Janice L. Bradley
Houston,TX
Summary
Adept at navigating complex healthcare systems, I leveraged my insurance verification expertise and effective telephonic communication to enhance patient satisfaction and streamline care coordination. My proficiency working in EPIC and Salesforce along with a strong patient advocacy approach improved service delivery, achieving a notable increase in successful patient navigation outcomes. I demonstrated knowledge of admissions, insurance verification and authorization processes in hospital and medical office settings. I was trained to be tech-savvy and a smart professional to be equipped with experience in medical environments and top-notch administrative skills. I work great with colleagues and maintain strong patient relations. I excel at following procedures and independently handling common questions and concerns.
Overview
11
11
years of professional experience
Work History
Patient Navigator, Oncology/Hematology
Millennium Physicians
Shenandoah, TX
07.2023 - 01.2025
- Contact patients over the phone to assist in doing an assessment for navigation resources needed
- Informing the patient on financial aspects of care and linking the patient to financial resources as needed
- Facilitating communication while working between the patient, family members, healthcare providers, and clinical care team to ensure patient satisfaction and quality of care to set goals for patient’s care
- Organizing schedules and managing appointments for patients to ensure they receive services in a timely manner
- Managing follow up visits and ensuring continuity of care and linkage to community resources
- Accommodating interpretive language services when needed and working with medical interpreters to reach patients of other languages
- Provide navigation for patients by addressing any transportation or logistic barriers, scheduling complications, financial assistance, etc., that would prevent a patient from showing up at their appointment
- Address any relevant insurance concerns or payment issues by connecting patients with appropriate resources and team members
- Assist patients in connecting with necessary emotional supportive care services, psychosocial and palliative care, home health, and social work
- Provide education about cancer clinical trials and when appropriate, assist patients in connecting with care teams about available services and resources to support participation
- Provide culturally sensitive services to patients from different cultures
- Accompany patients at clinical appointments when needed to provide support and advocacy
- Maintain regular periodic communication with the patient and their providers through clinical messages in IKM/EPIC, DOC HALO, via emails, phone calls and case review/chart audit meetings
- Refer to internal or external case management services when other issues are identified (i.e
- Hunger issues, domestic violence issues, etc.)
- Provide advocacy, patient education and support in accessing community-based and hospital-based programs
- Document every communication and intervention into the appropriate electronic medical record (IKM, EPIC, etc.)
- Develop and maintain a strong working relationship with the financial counselors, clinical teams, and any related services that may be required for assistance
- Be involved in evaluation and research activities in the program as needed
Patient Case Advocate, Reimbursement
SI-BONE
Santa Clarita, CA
02.2021 - 06.2023
- Provide effective collaboration as the liaison between the reimbursement team, surgeons/surgeon’s offices, and patients to coordinate attempts to secure coverage for iFuse system implantation
- Provide high-quality customer service and frequent interaction with surgeon offices and patients regarding case status and outcome of pre-authorizations and appeals in the company’s case management program
- Support the company’s strategic reimbursement plans, e.g., case management and reimbursement policy efforts
- Must always act and conduct company business in an honest, ethical, and strictly legal manner, complying with the Code of Conduct, other company policies, the AdvaMed Code, and all applicable laws and regulations, whether national, regional, state or local
- Encouraged, expected, and required to report any suspected violations of laws, regulations, the Code, or any other Company policy, and all other suspected unethical behavior
- Support the SI-BONE Quality System
- Communicate with patient’s insurance coverage to determine a process for pre-authorizations/pre-determinations through all levels of appeals; manage the insurance authorization process, including the verification of benefits, prior authorization process, and the appeal process
- Coordinate securing patient’s supporting medical documentation, letters of medical necessity, and appeal letter signatures from referring surgeons
- Guide patients through the insurance coverage support process; communicate regularly with patients and their families about case status and next steps in the appeal process, and address patient concerns
- Coordinate case authorization and appeal strategies with Area Reimbursement Manager
- Provide Territory Manager or other sales management personnel with case updates, as needed
- Track, monitor, and report the outcomes of reimbursement initiatives (e.g., appeal outcomes from peer-to-peer reviews, external [independent] medical review, trends observed from the various initiatives, etc.) in assigned territory
- Maintain accurate and complete documentation of all inquiries
Patient Access Specialist, Radiation Oncology
MD Anderson Cancer Center
Houston, TX
11.2019 - 05.2020
- Inform management about difficult situations with insurance companies
- Communicated openly in a non-judgmental and professional demeanor during all interactions with peers and management
