Ruth Thompson
Houston,TX
Summary
To obtain a position with in a professional atmosphere that is meaningful and challenging; which will contribute to both my employer's goals and my daily knowledge and growth. Conscientious professional with extensive experience advocating for social and economic well-being of individuals and families. Skilled at providing guidance, support and assistance. Strong communication and management skills and committed to inspiring community service.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Case Manager
Arthritis & Rheumatism Associates
Roswell, GA
05.2020 - 08.2023
- Plans, coordinates, and directs all activities between the interdisciplinary team to direct and facilitate departmental throughput in order to attain positive outcomes
- Insurance verification, specialty drug and skilled prior authorization, documentation review, ICD10/CPT knowledge, treatment plan coordination, financial analysis/ patient co-pay assistance
- Coordinates with ancillary departments such as lab, radiology, registration, and bed board to ensure proper turn-around times
- Makes daily assignments for all personnel according to the applicable skills inventory and the age and needs of the patient/population served
- Identifies and utilizes available resources to resolve problems; coordinates and collaborates with other clinical coordinators ensuring departmental staffing coverage
- Acts as a liaison, to departmental staff, medical personnel, patients and family members; assist in any patient care concerns, issues and complaints; conducts daily leadership rounding on assigned unit
- Utilizes critical thinking and sound clinical judgment and works autonomously to solve problems; escalates issues or notifies nursing leader/supervisor of significant occurrences, intervention, or delays, as appropriate
- Facilitates resolution to patient problems and concerns, ensuring appropriate service recovery
- Acts as a mentor/coach to assigned staff and provides input into the annual performance review of those staff members
- Participates in a systemic, interdisciplinary, and ongoing evaluation of programs, process improvement and desired client-centered outcomes
- Considers the diverse needs of each patient through the entire continuum of care, providing and ensuring the highest level of service according to established service standards, optimizing the patient experience
Intake Coordinator
KabaFusion
Cerritos, CA
08.2018 - 05.2020
- Secures authorization for ongoing patient care
- Notifies internal team members of authorization status
- Notifies internal team members, Account Executives, doctors and patients of patient issues or delays in care
- Prepares Financial Obligation Notifications Fobs, annually and throughout the year if the insurance or the plan changes
- Updates computer system with any changes in insurance, insurance plan or benefits
- Updates computer system with alerts regarding insurance, authorization or patient issues
- Collects and processes co-insurance payments
- Processes rejections from Part D payers
- Investigates reimbursement issues from the Suspend Report
- Works with the Accounts Receivable Department to resolve insurance, claims or payment issues
- Trains new team members
- Assists in verifying benefits and eligibility
- Updates physician information in computer system when applicable
- Backs up to the Intake Department as needed
Authorization Specialist/Intake/Case Management
Bright Horizons Home Health
Los Angeles, CA
09.2012 - 08.2018
- Responsible for receiving patient referral information
- Obtain initial authorization verification and follow-up for requested home care services with all agency vendors, private pay and other payer sources
- Work under the direct supervision of the Respite Manager, for the purpose of staffing, contact field staff to assign them to provide patient care services
- Maintain monthly staffing calendars for all patients
- Maintain calendars daily for accuracy and payroll processing
- Record all staff absences for infection control purposes
- Ensure collection and processing of staff paperwork is complete and entered into the appropriate system
- Assist the agency in complying with Federal / State regulations and Joint Commission standards, by maintaining the agency staffing records in a current and accurate manner
- Support contract/vendors requirements with weekly/monthly reporting
- Take referrals from contracts and under the supervision of DOCS/Administrator staff with appropriate approved personnel
- Report all complaints regarding patient care to direct supervisor
- Maintain schedule logs, schedule deficiencies and on-call log in a timely and accurate manner
