Monique Cook
Birmingham,AL
Summary
Talented Case Manager adept at handling high caseloads without sacrificing quality of care. Operates in high-pressure environments while recommending best resources and courses of action to benefit patient needs and return each to optimal quality of life.
Overview
13
13
years of professional experience
Work History
Case Manager
PALMETTO INFUSION SERVICES
06.2023 - Current
- The Insurance Case Manager functions as an integral member of a multidisciplinary clinical team which manages the care of patients
- The Insurance Case Manager will verify patients health benefits and coverage for infusion services
- The Insurance Case Manager works closely with Nurse managers and Reimbursement team in providing and promoting customer service, process flow operational integrity, quality care and process improvement along with high service standards.
- Partnered with physicians, social workers, activity therapists, nutritionists, and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
- Monitored clients' progress and tracked client services to provide crisis interventions.
Admissions Coordinator
Guidehouse
11.2019 - 06.2023
- Responsible for obtaining complete and accurate demographic and financial information from a variety of sources, including patient interviews physician offices and in-house departments
- Obtains required signatures on legal consents and insurance forms
- Performs required insurance verification, create payment estimates
- Pre-registered patients for procedures
- Enters data in computer and thoroughly documents any conversation with the patient in HQ/ registrations in manner prescribed
- Notifies patients, supervisors of insurance coverage issues, notifies patients of co-payments, deductibles or deposits needed, documenting all information in computer system
- Reviews Physician's orders for completion and ensures all required information is listed
- Knowledge of all Federal, State and Local Laws pertaining to insurance rules and regulations
- Maintains multiple computer systems
- Maintains positive customer service at all times, referring unresolved issues to appropriate supervisor
- Answers telephone calls
- Follows pre-established script and provide assistance to callers
- Completes all shift duties in a timely and accurate manner
- Complies with all safety regulations, policies and procedures as defined by Customer.
- Confirmed all insurance benefits met standards of admissions as dictated by policy.
- Assisted in patient admission process based on federal and state laws.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Completed preliminary paperwork for incoming and outgoing patients.
- Prepared and processed patient referrals and transfer requests.
- Conducted patient intake interviews, recording and documenting relevant information.
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
Front Office Manager
Drayer Physical Therapy Institute
04.2016 - 10.2017
- Responsible for directing incoming calls in a courteous manner, greeting patients, obtaining new patient information, patient counseling, scheduling appointments and assisting with other clerical support duties, such as: obtaining precertification, insurance verification, insurance authorization, patient counseling and posting payments/balance reconciliations/deposits.
- Coached employees through day-to-day work and complex problems.
- Managed files and records for clients and adhered to safety procedures to prevent breaches and data misuse.
- Supervised and guided new employees and responded quickly to questions to improve understanding of job responsibilities.
- Developed procedures to establish accurate and organized check-in and check-out processes.
- Reconciled end-of-day reports to determine accurate billing and payment processing.
- Created, prepared, and delivered reports to various departments.
Verification Clerk
Pre-registration
01.2014 - 02.2016
- Leads Financial Clearance Center Pre-Registration operations team for St
- Vincent's Birmingham
- Responsibilities within this production driven position include; investigating and gathering all necessary information from patient, ordering physician and patient's medical insurance company to ensure proper preregistration and quoting of patient's responsibility on date of service
- All tasks are done in compliance with city, state and federal laws and regulations.
Claims Analyst
Blue Cross & Blue Shield of Alabama
01.2012 - 01.2014
- Responsible for providing efficient, timely and courteous service to subscribers, providers, Host/Home plans or internal customers on claims and inquiries received
- This involved processing of all facility, professional, drug and dental claims and adjustments within the timeframe specified by the goals set by management
- This position requires extensive research, the ability to determine and apply contract benefits and some telephone development
- In addition, this position is in a production oriented work environment.
- Maintained strict confidentiality with all personal data as per company guidelines.
- Interacted with clients and employees, which helped cultivate positive working relationships.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Examined claims forms and other records to determine insurance coverage.
Education
High school diploma or GED - General Studies
Connie's Christian Academy
Birmingham, AL05-2005
Skills
- Scheduling
- EMR
- MS Word
- Clerical
- Insurance Verification
- Medical Scheduling
- Medical Office Experience
- Medical Billing
- Hospital Registration Experience
- Medical Terminology
- Office Management
- Call center management (2 years)
- Data Entry
- HIPAA
- Phone Etiquette
- Leadership
- Typing 35 WPM
- Windows
- Documentation review
- ICD-10
- Medical office experience
- EMR systems
- Case Management
- Referral Coordination
- Client Advocacy
- Care Coordination
Personal Information
Relocation: Huntsville, AL
Timeline
Case Manager
PALMETTO INFUSION SERVICES
06.2023 - Current
Admissions Coordinator
Guidehouse
11.2019 - 06.2023
Front Office Manager
Drayer Physical Therapy Institute
04.2016 - 10.2017
Verification Clerk
Pre-registration
01.2014 - 02.2016
Claims Analyst
Blue Cross & Blue Shield of Alabama
01.2012 - 01.2014
High school diploma or GED - General Studies
Connie's Christian Academy
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