Miquel Patterson
Houston,Texas
Summary
Healthcare Professional with over 10 years of healthcare / claims experience. Including but not limited to Patient Care, Claims Handling, Volunteering, 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
10
10
years of professional experience
Work History
Bodily Injury Claims Specialist
Statefarm Insurance
08.2022 - 09.2024
- Improved claim resolution times by managing a caseload of 50+ claims monthly in the Auto Injury Department.
- 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 by 30% and maintaining its reputation.
Healthcare Coordinator
UT Southwestern Medical Center
10.2019 - 08.2022
- 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.
- Assists in medical record auditing and trend analysis regarding coding/documentation.
- Assisted patients in navigating the healthcare system by providing education on insurance coverage, financial resources, and available support services.
Patient Consultant
Johns Hopkins Hospital
07.2017 - 09.2019
- 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.
Health Insurance Coordinator (Claims II)
Carefirst BlueCross BlueShield
08.2014 - 07.2017
- 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.
Education
Masters of Science - Healthcare Administration
University of Maryland University College
06.2018
Bachelors of Science - Healthcare Administration
Coppin State University
07.2014
Skills
- Claims Handling
- Patient Consulting
- Problem Solving
- Medicaid and Medicare Experience
- Leadership
- EPIC Systems
- Medical Terminology
- HIPAA Compliance
- CRM Software
- Insurance Policy Coverage
Timeline
Bodily Injury Claims Specialist
Statefarm Insurance
08.2022 - 09.2024
Healthcare Coordinator
UT Southwestern Medical Center
10.2019 - 08.2022
Patient Consultant
Johns Hopkins Hospital
07.2017 - 09.2019
Health Insurance Coordinator (Claims II)
Carefirst BlueCross BlueShield
08.2014 - 07.2017
Bachelors of Science - Healthcare Administration
Coppin State University
Masters of Science - Healthcare Administration
University of Maryland University College
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