- Complete account work timely and accurate using the appropriate work driver
- Ensure documentation standards are followed and account notations are made in the appropriate system(s) timely and accurate
- Complete high-quality work while adhering to productivity standards
- Demonstrate excellent skills in obtaining and recording eligibility and benefit information for all patients in the appropriate system(s) and screen(s)/field(s) within the system(s)
- Review the managed care contract database/matrices for information related to the contract terms and the corresponding estimated patient portion
- Refer to the Health Care System financial clearance policy as a guideline and document the appropriate patient liability portion, co-pays, or deductibles before or on the day of service
- Ensure accounts are financially secure by reviewing and documenting benefits, patient liabilities, authorization/pre-certification requirements, notification requirements, and other relevant information
- Notify the payer of the patient admission or procedure promptly, to ensure third-party reimbursement
- Support the Pre-registration team needs when insurance verification requirements are completed or as indicated by management
- Support other insurance verification department needs in other MDACC hospitals as indicated
- Assist with evaluations, coaching, and training while maintaining the development of new office staff as needed
- Review patient encounters for accuracy of codes for all relevant diagnoses, and procedures, and with correct modifiers for billing accuracy
- Review and analyze patient chart clinical encounters for accurate code assignment
- Develop, and implement
- Monitor processes to ensure all professional charges are accurately applied
- Audit and review daily patient arrival of scheduled appointments or cancellations
- Notify nursing staff of any missing or incomplete documentation
- Identifies compliance risks and financial opportunities based on chart review to reduce systemic billing errors
- Create, maintain, and develop departmental audits for billing accuracy
- Ability to cover for other employees
Insurance Verification Coordinator II, Diagnostic
Houston Methodist Willowbrook
Houston, TX
03.2014 - 10.2019
- Contacted insurance carriers for benefits information about levels of treatment needed to serve the patient
- Discussed benefits, copays, deductibles, OOP, and expenses with patients regarding medical care
- Maintained positive customer service relationships with patients, visitors, and hospital staff
- Interaction with patients regularly and ensure patient satisfaction for exceptional customer satisfaction
- Identified and executed patient needs in a timely fashion
- Responded to patient queries and concerns professionally
- Documented patient complaints and resolutions for management review
- Oversee general office coordination for the departments
- Maintained confidentiality in all aspects of client, staff, and company information per HIPPA guidelines
- Prepared responses to correspondences containing routine inquiries
- Interacted daily with C-level visitors and daily administrators
- Supported staff in assigned project‐based work
- Created and modified documents such as reports, memos, letters, and other documents
- Conducted administrative and clinical intake of calls for quality control review
- Maintained written documentation according to HMWB facility documentation policy
- Provided administrative support to the provider staff and consultants as needed
- Provided quality customer service through interactions with providers, administrative staff, and others
- Collected and entered confidential information and ensured the highest level of confidentiality
- Provided telephonic education to providers and office staff
- Processed daily reports to obtain productivity
- Revised and finalized documents to present to patients and management
- Created a process flow for receiving pertinent information regarding client eligibility and benefits for STAT services
Education
Master of Business Administration - Business Administration And Management
University of Houston Downtown
Houston, TX12-2025
Bachelor of Business Administration - General Business Courses, Marketing, International Business, and Insurance
Texas Southern University
Houston, TX08-1996
Skills
- Insurance Verification Expertise
- Workforce Development
- Performance Management
- Effective Telephonic Communication
- Detail-Oriented Analysis
- Word
- Excel
- PowerPoint
- Access
- Advocate Liaison
- Effective Client Relations
- Troubleshooting
- Effective Solutions Development
- Professional Writing Proficiency
- Public Speaking Proficiency
- Salesforce
- Document Management
- Effective Leadership Communication
- Independent Project Initiator
- Employee Relations
- Alternative Dispute Resolution
- Financial Specialist
- Effective Complaint Resolution
- Reports and Documents Specialist
- EPIC Super User
- Next Gen
- Proficient in EPIC
- Proficient in Salesforce
- Experienced with Microsoft Office Applications
- Client Service Platforms
- Hyland/OnBase
- Mosaic
- Internet Explorer
- Chrome
- 55 WPM
- 10-key type/touch
Personal Information
Title: Patient Navigator / Patient Case Advocate Specialist / Insurance Coordinator
Timeline
Patient Navigator, Oncology/Hematology
Millennium Physicians
07.2023 - 01.2025
Patient Case Advocate, Reimbursement
SI-BONE
02.2021 - 06.2023
Patient Access Specialist, Radiation Oncology
MD Anderson Cancer Center
11.2019 - 05.2020
Insurance Verification Coordinator II, Diagnostic
Houston Methodist Willowbrook
03.2014 - 10.2019
Master of Business Administration - Business Administration And Management
University of Houston Downtown
Bachelor of Business Administration - General Business Courses, Marketing, International Business, and Insurance
Texas Southern University
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