MARITZA ADAMS
Lithonia,GA
Summary
Motivated and dedicated professional with extensive experience in customer relations and a strong focus on service satisfaction. Proficient in executing job responsibilities with a proven track record of success in compliance and administrative duties. Expert insight in following policies and procedures to ensure adherence to organizational guidelines. Skilled and collaborative team player with a background in coordinating, planning, and providing support for daily operations.
Overview
8
8
years of professional experience
Work History
Care Navigator
Curative Health Insurance
11.2023 - Current
- Ensure assigned members have great experiences seeking and receiving care
- Work with Curative physicians and other Curative clinical staff to administer personalized, preventative care
- Optimize the care and health outcomes of member's
- Use Electronic Health Records to fetch and complete patient records
- Manage patient communications and answer messages in a timely manner
- Be knowledgeable about technology products, clinical programs, and policies and are able to communicate them effectively
- Follow up with patients after their health appointments to assist with any follow-up steps, questions, and concerns to ensure all their needs have been met.
Care Coordinator
Carbon Health
02.2022 - 08.2023
- Responsible for management of patient care and scheduling
- Coordinate the care for hundreds of patients and consistently achieved goals in order to generate an improved health outcome for each patient
- Document all client interaction and maintain accurate medical records for easy follow-up
- Create new electronic files, answer incoming calls, respond to inquiries and route calls to the appropriate areas
- Effectively communicate with staff/management to ensure quality of work performed
- Process 30+ referrals daily, verify insurance benefits, advise of copays and review prior authorizations.
Health Survey Specialist
CVS
09.2021 - 02.2022
- Documented calls and ensured strict compliance with regulatory standards and requirements
- Met/exceeded all key performance metrics as established
- Worked to resolve any issues/concerns within a timely manner in order to retain loyal business and increase client satisfaction
- Prioritized workflow, providing support to members handling enrollments and quickly identify client needs.
Specialty Coordinator
Kaiser Permanente
08.2017 - 07.2021
- Schedules, re-schedules, and verifies patient specialty appointments, creates Medical record number as appropriate
- Responds to member question and concerns and verifies member and benefit eligibility
- Transfers callers to advice nurse or appropriate medical office increase customer satisfaction and retention by providing members, and providers with accurate consistent information
- Maintains confidentiality of patient’s medical record and demographic information
- Worked with department staff to research, identify and provide solutions to client and insurance company inquiries.
Insurance Verification Specialist
Mercy Internal Medicine
09.2016 - 07.2017
- Ensured that all insurance information needed for billing and collection processes are appropriately obtained and recorded in the computer system
- Initiated the pre-authorizations/pre-determinations for insurance to get verified and processed correctly
- Communicated with both patients and primary care physicians (PCP's) and/or specialists in regards to standings
- Generated billings using ICD-10, as well as CPT codes when doing daily office visit charges
- Trained new hires and served as Subject matter Expert to current staff.
Education
High School Diploma -
Lithonia High School
Skills
- Zendesk
- Slack
- Reports/Documentation
- Communication Skills
- Medical Terminology
- Process Improvement
- Deadline Oriented
- HIPAA Compliance
- Customer Service
- OSHA Knowledge
- Client Relations
- Time Management
- Insurance Verification/ICD-10
- CPR Certified
- Patient Care
- Patient Access
- Administrative
Care Coordination
Timeline
Care Navigator
Curative Health Insurance
11.2023 - Current
Care Coordinator
Carbon Health
02.2022 - 08.2023
Health Survey Specialist
CVS
09.2021 - 02.2022
Specialty Coordinator
Kaiser Permanente
08.2017 - 07.2021
Insurance Verification Specialist
Mercy Internal Medicine
09.2016 - 07.2017
High School Diploma -
Lithonia High School
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