Raquel Thomas
Ocala,FL
Summary
Inspiring manager with extensive experience Home Health Care product industries and 16 years of experience in leadership roles.
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
18
18
years of professional experience
Work History
Admin Assistant to Neuro-Headache
University of Miami School of Medicine
Miami, FL
06.2023 - Current
- Answered phones and scheduled appointments for patients.
- Conducted outbound calls to remind patients of upcoming appointments.
- Provided assistance with additional tasks as needed or requested by management.
- Responded quickly and efficiently in emergency situations.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Used excellent verbal skills to engage customers in conversation and effectively determine needs and requirements.
Client Relationship Manager
HomeCentris HealthCare
Philadelphia, PA
05.2021 - 05.2022
- Managed over 150 client cases
- Scheduled home visits with client to ensure safety protocols were met for services
- Maintained communication with insurances on client's medical appointments
- Enhanced sales volume through skilled support to both new and inactive customers.
- Counseled clients on Health Care concerns.
- Resolved participants/ caregiver complaints regarding homecare service
- Met with clients to ascertain needs and develop plans which address current and long-term goals.
- Electronic Visit Verification (EVV)
- EIM (Critical Incident Report)
- Planned and executed compliance audits to check company policies, procedures and controls.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Maintained files for referral and insurance information, entering referrals into system.
- Coordinated resolutions for issues and appealed denied authorizations.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
Service Coordinator Supervisor
BestCare Home Healthcare Inc.
Brooklyn, NY
08.2010 - 08.2020
- Managed over 100 client cases
- Scheduled home visits with client to ensure safety protocols were met for services
- Maintained communication with insurances on client's medical appointments
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Maintained files for referral and insurance information, entering referrals into system.
- Coordinated resolutions for issues and appealed denied authorizations.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Assigning home health aides to cases according to hospital requirements
- Working knowledge of HC Plus and HHA Exchange
- Insured compliance with NYS Dept. of Health Regulations and Joint Commission Standards
- Documented patient plan of care from hospital, CHHA and HICCUP referrals
- Compliance with annual health requirements, in-service training attendance
- Performed on call-responsibilities for weekday evening, weekends, and holidays
- Coordination of daily operations to insure patient coverage
- Confirms appointments by telephone and/or mail
- Fills vacancies due to cancellations
- Assist with various projects as assigned by direct supervisor
- Ensure prescription validity with the patient Initiate communication with customers/patients by phone to set up new or existing prescription orders
- Provides support and information to providers to problem solve and manage complex administrative patient issues
- Take responsibility for helping the caller Verifies and enters pre-registration and insurance information into the computer system and prepares daily printed schedules for designated areas
- Obtains and/or verifies patients demographic data by phone or in person
- Compiled technical, legal or medical terminology and information used in translations.
- Translated software technical manuals to another language and culture
- Incidents report
- On Call Handled emergency phone calls calmly and obtained pertinent information with composed approach.
- Advised personnel about accidents, weather conditions or other hazards
Clerical/Payroll Coordinator
BestCare Inc. Home Healthcare Inc.
Brooklyn, NY
08.2007 - 08.2010
- Verification of home health aide attendant time sheets with personnel specialist master schedule
- Process time sheets rejections and investigate/correct errors with personnel specialist
- Finalized and transferred payroll information to computer service for processing of checks and schedules
- Handled an 23-line switch board, received, transferred calls and took messages for 35 employee office
- Collect and verify basic payroll information from approved payroll documents such as status change form, new joiner form and payroll allowances and deduction forms
- Ensure that payroll data is provided and submitted to the payroll provider for payroll processing
- Manages issues within the payroll systems and collaborate with Business Analyst/s to improve efficiencies of the system
- Performs other duties as assigned
- Research returned checks, initiates stop payment requests
- Assists central payroll staff to validate data entry accuracy and compliance related to deductions, changes, refunds, buy-backs and similar transactions
- Reconciles data entry and notifies departments or other department staff of errors in time, attendance, and payroll records
- Balancing of accounts, Runs standard queries and learns to identify potential errors or identify answers to questions or concerns regarding payroll transactions
Education
High School Diploma -
Technical School of Florida
Miami, FL2006
Skills
- Customer Complaint Resolution
- Relationship Building
- HHA Exchange
- EIM
- Bilingual Fluent English/Spanish
- Microsoft Outlook
- Microsoft Word
- Switch Board
- HC Plus
- Sandata
- HIPPA
- Data Entry
- MedSys
- Decision Making
- Customer Service
- Staff Training and Development
- Verbal and Written Communication
- Operating Procedures and Policies
- Remote
- Community Resource Expertise
- EPIC
- COVERMYMEDS
- CRM
- Prior Authorization
- VYepti enrollment form
- Nerivio prescription form
- GammaCore Prescription Form
- PRL -Physician Leave Requests & Add-On Sessions
- 25Live Conference room request
- Zoom- create meetings
- MRI Prior Authorization
- Excuse Letter
- Clearance Letter
Timeline
Admin Assistant to Neuro-Headache
University of Miami School of Medicine
06.2023 - Current
Client Relationship Manager
HomeCentris HealthCare
05.2021 - 05.2022
Service Coordinator Supervisor
BestCare Home Healthcare Inc.
08.2010 - 08.2020
Clerical/Payroll Coordinator
BestCare Inc. Home Healthcare Inc.
08.2007 - 08.2010
High School Diploma -
Technical School of Florida
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