Case Management

Rate, USD
Not specified
Work schedule
Full Time, Part Time,
Language skills
English
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About me

Results-driven and highly organized professional with a proven track record in healthcare administrative roles and customer service, seeking to leverage a strong foundation in healthcare
administration and customer service for an HR position. Proficient in data management, compliance, and communication, with a keen eye for detail and a commitment to ensuring accuracy and adherence to regulations. Excels in providing top-tier customer service, whether it’s addressing patient inquiries or collaborating with healthcare professionals. Enthusiastic about transitioning to an HR role to contribute strong organizational and interpersonal skills, along with a dedication to optimizing processes and supporting a positive work environment.




Education

02/2023-current Human Resource Management @ Rowan College of South Jersey
02/2015-12/2015 Health claims Specialist @ Harris School of Business

Experience

10/2023-current Companion/Caregiver @ Self employed

• Assisted hospice patients with daily living activities, encompassing tasks such as hygiene, ambulation, eating, dressing, toileting, and shaving, ensuring that residents needs were met promptly and compassionately.
• Engaged with residents, offering companionship and participating in resident activities.
• Fostered positive and enjoyable environments by conversing with residents, listening to their stories,
and sharing personal experiences.
• Prioritized resident safety and comfort, providing assistance with transfers, such as moving clients in and out of beds, baths, wheelchairs, or cars.

June 2023 to October 2023 Case Manager @ TeamPHCA

• Managed time cards and tracked clock in/out locations, ensuring accurate attendance records.
• Assisted in finding suitable staff to support protected clients, contributing to their well-being.
• Facilitated onboarding paperwork for new hires, streamlining the recruitment process.
• Initiated follow-up emails and calls to staff, families, and CLA/Lifeshare providers for effective communication.
• Collaborated with Program Coordinators (PCs), Service Coordinators (SCs), and Behavioral Specialists
to schedule 24-hour trainings.
• Conducted 90-day performance surveys to assess staff performance and improvement opportunities.
• Reviewed Individualized Service Plan (ISP) plans and ensured daily progress notes aligned with care plan guidelines.

September 2020 to June 2023 Case Management @ Array Behavioral Care

• