Summary
Overview
Work History
Education
Skills
Timeline
Generic

Edgar Ward

San Antonio,TX

Summary

Outcome-driven professional with track record of managing administrative processes in healthcare settings. Adept at performing multiple functions, including inbound and outbound calls, patient information management, and provider support. Strong interpersonal and communication skills, with a focus on delivering exceptional customer service. Skilled in emphatically listening to customer grievances, resolving conflicts, and offering appropriate solutions, while demonstrating patience, calmness, and professional endeavor. Expertise in maintaining accurate records, streamlining operations, and contributing to the overall efficiency of clinical administrative functions. Ability to foster a transparent and winning environment with humility, resourcefulness, directness, and absolute professionalism.

Overview

11
11
years of professional experience

Work History

Patient Care Coordinator/Contractor

ROSE INTERNATIONAL/WELLMED
San Antonio, TX
05.2024 - Current
  • Handle 75-90 outbound/inbound patient telephonic calls per day to schedule patient’s health screenings of quality measures
  • Collect and verify patient demographic information, insurance eligibility including plan co-insurance, language, and ethnicity preference for future contact follow-up with patient will include rescheduling appointments that were cancelled, rescheduled and no-show
  • Follow-up with patients reschedule appointments that were cancelled, rescheduled or no-shows
  • Average appointments set per day nine
  • Met all established daily productivity goals with first monthly assessment score 96.7.

Care Team Associate (position eliminated)

UNITED HEALTH GROUP
San Antonio, TX
11.2019 - 08.2023
  • Collaborate in obtaining medical records from providers through phone and fax for timely preparation of authorizations
  • Facilitate transmission of medical records to nurses for thorough review
  • Support the initial screening of concurrent authorization requests across various communication channels
  • Analyze data to generate ongoing key performance indicators, summarizing findings for presentation to departmental leadership
  • Successfully obtained approval for 100 treatment requests daily
  • Offered assistance in troubleshooting authorization-related issues identified by the Medical Management team
  • Executed concurrent authorizations in WellMed authorization system in line with approved policies/procedures.

Research Interviewer

NIELSEN
San Antonio, TX
10.2017 - 04.2019
  • Oversaw outbound calls to engage participants in media survey
  • Sustained participant engagement during short or medium-length surveys with low to medium complexity, while ensuring accurate capture of respondent answers
  • Secured consistent and unbiased data by encouraging household cooperation in participating in the survey.

Engagement Specialist

CARENET HEALTHCARE SERVICES
San Antonio, TX
02.2016 - 10.2017
  • Delivered recovery-oriented, trauma-sensitive, and direct clinical services by efficiently managing inbound and outbound calls
  • Gathered and entered essential information on plan coverage and patient details into the system
  • Organized precise records of patient care, including condition, progress, and concerns
  • Conducted outreach to members, identifying needs and assisting in scheduling Primary Care Physician (PCP) appointments.

Licensed Agent

ALORICA (West Corporation)
San Antonio, TX
06.2014 - 01.2016
  • Facilitated distribution of crucial information to increase enrollment in pre-65, group, and individual Medicare/supplemental insurance plans
  • Demonstrated effective communication skills in instructing customers on health plans and insurance policies, contributing to enhanced understanding and informed decision-making
  • Led high volume of inbound calls related to member enrollment
  • Acquired Health, Life, Accident license.

Client Services Representative

CGI
San Antonio, TX
05.2013 - 06.2014
  • Answered inbound calls from hospitals, medical centers, and doctors about enrollment with the Center for Medicare and Medicaid Services
  • Solved provider issues related to reimbursement, proper utilization of policies and procedures, and coordinated resolution through provider education
  • Aided providers in navigating and understanding processes associated with testifying for meaningful use.

Customer Service Representative – Senior

UNITED HEALTH GROUP
San Antonio, TX
  • Responded to inbound and outbound calls, addressing inquiries and concerns related to benefits, eligibility, claims, financial spending accounts, and correspondence
  • Liaised with care providers on behalf of customers, facilitating appointment scheduling and connections with internal specialists for additional support
  • Educated customers on the principles and advantages of consumer-driven health care, providing guidance on selecting optimal benefit plan options, maximizing health plan benefits, and selecting quality care providers
  • Guided customers in navigating myuhc.com and other UnitedHealth Group websites, encouraging and supporting them in becoming self-sufficient users of these tools.

Education

High School Diploma -

Boston Technical High School
Boston, MA

Skills

  • Healthcare Operations Management
  • Medicare and Medicaid
  • Customer Education & Support
  • Team Training & Leadership
  • Enrollment Procedures
  • Patient Care & Coordination
  • Data Analysis & Reporting
  • ICD-9 & ICD-10 Coding
  • Procurement
  • Policy Development
  • Regulatory Compliance
  • Continuous Improvement
  • MS Office
  • Excel
  • Word
  • Administrative processes
  • Inbound and outbound patient information management
  • Provider support
  • Strong interpersonal and communication skills
  • Customer service
  • Clinical administrative functions

Timeline

Patient Care Coordinator/Contractor

ROSE INTERNATIONAL/WELLMED
05.2024 - Current

Care Team Associate (position eliminated)

UNITED HEALTH GROUP
11.2019 - 08.2023

Research Interviewer

NIELSEN
10.2017 - 04.2019

Engagement Specialist

CARENET HEALTHCARE SERVICES
02.2016 - 10.2017

Licensed Agent

ALORICA (West Corporation)
06.2014 - 01.2016

Client Services Representative

CGI
05.2013 - 06.2014

Customer Service Representative – Senior

UNITED HEALTH GROUP

High School Diploma -

Boston Technical High School
Edgar Ward