Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

Stephanie D Jones

Matteson,IL

Summary

Dedicated customer service, administrative professional and care coordination with years of progressive experience in a fast-paced environment seeking an opportunity in a team-orientated organization. Experienced in defining and analyzing customer/member requests to resolve issues accurately and quickly with high first contact resolution rates. A confident and effective communicator who receives excellent customer/member feedback. Customer Service Excellence Exceptional Customer Service Diversity and Sensitivity Time Management Basic Medical Terminology Medical Terminology Medicare Basics Introduction to HIPAA Illinois Medicaid Training Americans with Disabilities Act for Medicaid Healthcare Fraud Awareness Training Medicaid Cultural Competency Behavioral Health for Medicaid Risk Management Americans with Disabilities Act for Medicaid Service Excellence Combating Medicare Fraud Health Care Reform - Medical Loss International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT)

Overview

24
24
years of professional experience

Work History

Senior Service

Chicago, IL
01.2020 - Current
  • The Senior Service Advocate use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes
  • The Senior Service Advocate outreaches Dual Eligible Special Needs Plan (DSNP) members via phone to introduce the DSNP services and complete the Health Risk Assessment (HRA)
  • Acts as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel as appropriate
  • Interacts with members/clients telephonically
  • Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers, and insurance carriers) telephonically
  • Prepares all required documentation of case work activities as appropriate
  • Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes
  • May make outreach to treating physician or specialists concerning course of care and treatment as
  • Collaborates with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs
  • Testifies as required to substantiate any relevant case work or reports
  • Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data
  • Utilizes case management processes in compliance with regulatory and company policies and procedures
  • Monitors member/client progress toward desired outcomes through assessment and evaluation.

Team Lead-Care Associate

Chicago, IL
01.2018 - 01.2020
  • With supervision, supports the overall operational effectiveness of prior authorization team so all member experience metrics are achieved
  • Partnering with management, supports provider satisfaction, retention, and growth by efficiently delivering competitive services to providers
  • Responsible for escalated calls, ensuring satisfaction through prompt, accurate and careful handling
  • Coaches and mentors less experienced team members, assisting with complex questions and customer interactions
  • Performs quality audits and provides feedback based on the results of the audits
  • Acts as liaison between staff and other areas, including management, communicating workflow results, ideas, and solutions
  • Completes various business reports, including tracking, trending, and phone metrics
  • Works with manager to allocate resources to meet volume and performance standards including targeted metrics
  • Responsible for team’s standard operating procedures, with a focus on process improvement
  • Working with manager to build a cohesive team
  • Responsible for managing medical denials by setting up peer-to-peer with medical director and physician or clinical reviewer
  • Contribute to workflow review/distribution
  • Cross trained to serve as back up to manager.

Care Associate

Chicago, IL
01.2017 - 01.2018
  • The Care Associate is responsible for taking incoming calls from providers regarding services via telephone and fax
  • Supports the nurse and the medical director by collecting, interpreting, and evaluating medical information received for authorization
  • The Care Associate will communicate with internal and external providers regarding authorization status
  • Process request for authorization from hospitals, providers, members, and vendors
  • Determine authorization requirements based on company policy, member benefit grid and provider status
  • Review authorization requests and make determinations on correct authorization process
  • Approve services that do not require a medical review in accordance with the benefit plan
  • Performs non-medical research including eligibility verification, COB, and benefits verification
  • Provide determinations on authorizations request to members and/or providers based on benchmark standards for authorization decisions
  • Process extensions of authorizations as appropriate
  • Processes denials including correspondence sent to families, members, facilities, and applicable contracted providers
  • Notifies responsible parties prior to initiation of denial letter and ensures that member and responsible party understand details of the letter and the appeals processes to follow
  • Completes review of non-authorized medical claims
  • Process Notice of Action denial and approval letters to members and providers.

Office Administrator

Hanger Clinic
Matteson, IL
01.2016 - 01.2016
  • The Office Administrator will provide the highest level of customer service to patients, fellow employees and referral sources through the coordination and administration of the “front office” activities
  • Typical responsibilities include all aspects of the clinic administrative operations from scheduling appointments, validating insurance and payment authorization, inputting claims, processing payments, performing account collections, conducting billing research and responding to telephone inquiries
  • Ensure billing for all services provided is accurate, timely and fully documented
  • Responsible for all aspects of patient appointment scheduling, insurance verification, creation of new patient charts and maintenance of patient records, scanning and filing patient documents, ensuring complete and accurate information, managing incoming phone calls, timely completion of all assigned tasks
  • Provides administrative support for all aspects of closing a patient visit including obtaining insurance authorization, providing financial counseling for patients, posting over the counter payments, timely completion of all assigned tasks, mail forwarding tasks and daily document research on an electronic health/medical record system, coordinating with clinical staff in managing in progress services, scheduling return appointments, reviewing and managing incoming documents and tasking to appropriate parties to outstanding requests for information.

