Dedicated Intake Specialist skilled in claim eligibility analysis and utilization management. Excellent communication and interpersonal skills. Familiar with industry standards and requirements. Managing duties to facilitate smooth workflow and operational efficiency.
Overview
17
17
years of professional experience
Work History
Provider Relations Associate
Optum, UnitedHealth Group
03.2016 - 05.2024
Training and on-going education of providers on policies and procedures
On-site assessments to ensure that providers are compliant with contractual terms
Trouble shooting provider concerns internally with expectations of timely resolution of issues
Traveling to provider offices quarterly to build relationships, up to 75% travel within specific region in Kansas
Presentations to train providers on new requirements, or reiterate existing requirements
Documenting outreach, as applicable
Developed strong client relationships through timely and thorough follow-up on inquiries and concerns.
Optimized departmental processes with implementation of innovative strategies, resulting in improved efficiency and reduced costs.
Managed diverse team of professionals, fostering inclusive work environment that encouraged collaboration and innovation.
Patient Navigator
Optum, UnitedHealth Group
03.2016 - 06.2023
Responsibilities
Cross market trained BCBS Acute and UHC
Met needs of up to 46 clients in order to decrease patient readmission
Identified barriers when treatment goals not met, treatment plan not followed or important appointments missed and collaborated in redeveloping patient treatment goals.
Collaborate with peers
Provide peer as well as patient support when needed
Participated in regular team meetings, huddles, staff meetings and quality improvement projects to improve patient care.
Assisted patients in scheduling doctor and healthcare appointments.
Educated patients on insurance and healthcare plans.
Engaged with patients to provide critical information.
Worked with patients to ascertain issues and make referrals to appropriate specialists..
Resolved customer complaints using established follow-up procedures.
Helped address client complaints through timely corrective actions and appropriate referrals.
IMAGING TECH ASSISTANT
UHG, United Health Group
03.2016 - 05.2022
Schedule Stereotactic, Ultrasound Guided, and MRI biopsies as well as Wire Localization procedures.
Consent patients and go over post op instructions with the patient before the procedure begins
Prepped and draped sterile trays prior to procedures.
Assist the Radiologist with Stereotactic, Ultrasound Guided, MRI biopsies as well as with the Wire Localization procedure.
Perform bone density scans for the breast imaging center
Upload outside images for the Radiologist to compare along with other medical duties.
Organized work to meet demanding production goals.
Inspected equipment to identify areas of wear or causes of malfunctions.
Completed basic and semi-skilled work with little or no oversight.
Maintained quality assurance and customer satisfaction objectives.
Ran QC check on Bone Density machine each morning before seeing patients.
Acted as a team leader in group projects, delegating tasks and providing feedback
Managed time efficiently in order to complete all tasks within deadlines
Demonstrated strong organizational and time management skills while managing multiple projects
Used strong analytical and problem-solving skills to develop effective solutions for challenging situations
Proven ability to learn quickly and adapt to new situations.
Excellent communication skills, both verbal and written.
DENTAL ASSISTANT
Uptown Endodontics
09.2015 - 02.2016
Assisted the specialist in root canal therapy, appendectomy's, and performed clerical work.
Designed dental report card to explain patient dental health status and treatment plans.
Assisted dentists by passing instruments, suctioning intraoral fluids, adding water, and mixing materials for fillings, , casts and impressions.
Prepared and sterilized instruments and materials for use by dentists.
Recorded patients' health histories, documented current symptoms, and pulled up records from prior visits for dentists to view and evaluate.
Sanitized trays, instruments, and surfaces for clean dental office setting and patient safety.
Monitored patient comfort and safety during dental procedures.
Assisted in chair-side dental procedures by filling cavities and taking impressions.
Prepared patient X-rays and images for review by dentist.
Took dental images following strict patient protection rules, applying lead aprons.
Documented patient dental health information, medical history, and vital signs for future reference.
RDA/ASSISTANT
Anesthesiology for Dentistry
06.2015 - 08.2015
Assisted the Anesthesiologist during surgeries with setting up the IV, jaw thrusting, monitoring patients breathing, and post ops.
Prepared and positioned patients for procedures, clipping dental napkins and placing patient safety devices.
Successfully assisted dentist by performing four-handed dentistry and other chair-side duties.
Educated patients on postoperative care and best practices for protecting dental work and boosting healing process.
Performed general chair-side duties for general dentistry, endo procedures, and oral surgery.
Explained treatment procedures and instructed patients on home care guidelines.
Patient Services Coordinator
PATIENT SERVICES, Solis Women's Health
11.2007 - 08.2014
Registered up to ninety patients a day, using the Sectra RIS/PACS system for mammograms, biopsies, and bone density scans
Explained medical forms, collected payments, deposit requirements, verified insurance, and scanned in bone density results
Prepared patients for examinations, set up sterile trays, recall patient for second appointment, scheduled patients for biopsies, followed up with biopsy orders, and consented patients for treatment.
Administered billing functions to maintain profitability and meet compliance, quality and productivity standards.
Collected time of service payments and issued receipts.
Communicated with primary care offices and insurance companies to obtain authorization.
Verified patient availability during appointment scheduling process to reduce reschedules and cancellations.
Oversaw monthly inventory orders to guarantee properly stocked office.
Verified patient's insurance eligibility and benefits coverage.
Collected forms, insurance card and co-pay to facilitate registration process and prepare patient for appointment.
Demonstrated exceptional customer service to foster welcoming and professional environment for patients.
Education
Dental Assistant Program - Registered Dental Assisrance
Concorde Career College
Grand Prairie, TX
06.2015
Skills
Compassionate
Reliability and Dedication
Coordinate Referrals
Microsoft word, Excel, One Note, Outlook, and Teams experience
Active Listening
Appointment Confirmation
Outbound Calling
Home Health Experience
Outpatient and Skilled Nursing Experience
Proficient in Medical Terminology
EMR, EHR , EXA Experience
Managed Care Experience
Accomplishments
Collaborated with team of 8 in the re-development of the Welcome Call Schedule
Achieved great result by completing my task with accuracy and efficiency.
Received an award for "Dedicated to Service" by my colleagues.
Timeline
Provider Relations Associate
Optum, UnitedHealth Group
03.2016 - 05.2024
Patient Navigator
Optum, UnitedHealth Group
03.2016 - 06.2023
IMAGING TECH ASSISTANT
UHG, United Health Group
03.2016 - 05.2022
DENTAL ASSISTANT
Uptown Endodontics
09.2015 - 02.2016
RDA/ASSISTANT
Anesthesiology for Dentistry
06.2015 - 08.2015
Patient Services Coordinator
PATIENT SERVICES, Solis Women's Health
11.2007 - 08.2014
Dental Assistant Program - Registered Dental Assisrance
Regulatory Compliance Consultant/Manager/Contracts Manager at Optum, UnitedHealth GroupRegulatory Compliance Consultant/Manager/Contracts Manager at Optum, UnitedHealth Group