TROY BURTON

• Developed and maintained positive customer relations and coordinated with team members to properly handle requests and questions
• Developed and utilized reports to assist leadership with key decisions and outperformance of operational targets
• Identified prospect needs and developed appropriate responses along with information on suitable products and services
• Created and deployed best practices to improve efficiency and reduce defects
• Noted trends in product quality and functionality to determine problem areas and plan for improvements to processes
• Communicated with production team members about quality issues
• Completed precise measurements using special tools
• Determined root cause of deviations and non-conforming results and implemented appropriate corrective and preventive actions throughout product development process
• Perform non-clinical reviews and process re-determination for claims/appeals.
• Ensured compliance with applicable laws and regulations governing the handling of financial documents.

Translated written documentation and notes into emails and other types of correspondence.

• Answered incoming phone calls and directed callers to appropriate departments and personnel.
• Developed training materials for new employees on processing procedures.
• Adhered to compliance and privacy policies and procedures to maintain confidentiality and information protection.
• Maintained confidentiality of sensitive customer information at all times.
• Emailed completed documents to supervisors and co-workers to confirm accuracy.

• Review invoices against payer contracts and bill rules and correct discrepancies timely and accurately
• Demonstrates complete understanding of how to research and resolve issues pertaining to the precertification and day-to-day operational concerns
• Demonstrates full understanding and ability to differentiate the PostAcute Care processes over multiple health plans across multiple states to ensure compliance with both Medicare and Medicaid guidelines by state regulations
• Collaborate effectively with internal business partners as well as external players to drive timely and accurate collections of invoiced amounts.

• Discharge orders, Discharge summary, Discharge instructions care plans Reviews the member record for completeness Requests medical records from health care providers Reviews census daily and identifies new admissions and notifies Reviews the member's benefits and eligibility Reviews the member record for completeness Communicates and documents authorization to appropriate naviHealth personnel, health providers and Health Plan, as indicated
• Runs reports to assure LiveSafe/HRA+are complete and timely
• Informs designated naviHealth personnel when there are discrepancies or omissions in the medical record and/or naviHealth database
• Release of Records consent ,Medical Power of Attorney/Power of Attorney documents Living Will/Advance Directives, Physician notes Adheres to organizational, departmental and regulatory policies and procedures
• Promotes a positive attitude and work environment
• Assessed patients and documented their medical histories
• Managed various general office duties such as answering multiple telephone lines, completing insurance forms and mailing monthly invoice statements to patients
• Provided patient education and review claims for billing purposes.
• Accurately documented all elements of nursing assessment, treatments, medications, discharge instructions, and follow-up care
• Partnered with a team of registered nurses to achieve the overall well-being of all patients.

• Primary liaison between customer and departments Collaborate with Prescription Specialists and Pharmacists to ensure that all prescription needs are met Communicate with customers/patients by phone to set up new or existing prescription orders Contact the customers/patients on a monthly basis to inform of order changes Review product shortages, product changes, recalls, or backordered or discontinued products Coordinate with other departments to ensure resolution to order discrepancies
• Assessed patients and documented their medical histories
• Trained new staff on quality control procedures.

• Effectively communicated with internal/external customer to manage expectations, needs, and priorities Used problem solving skills to liaison with insurance companies to resolve patient claims issues Communicate with customers/patients by phone to set up new or existing prescription orders Contact the customers/patients on a monthly basis to inform of order changes Review product shortages, product changes, recalls, or backordered or discontinued products Coordinate with other departments to ensure resolution to order discrepancies Team leader who exercised sound judgment, made logical decisions with minimal supervision
• Described product to customers and accurately explained details and care of merchandise
• Investigated and resolved customer inquiries, billing and complaints in a timely and empathetic manner.