Miquel Patterson
Los Angeles,CA
Summary
Accomplished Healthcare Professional with over ten years of healthcare experience. Including but not limited to Patient Care, Claims Handling, Patient Consulting, Insurance Verification, Coordinating, Medicaid and Health Plan Enrollment. Leadership, CPR Certified and training with EPIC systems. Well versed in medical terminology and HIPAA Compliance Laws.
Overview
12
12
years of professional experience
Work History
Customer Specialist
Statefarm Insurance
08.2023 - Current
- Achieved high customer satisfaction ratings by providing clear and timely communication throughout the claims process.
- Improved claim resolution times by efficiently managing a caseload of 50+ claims per month.
- Negotiated favorable settlements with claimants, attorneys, and other insurance carriers to minimize financial risk for the company.
- Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
- Collaborated with legal teams to defend against fraudulent claims, saving company resources and maintaining its reputation.
- Collaborated with cross-functional teams to resolve escalated customer concerns promptly.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Responded to customer inquiries via phone, email and web-based platforms.
Healthcare Coordinator
Ut Southwestern Medical Center
10.2021 - 08.2023
- Insurance Account Follow-up (hospital or physician), which may include a focus on claims denied by insurance carriers or paid incorrectly (underpaid)
- Drives department service standards and activities to impact department and/ or system score for patient/ customer-based satisfaction through role modeling and accountability
- Drives and promotes customer service orientation and performance throughout all practices
- Assists in medical record auditing and trend analysis regarding coding/documentation
- Contributes to the development, implementation and maintenance of system-wide compliance programs, policies and procedures.
- Assisted patients in navigating the healthcare system by providing education on insurance coverage, financial resources, and available support services.
Patient Compliance Consultant
LBJ Hospital
05.2019 - 08.2021
- Assist in the review of medical records to highlight star opportunities for the medical staff
- Provides reporting to health plan leadership on progress of overall performance, gap closure, and use of virtual administrative resource
- Activities include data collection, data entry, quality monitoring, upload of images, and chart collection activities
- Locate medical screening results/ documentation to ensure quality measures are followed in the closure of gaps
- Ensures medical necessity compliance by obtaining necessary data, reviewing Compliance System, communicating information to patient or guarantor and obtaining necessary signatures
- Documentation of payments in the computer system and generates the appropriate patient receipts.
Patient Consultant
Johns Hopkins Hospital
07.2017 - 09.2018
- Receive inbound contacts (calls, emails, faxes, etc.) from patients and physicians requesting services within JHMI
- Coordinate complex appointment scheduling linking consults and ancillary services required for assigned specialty services within the department, maintaining patient demographic and insurance pre-registration information in appropriate department scheduling system
- Knowledge of medical and insurance terminology
- Knowledge of medical insurance plans, billing, regulations, especially managed care plans and provider referral protocols
- Interviews callers to obtain full understanding of what information is being requested.
Healthcare Insurance Coordinator (Claims) II
Carefirst BlueCross BlueShield
08.2016 - 06.2017
- Maintains an in-depth knowledge of all lines of business, claims procedures, underwriting, membership, and regulations related to the health insurance industry
- Examines adjudicated claims to identify key elements and processing requirements based on diagnosis, procedure, provider, medical policy, contracts and policy procedures
- Calculates and verifies deductibles, maximums, co-payments and coinsurance for resolving inquiries, facilitating adjustments, initiating extra contractual and reporting of any systems processing errors, overpayments and underpayments
- Identification of other insurance and coordination of benefits, benefit exclusions, administration of direct pay, credit card payment, debit accounting and other enrollment and billing transactions
- Appropriately documents all client interactions according to departmental procedures.
Medicaid Customer Service Representative
Maryland Health Connection
02.2014 - 07.2016
- Helped individuals file for Medicaid/Medical Assistance benefits
- Educating families on the availability of free or low-cost health coverage under Medicaid and CHIP, identifying children likely to be eligible for these programs
- Assisting families with the application and renewal process
- Achieve performance targets, working closely with the Sr
- Program Associate and others to identify and overcome challenges
- Adhere to all state and federal privacy regulations, including HIPAA and 42 CFR.
Patient Care Technician (CNA)
Northwest Hospital
01.2012 - 02.2014
- Takes temperature, pulse, blood pressure, respiration, daily weights and dietary intake of assigned patients, and records output fluids
- Accurately records information according to department procedure to ensure inclusion in the patient's medical record
- Performs specific, technical patient care procedures such as administration of enemas, applications of heat and cold
- Assists patient with eating, drinking, dressing, bathing and personal hygiene.
Education
MA - Healthcare Administration
University of Maryland University College
08.2018
BS - Healthcare Administration
Coppin State University
05.2014
Skills
- CRM Software
- Claims Processing
- Familiar with fraud statutes
- Risk Assessment
- Insurance policy coverage knowledge
- Policy investigations
- Medicare Compliance
- Underwriting knowledge
- Policy Interpretation
- Quality Improvement
- Healthcare administration
- HIPAA Compliance
Timeline
Customer Specialist
Statefarm Insurance
08.2023 - Current
Healthcare Coordinator
Ut Southwestern Medical Center
10.2021 - 08.2023
Patient Compliance Consultant
LBJ Hospital
05.2019 - 08.2021
Patient Consultant
Johns Hopkins Hospital
07.2017 - 09.2018
Healthcare Insurance Coordinator (Claims) II
Carefirst BlueCross BlueShield
08.2016 - 06.2017
Medicaid Customer Service Representative
Maryland Health Connection
02.2014 - 07.2016
Patient Care Technician (CNA)
Northwest Hospital
01.2012 - 02.2014
MA - Healthcare Administration
University of Maryland University College
BS - Healthcare Administration
Coppin State University