Shawn Bulmer

• Patient Interaction & Support:Scheduling Appointments:

I would assist patients in scheduling their diagnostic tests, either in person or over the phone.
Providing Information: Answering questions about tests, procedures, preparation instructions (e.g., fasting), and other general inquiries.
Explaining Test Results and Processes: Although i do not have interpreted test results directly, I would explain the general process for getting results and how patients can access them.
Managing Patient Concerns: Handling any issues or concerns, such as billing questions, insurance verification, or dissatisfaction with services.

• Handling Insurance and Billing Issues:Verification of Insurance: I would have to verify insurance information, ensure that tests are covered, and provide estimates of costs to patients.
  Billing Support: Assisting with billing questions, explaining charges, and sometimes setting up payment plans or redirecting patients to the right department for further assistance.
  
• Providing Excellent Patient Experience:Customer Care: My role involves delivering compassionate, efficient, and professional customer service to ensure patients felt comfortable and valued.
  Problem Resolution: Handling complaints or concerns, ensuring patients felt heard, and resolving issues related to wait times, test preparations, or service quality.
  
• Data Entry & Administrative Support:Accurate Patient Data Entry: I am responsible for entering patient information into Quest's systems (e.g., demographics, insurance, test orders).
  Documenting Communications: Logging phone calls, emails, or in-person interactions to track patient concerns or requests.
  Confirmation and Reminders: Sending appointment confirmations and reminders to ensure patients show up for their appointments and understand any prep required.
  
• Collaboration with Other Departments:Working with Lab and Medical Staff: I would have to coordinate with lab technicians, doctors, and other staff to ensure tests were ordered correctly, results were processed in a timely manner, and any special requests were handled efficiently.
  Referrals: In the past, I have referred patients to other departments, such as billing, insurance, or specialized test coordinators, when needed.
  
• Compliance and Privacy:HIPAA Compliance: As with any healthcare position, protecting patient confidentiality would be considered paramount. Ensuring that all personal and medical information was handled in accordance with HIPAA (Health Insurance Portability and Accountability Act) guidelines is apart of my role.
  

• Processed and adjudicated health insurance claims , ensuring compliance with company policies and regulatory requirements, while maintaining accuracy and timeliness in claim resolutions.
• Reviewed claims submissions for completeness, verifying patient eligibility, benefit coverage, and medical coding (CPT, ICD-10, HCPCS) to determine appropriate payments.
• Collaborated with healthcare providers to resolve discrepancies, request additional documentation, and clarify treatment details, ensuring smooth processing and accurate reimbursements.
• Resolved complex claim issues by analyzing claims data, medical records, and insurance policies, adjusting payments and processing adjustments when necessary.
• Managed claim denials and appeals : Analyzed denied claims, explained the reason for denials to providers and members, and assisted with the appeals process to ensure proper claim reconsideration.
• Maintained HIPAA compliance by ensuring patient information was handled securely and in accordance with privacy regulations, while keeping meticulous records of claim activities.
• Enhanced claims processing efficiency , meeting or exceeding departmental goals for claims processed per day (e.g., processed 50+ claims daily) while maintaining a high level of accuracy and reducing errors.
• Provided outstanding customer service , assisting members with claim inquiries, explaining coverage details, and resolving billing issues promptly to ensure positive customer experiences.
• Generated and reviewed claims reports to track performance, identify trends in claims denials or errors, and recommend improvements to streamline workflows and improve accuracy.