Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand. Looking forward to becoming an asset to the team at State of Franklin Healthcare Associates.
Overview
9
9
years of professional experience
Work History
Health Navigator
Main Street Rural Health
Nashville, TN
08.2023 - Current
Developed appropriate community resources such as mental health services, substance abuse, treatment and housing.
Coordinated appropriate educational material for patients, families and medical staff to accomplish best possible patient care outcomes.
Confirmed patients received necessary support services such as medical care, housing and public benefits.
Worked collaboratively with physicians, staff and other health care professionals to develop, implement and evaluate integrated and comprehensive plans of care for patients.
Documented patient information in appropriate systems to guarantee care coordination throughout patient care continuum.
Served as an advocate for patients' rights within the healthcare system.
Participated in continuing education activities to stay up-to-date on current trends in healthcare navigation practices.
Monitored changes in patient conditions and responded accordingly by adjusting care plans or making referrals as necessary.
Conducted thorough assessments to determine the best course of action for each patient's individual needs.
Attended regular meetings with staff members to discuss ongoing cases and develop new strategies for providing patient care.
Educated patients on self-management techniques such as stress reduction strategies and lifestyle modifications.
Facilitated communication between patients and healthcare providers regarding treatment decisions.
Identified gaps in existing services or resources for navigating healthcare issues.
Assessed patient eligibility for various insurance programs and helped them apply when necessary.
Maintained accurate records of patient interactions and progress towards goals.
Developed care plans to ensure that all medical needs were met in a timely manner.
Coordinated referrals to appropriate specialists or community programs as needed.
Billing Specialist/Collections Agent
Intellihartx
Kingsport, TN
03.2022 - 08.2023
Contacted insurance providers to verify insurance information and obtain billing authorization.
Leveraged integrated billing software to submit accurate claims.
Worked closely with patients to discuss payment arrangements when needed.
Developed financial reports detailing accounts receivable aging status.
Implemented new policies related to billing processes when required.
Investigated incorrect billings and processed refunds as necessary.
Performed additional duties as assigned by management team.
Resolved discrepancies between customers' remittances and invoices received.
Calculated billing charges, prepared and submitted claims to insurance companies.
Reviewed medical records to ensure accuracy of billing information and patient data.
Processed credit card transactions through Point-of-Sale terminals or online systems.
Maintained accurate records of collections, adjustments and denials in the system.
Verified insurance coverage and identified third-party payers for billing purposes.
Claims Processor
United Health Group, Optum
Minnetonka, MN
11.2015 - 03.2022
Verified claim data correctness in preparation for processing.
Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
Analyzed contracts and claim systems to apply appropriate benefit amounts.
Addressed customer inquiries to provide information and explanations on coverage and terms, expediting claims.
Conducted and documented comprehensive investigations to negotiate settlements or deny claims.
Coordinated benefits with medical insurance plans and Medicare providers.
Researched medical claims for validity to resolve discrepancies.
Reviewed history records to determine benefit eligibility for services.
Corresponded with providers regarding any missing or incomplete documentation needed for successful adjudication of claims.
Maintained accurate records of all processed claims in accordance with departmental requirements.
Updated job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations .
Documented decisions on each claim based on research findings and applicable benefit plans.
Analyzed and evaluated claim forms, medical reports, bills, and other documents to ensure accuracy of data.
Researched discrepancies between submitted documentation and actual records to identify errors or omissions.
Adhered to all applicable laws, regulations, and company standards while processing claims.
Education
High School Diploma -
Lee High School
Jonesville
06-2000
Skills
Resource Navigation
Care Coordination
Health Education
Cultural Competency
Medical Recordkeeping
Community advocate
Medical Billing
Confidentiality
Insurance expert
Healthcare knowledge
Medical Terminology
Community Resources
Community Health Services
Community Resource Referral
Medical Advocacy
Critical Thinking
Problem-Solving
Social Research
Paperwork Organization
Patient Evaluation
Electronic Medical Record Software
Effective Communication
Coaching patients
Adaptability and Flexibility
Timeline
Health Navigator
Main Street Rural Health
08.2023 - Current
Billing Specialist/Collections Agent
Intellihartx
03.2022 - 08.2023
Claims Processor
United Health Group, Optum
11.2015 - 03.2022
High School Diploma -
Lee High School
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