Sandra Baxter

Process consults for Community Care program, which include eligibility, and interaction with veterans for in network vendor choice

• Used CPRS for documentation notifying appropriate staff for review.
• Interact with nurse navigator on complex consults for expedited care.
• Ensure authorizations generate correctly to Health Share Referral Manager (HSRM) to correct category of care.
• Fax consult packet and authorization to vendor
• Generate authorization letters and mail to veterans.
• Follow up with vendor for veteran appointment date.
• Request records following veteran's appointment
• Scan reports and alert ordering provider and nurse navigator.
• Rotate on customer service phones

• Validated and submitted claims for all insurance and verified eligibility.
• Processed billings using ICD-10 MC, HCPCS
• Processed payments that had been received from insurance companies and Medicare & Medicaid
• Utilize EMA to schedule clients' appointments per centralized scheduling guidelines.
• Collected, arranged and input information into database system.
• Maintained computers, telephone systems, copiers and fax machines.
• Performed clerical duties by typing, filing, copying, faxing and completing and submitting forms.
• Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
• Received, recorded and addressed incoming and outgoing communication via telephone and email.
• Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
• Managed office bookkeeping with insurance billing and patient payments.
• Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.
• Handled high volume of in-bound calls pertaining to reconciliation of delinquent accounts.
• Handled priorities, timelines and deadlines assigned.
• Responded to customer concerns and questions on daily basis.
• Processed payment via telephone and in person with focus on accuracy and efficiency.
• Received and sorted mail, prepared packages for delivery and scanned
• Used a wide range of office software applications such as Microsoft Access, Excel, and Word.
• Processed medical record request from outside medical offices and patients.
• Flexible in adapting to changing demands within specific time lines.
• Composed correspondence as needed.

• Collected payments from patients for processing.
• Entered all insurance information and filed claims
• Verified eligibility on all insurance
• Responded to inbound inquiries regarding accounts and payments.
• Reconciled accounts receivable ledger to verify payments and resolve variances.
• Set up newborn accounts
• Processed medical records
• Processed payments that had been received from insurance companies and Medicare.
• Identified overpayments and processed refunds for insurance carriers and patients.