KACHE SISSON
Maple Heights,USA
Summary
Results-driven Remote Patient Advocate III skilled in processing Medicaid applications accurately and efficiently. Collaborates with healthcare teams to uphold HIPAA compliance while delivering high-quality patient support. Leverages strong time management and problem-solving abilities to enhance team effectiveness and contribute to organizational success.
Overview
13
13
years of professional experience
Work History
Patient Advocate III
Elevate PFS
Remote
02.2026 - Current
- Screened 75 to 90 uninsured hospital patients daily to determine if patient is a viable candidate for Federal, state, and or county Medicaid or disability assistance.
- Confirmed patient insurance coverage through systematic verification processes.
- Completed applications and ensured 98% approval through consistent follow-up.
- Maintained timely contact with applicants and government agencies through phone communication and organized daily work queue management.
- Assist the applicant with gathering any additional reports or records, meeting appointment dates and timelines.
- Managed patient account work queue, ensuring efficient handling of high data volumes.
- Collaborated with hospital staff, case managers, social workers, and financial counselors through clear verbal and written communication.
- Collaborated through verbal/written correspondence with hospital staff, case managers, social workers, financial counselors.
- Executed daily tasks in work queue to facilitate prompt communication with applicants and government agencies.
- Verify Insurance.
Medicaid Eligibility Specialist III
Centauri Health Solutions
Remote
10.2013 - 02.2026
- Facilitated evaluations of patients to identify potential candidacy for medical assistance programs at various governmental levels.
- Assessed potential eligibility for long-term health care coverage in compliance with state, federal, and local regulations.
- Guided patients and guarantors in completing applications to ensure access to available programs.
- Educated patients and guarantors on eligibility criteria and necessary documentation to facilitate the eligibility process.
- Entered relevant patient details and account activities into appropriate systems to facilitate effective patient care management.
- Assessed and analyzed administrative requirements to support patients in achieving eligibility for disability Medicaid and other applicable assistance programs.
- Facilitated mentorship and guidance for teammates to enhance team performance.
- Developed and delivered updated training materials and policies to new teammates.
- Utilized advanced customer service techniques to foster collaboration with senior management, reinforcing alignment with organizational goals.
- Validated insurance information for accuracy and currency to ensure seamless authorization processes.
- Facilitated timely insurance authorization processes to ensure seamless patient care.
- Reviewed and confirmed insurance details to ensure correctness and reliability.
- Facilitated communication with hospitals and physician offices to collect diagnoses and CPT codes, ensuring efficient authorization processes.
- Conducted regular audits of spreadsheets and work lists to maintain timely insurance processing standards.
- Maintained up-to-date knowledge of online payer eligibility programs to support accurate claims processing.
- Oversaw simultaneous management of multiple software systems and databases to ensure accurate tracking of member progress and documentation.
- Conducted in-depth discussions to resolve issues and strengthen client communication through targeted questioning techniques.
- Developed and implemented comprehensive training sessions for new employees to ensure seamless integration into the team.
- Facilitated patient care by performing essential tasks and ensuring timely follow-up.
- Monitored work chat to assist new team members and provided guidance on performance metrics to enhance goal attainment.
- Managed approximately 55- 60 incoming emails per day.
Education
Some College (No Degree) - Human Services and Communication
Cuyahoga Community College
Cleveland, OhioSkills
- EMR systems-Epic and Cerner
- ICD-10 and CPT coding
- HIPAA compliance
- Insurance verification processes
- Insurance authorizations
- Patient eligibility verification
- Patient relations management
- Case Management
- Telehealth communication
- Call center operations
- Microsoft Office Suite: Word, Excel, Outlook
- Critical thinking skills
- Problem solving
- Ability to adapt to change
- Able to follow complex instructions and procedures, paying close attention to details and to organize work in a systematic and efficient fashion
- Skilled in organizing and setting priorities, which accurately reflect the relative importance of job responsibilities
- Organizational and planning skills
- Time management strategies
- Multitasking abilities
- Work prioritization based on company needs
- Customer relationship Management
- Skill in reading documents written in Standard English text such as administrative policy and procedures manuals
- Ability to establish and maintain cooperative working relationships with patients, third party resources, co-workers and management
- Consistently updates knowledge of multi-state/federal/local programs
- Skilled in speaking clearly and distinctly using appropriate vocabulary and grammar to obtain the information necessary to execute the business of Elevate
COMPLIANCE
- Thorough understanding of regulatory requirements such as HIPAA and state regulations.
- Problem-Solving: Proven ability to research and resolve enrollment discrepancies identify errors and implement solutions.
- Have experience working remotely and have a private, quiet office space.
QUALIFICATIONS
- 12+ years of experience in registration/customer service within a health care setting.
- Advanced understanding of the Medical Assistance application process, including a basic understanding of various aspects of eligibility analysis and evaluation process.
- High volume call center experience.
- Epic-electronic medical records
- Flexible and adaptable to changes.
- Strong Literacy
- Strong customer servicer skills
- Excellent interviewing and communication skills
- People oriented.
- Strong analytical skills and problem-solving skills.
- Goal-driven with strong action and results.
- Team-oriented with the ability to collaborate effectively.
- Thorough understanding of the entire Patient Access process.
- Knowledge of multiple state/federal/local program policies and procedures
Timeline
Patient Advocate III
Elevate PFS
02.2026 - Current
Medicaid Eligibility Specialist III
Centauri Health Solutions
10.2013 - 02.2026
Some College (No Degree) - Human Services and Communication
Cuyahoga Community College