Francisco Velez
Carol Stream,Il
Summary
Current role is a Human Service Caseworker with in-depth knowledge of county program forms, procedures and policy systems. Accommodating individual skillful in creating customized plans for each client. Commended for effectively handling complex claims and rectifying discrepancies. Previous role as a health care professional with over ten years of experience working in service oriented environments, and enhancing the provision of quality care. Possess a versatile background implementing highly effective operational solutions within different health care environments. Possess the ability to work in unison and effectively communicate with peers and senior management. Seeking a position to utilize these skills to strengthen and create well managed and quality focused professional health care focused environments.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Human Services Caseworker
State of Illinois-Department of Human Services
Chicago, IL
09.2019 - Current
- Analyzed numerical and narrative data from automated system to interpret eligibility determinations.
- Attended meetings and participated in staff development training activities.
- Interviewed applicants to verify information eligibility for public assistance.
- Contacted applicants to discuss discrepancies and referred questionable cases to upper management for follow-up.
- Completed accurate legible documentation for client profile as outlined by policy, reports and observations.
- Discussed rights and responsibilities associated with public assistance with applicants.
- Obtained income, asset and financial information to determine program eligibility.
- Supported applicants in completing documents with accuracy for human service programs.
- Conducted assessments of family strengths, needs and barriers.
- Prepared documents necessary to initiate, continue and modify public assistance.
- Processed benefit computations and under or overpayment adjustments.
- Collaborated with social workers to support patients.
- Maintained thorough and accurate records outlining program operations and participant progress.
- Evaluated patient behavior and reported changes to clinical team.
- Observed safety protocols to minimize accidents and spread of disease.
- Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
- Answered questions and responded to inquiries to deliver high level of service to customers.
- Answered questions and responded to inquiries to deliver high level of service to customers.
- Discussed available program services with potential participants and outlined procedures to facilitate smooth engagement in program processes.
Quality Inspector
O & K American Corporation
Chicago, Il
09.2016 - 07.2019
- Completed critical inspections of products using various quality instrumentation methodologies.
- Completed recalibration of micrometers for the entire corporate personnel.
- Performed data entry of production data and created production reports for upper management.
- Key member of the safety and emergency response teams.
- Provided team training and mentoring on all machinery.
- Conducted spectrometer analysis of products.
Financial Aid Advisor
Career Education Corporation
Schaumburg, Il
05.2013 - 06.2015
- Work closely with Admission Representatives to facilitate outstanding customer service to prospective students.
- Work closely with future, active, transfer and re-entry students to evaluate financial aid options.
- Develop financial aid plans that meet the student's needs and Federal regulations.
- Maintain complete and accurate files to ensure 100% verification and compliance.
- Access reports to maintain and track correct disbursements and funding.
- Maintain over a 75% average completed student file every month.
- Developed close professional relationships with trust and respect among all departments.
- Developed excel spreadsheets and PDF versions of many forms used by FAC's.
- Maintain students eligible for Federal Aid and ensure proper funding.
- Eligibility Patient Advocacy Liaison Services (Team Lead).
NCO Group Incorporated
Milwaukee, WI
08.2010 - 05.2013
- Educate patients and patient representatives on the eligibility requirements, application process, and verification requirements for applicable programs.
- Ensure accounts are processed in accordance to Eligibility Program standards, Client expectations, and federal and state regulations including but not limited to, Health Insurance Portability and Accountability Act (HIPAA) guidelines.
- Provide feedback to management concerning possible problems or areas of improvement.
- Facilitate the application process when appropriate for the patient by assisting the patient in the completing of the application, scheduling appointment interviews and obtaining required verification.
- Maintain consistent proactive communication with the patient and/ or patient representative throughout the eligibility process, keeping the patient informed of the accounts progress.
- Maintain a professional relationship with the patient and governmental agencies to ensure cooperation and compliance.
- Document pertinent patient information and all work activity in the appropriate systems dictated by NCO policies and procedures.
- Knowledge, understanding, and compliance with all applicable Federal, State, and Local laws and regulations.
- Knowledge, understanding, and compliance with NCO policies and procedures.
- Maintain knowledge of functional area and company policies and procedures.
- Make recommendations to implement improved processes.
- Maintain the appropriate level of work activity according to work standards and establish work processes to ensure timely certification.
- Train and interview potential employees.
- Conduct and initiate proper training protocol procedures for new employees.
- Monitor employees to ensure that NCO policies are being implemented as well as evaluate employee's productivity.
Patient Accounts Representative
Aurora Healthcare
Milwaukee, WI
06.2006 - 09.2007
- Analyzed, prepared, and followed up on insurance claims to include private insurance, Medicare, or Medicaid.
- Performed a variety of specialized clerical tasks involved in obtaining patient financial pre-certification and authorizations for health care services and procedures.
- Organized inpatient and outpatient claims for electronic or hard-copy mail and forwarded them to appropriate third party payers.