- Assist with On-Call as directed
- Accepts and performs duties as assigned
- Conforms to all agency policies and procedures
- Maintains/conserves confidentiality of patient and agency information at all times to HIPAA regulations
- Doing administrative and clerical tasks
- Preparing and editing letters, reports, memos, and emails
Call Center Health Service Representative
Cigna - Healthspring
Philadelphia, PA
11.2008 - 09.2012
- Servicing new and existing healthcare providers to resolve current claims
- Resolve all aspects of customer inquiries
- Provide accurate and timely responses
- Enter accurate information into the database
- Effectively communicate written and verbal policies, procedures and benefits to healthcare providers
- Review clinical documentation to determine authorization decisions based on company policy
- Manage large amounts of inbound and outbound calls in a timely manner
- Meet personal/team qualitative and quantitative targets
- Measure performance with key metrics such as call abandonment, calls waiting etc
- Anticipate escalation and take over calls when needed
Medical Assistant
Pejman E. Cohan M.D
Beverly Hills, CA
03.2008 - 06.2012
- Opening and closing the exam rooms at designated times and have all exam room terminals /equipment operational at the start of business hours and shut down at close of business hours
- Rooms and completes patient vitals in a timely fashion
- Responsible for maintaining daily exam room inventory from administrative supplies to clinic supplies
- Reports need for re-orders to MD
- Responsible for processing procedure reports for designated physician and follows through to completion as designated by established protocol
- Check patient in/out, schedule follow up appointment or procedure and collect payment
- Obtains authorizations for referrals, medication refills as needed
- Verifying medical benefits and discussing any financial obligations
- Performing EKG's labs draws, injection while following Osha regulations
- Performing any combination of clerical task that is associated with the daily activities of treatment of our patients and office daily procedures
Medical Assistant
Comprehensive Pain Relief Group
Redondo Beach, CA
06.2004 - 12.2007
- Checking patient in/out, answering phone calls, assisting with injections, Obtaining/checking insurance authorizations
- Knowledge of workers compensation
- Performing various pain management therapy
- Calling in prescriptions and providing medication in office
- Traveling to various surgery centers and completing all history and physical under MD supervision
- Responsible for all front and back office duties including vital signs
- Authorization requests for HMO & PPO health plans, Answering phone
- Working in a fast paced environment, and a high level of multitasking
Education
Associate - Paralegal Studies
Current
High school diploma - undefined
June 1994
Skills
- Computer Skills
- Microsoft Office (8 years)
- ICD-10 (5 years)
- Infusion (3 years)
- Sales (2 years)
- Inside sales (3 years)
- Medical scheduling (8 years)
- Customer service (10 years)
- Transcription (2 years)
- Pain Management (3 years)
- Medical Coding (1 year)
- Typing
- Translation
- Medical receptionist COMPUTER SKILLS:
- Microsoft Office, Excel, Outlook, PowerPoint, Medicare
- Knowledge and EMR
- Certifications and Licenses
- BLS Certification
Certification
EMR (10+ years)
EXCEL (5 years)
MICROSOFT OFFICE (8 years)
MS OFFICE (8 years)
OUTLOOK (10+ years)
Home Health (8 years)
Case Management (2 years)
Utilization Review (3 years)
Phlebotomy (3 years)
Infection Control Training (5 years)
HIPAA
Experience Administering Injections (5 years)
Medical Billing (1 year)
Medical Records (10+ years)
Vital Signs (8 years)
Patient Care (10+ years)
Medical Office Experience (10+ years)
Venipuncture (5 years)
Laboratory Experience
Microsoft Office (10+ years)
Medical Terminology (10+ years)
Nursing
Triage (3 years)
Insurance Verification (8 years)
Anatomy Knowledge
Additional Information
- Willing to relocate: Anywhere, Authorized to work in the US for any employer Authorized to work in the US for any employer
Timeline
Case Manager - Arthritis & Rheumatism Associates
05.2020 - 08.2023
Intake Coordinator - KabaFusion
08.2018 - 05.2020
Authorization Specialist/Intake/Case Management - Bright Horizons Home Health
09.2012 - 08.2018
Call Center Health Service Representative - Cigna - Healthspring
11.2008 - 09.2012
Medical Assistant - Pejman E. Cohan M.D
03.2008 - 06.2012
Medical Assistant - Comprehensive Pain Relief Group
06.2004 - 12.2007
Los Angeles Southwest College - Associate, Paralegal Studies
Leuzinger High School - High school diploma,
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