Patient Access Representative

Northwestern Medicine
Chicago, IL
01.2012 - 01.2015
  • The patient access representative is responsible for answering and managing incoming telephone calls, scheduling patient appointments, registering patients, updating patient insurance and demographic information, and responding to customers' information needs
  • Politely and promptly answers and appropriately triages department telephone calls
  • Correctly identifies and collects patient demographic information in accordance with hospital standards
  • Schedule’s appointment in centralized scheduling system
  • Proactive in preventing issues with patient visit by double checking type of test, preps required, assuring no conflict with other tests, verifying time and location, communicating NMH environment (parking, directions)
  • Communicates information to the patient regarding questions about physician referrals, insurance referrals and consultations
  • Collects Authorization numbers in appropriate systems as applicable
  • Interacts with various hospital departments and physician’s offices to effectively schedule and direct patients through the NMH system in a patient/customer friendly manner
  • Utilizes multiple online order retrieval systems to verify or print the patient’s order
  • Reach out to patients to schedule an appointment, when necessary
  • Understands departmental and individual quality metrics, including– abandonment rates, average answer
  • Performs medical necessity checks for scheduled services, communicates options to patient if appointments fail
  • Proactively analyzes account activity, identifies problems, and initiates appropriate actions/resolutions
  • Evaluates procedures and suggests improvements to enhance customer service and operational efficiency
  • Verifies insurance eligibility and benefit levels using online clearinghouse tools or over the phone as necessary
  • Facilitates the pre-authorization of diagnostic exams, between referring physicians and insurance carriers, using online tools, worklists, and direct phone calls as necessary
  • Ensures that outpatient procedures have a valid ICD-10 code
  • Communicates with physician offices to troubleshoot failing medical necessity for Medicare patients
  • Informs patients of any issues with securing the financial account for their encounter
  • Cross-training between various departments may take place to ensure coverage.

Customer Support

American Society for Clinical Pathology
Chicago, IL
01.2007 - 01.2012
  • Acts as first line support representative to customers of the Board of Certification and membership department
  • Handles all general telephone calls from callers requesting information on BOC certification, the CMP program and membership inquiries
  • Responds to general correspondence and emails for the department
  • Scans and indexes in Docuware all applications and other applicant material received from the Evaluators
  • The customer service representative is responsible for ensuring timely and accurate dissemination of information to callers (constituents, customers) regarding membership, certification, continuing education programs, teleconferences, subscriptions, and press publications
  • Answers all general telephone calls regarding certification, licensure examinations, membership, and continued education programs
  • Process applications from applicants that applied for certification and licensure examinations and certification maintenance program
  • Maintain paperwork for certification, licensure examinations and certification maintenance program
  • Responds to all general emails received requesting information
  • Enters members and applicant’s information into the database
  • Makes name and address changes for certificates
  • Provide end-user customer service support via online by giving instruction and basic troubleshooting
  • Process membership dues.

Client Service Specialist

Nortel Communications, CT
Naperville, Wethersfield, IL
01.1996 - 01.2007
  • Provide office services by implementing administrative systems, procedures, and policies
  • Monitor administrative projects in addition to scheduling and dispatching service personnel
  • Progressed from Receptionist/Administrative Support to Service Advisor/, Ensure client ‘s issue is resolved in a prompt courteous manner
  • Dispatch and coordinate the entire service event for clients
  • Proactively identify client issues and work directly with the Manger of Client Services
  • Maintain ownership of inbound customer calls and their resolution
  • Provides information by answering questions and requests
  • Completes operational requirements by scheduling and assigning administrative projects, expediting work results
  • Coordinating, scheduling, and dispatching of all troubles calls & move, add, & change orders (MAC’s) daily
  • Analyzing and prioritizing workload based on manpower, geographic location, and customer priority and problem severity
  • Prepare weekly load balances for branch supervisor by estimating labor hours and coordinating technician skills sets to jobs
  • Dispatching technicians
  • Reconcile technician’s labor hours daily
  • Manning after hour’s emergency line
  • Trouble shooting and/or dispatching on calls technicians or field service engineers to emergency site
  • Moving equipment from technician’s truck to appropriate MAC’s and maintenance tickets, incomplete and tech time
  • Order materials & equipment for technicians
  • Responsible for updating and distributing of various spreadsheets, organizational reports, and memos
  • Update weekly temporary employee’s spreadsheets in a timely manner
  • Work in the call receipt department, processing customer for repairs.

Education

Certificate of Successful Completion Basic Telephony Seven Habits of Highly Effective People Effective Communication Skills - Business Administration

Hartford Public High School Greater Hartford Community College

Skills

Office Skillsundefined

Accomplishments

  • Achieved [Result] by completing [Task] with accuracy and efficiency.
  • Achieved through effectively helping with member outreach.

Timeline

Senior Service

01.2020 - Current

Team Lead-Care Associate

01.2018 - 01.2020

Care Associate

01.2017 - 01.2018

Office Administrator

Hanger Clinic
01.2016 - 01.2016

Patient Access Representative

Northwestern Medicine
01.2012 - 01.2015

Customer Support

American Society for Clinical Pathology
01.2007 - 01.2012

Client Service Specialist

Nortel Communications, CT
01.1996 - 01.2007

Certificate of Successful Completion Basic Telephony Seven Habits of Highly Effective People Effective Communication Skills - Business Administration

Hartford Public High School Greater Hartford Community College

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Stephanie D Jones