- Reviewed claims to make sure that payer-specific billing requirements are met, followed up on billing, determined and applied appropriate adjustments, answered inquiries, and updated accounts as necessary.
- Provided financial counseling to patients and their families regarding charges for health care services.
- Determined fees for services provided and implemented appropriate collection and refund actions.
- Assisted financially responsible persons in arranging payment schedules.
- Determined necessity of third party sponsorship and processed patients accordingly.
- Examined insurance policies and other third party sponsor materials for sources of payment.
- Maintained records of patients' accounts and corrected, updated, and consolidated records to include the application of proper discounts to patients.
Multi-Task Clerk (Team Lead)
Norwegian American Hospital
Chicago, Il
03.1998 - 10.2005
- Greeted, assisted, and directed patients.
- Collected information from incoming patients regarding services needed, insurance available or financial status.
- Performed registration, admission, pre-admission, reception, and discharge functions for all patients receiving services in the Healthcare system.
- Obtained complete and accurate patient demographic information.
- Assisted in completion of admissions or insurance forms, collected co-payments and deductibles from patients and handled daily cash management.
- Contacted insurance providers such as Blue Cross Blue Shield, Aetna, etc.
- To verify coverage and obtain authorization for service.
- Served as liaison between patients and staff.
- Responsible for scheduling MIR and SDC services.
- Originate pre-existing charts, utilized Meditech for data management and ECARE for billing.
- Entered charges for Neonatal, Diagnosis (ICD/9), Procedure codes and reviewed claims or records in order to ensure accurate completion or coding in an effort to reduce reimbursement denials.
- Very familiar with standard concepts, practices, and procedures within medical billing and coding.
- Adhered with all State and Federal regulations such as EMTALA and HIPPA requirements.
- Trained and educated new employee's within a health care environment.
- Required on call duties for designated shifts for the Outpatient Department.
Education
B.A - Healthcare Management
2011
A.S.B.A - Medical Coding and Billing
Colorado Technical University
2008
Medical Billing & Coding). -
Colorado Techinical University
Healthcare Management). -
Colorado Technical University
Executive Master of Business Administration -
Skills
- JCAHO, ACR, COLA
- Operating Systems: Windows NT/2000/XP/Vista/7, Microsoft Server 2000 - 2008, Linux, and MAC OS
- Proficient in the various software: MS Access, Visio, Documentum Document Management System, MS Project, MS SharePoint, MS Word, Excel, PowerPoint, WordPerfect, MS Outlook Email, MS Money, NetMeeting, LiveMeeting, Quicken, Citrix User Client, Symantec Antivirus, Kronos Time System, Novell GroupWise Email, Lotus Notes Email, NSLDS, COD, SSSGOV, FACS, STAR, BCARB, Meditech, DataMax, 3M, Allegra, Logicare, Midas, Carenet, SDK, FACS, Advantage and Cerner Care Connection
- Proficient with: VPN Token, Healthcare Data Management Software, Content Management Systems, Process Analysis, Streamline Administration, Reducing costs and enhancing patient Safety and Satisfaction
- Streamline, Excel spreadsheets
- Antivirus, Excel
- Billing, Mail
- Cash management, MS Money
- Charts, NetMeeting
- Citrix, MS Outlook
- Clerical, PowerPoint
- Content Management, MS Project
- Counseling, 2000
- Client, Windows NT
- Customer Service, MS Word
- Data entry, Midas
- Data Management, Operating Systems
- Diagnosis, PDF
- Document Management, Personnel
- Documentum, Policies
- Email, Process Analysis
- English, Processes
- Financial, Coding
- Forms, Progress
- Functional, Quality
- Novell GroupWise, Quality Control
- Insurance, Quicken
- Kronos, Receiving
- Team Lead, Reception
- Leadership, Safety
- Linux, Scheduling
- Lotus Notes, Spanish
- Machinery, Symantec
- MAC OS, Visio
- Materials, Vista
- Medical Billing, VPN
- Meditech, WordPerfect
- Mentoring
- Access
- MS Access
Languages
English/Spanish
Certification
- Certified Human Services Caseworker, State of Illinois - 2019
Timeline
Human Services Caseworker
State of Illinois-Department of Human Services
09.2019 - Current
Quality Inspector
O & K American Corporation
09.2016 - 07.2019
Financial Aid Advisor
Career Education Corporation
05.2013 - 06.2015
NCO Group Incorporated
08.2010 - 05.2013
Patient Accounts Representative
Aurora Healthcare
06.2006 - 09.2007
Multi-Task Clerk (Team Lead)
Norwegian American Hospital
03.1998 - 10.2005
B.A - Healthcare Management
A.S.B.A - Medical Coding and Billing
Colorado Technical University
Medical Billing & Coding). -
Colorado Techinical University
Healthcare Management). -
Colorado Technical University
Executive Master of Business Administration -
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