

Certification

  • Business Administration Management Certification - 08/2005-06/2006
  • Business Administration Management Certification Hammond Area Career Center - 08/2005 - 06/2006

Timeline

Patient Advocate

Zion B Advocates LLC
06.2019 - 04.2022

Provider Services Associate

Magellan Health
09.2015 - 06.2019

Referral Specialist

BJC Medical Group Communication, Answering Service
02.2014 - 07.2015

Prior Auth Representative

Express Scripts
08.2013 - 10.2014

Customer Service

Macys.com
10.2012 - 12.2012

Project- Extraction Operator

Randstad IRS
04.2012 - 05.2012

Greeter

Wal-Mart Door
10.2011 - 03.2012

Forms Processor Mail Room Clerk

Citrix
02.2010 - 01.2015

Diploma - Computer Applications

Morton Senior HS

Business Technology/ Administration Certification Hammond - Business Administration And Management

Hammond Area Career Center

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Crystal Bogan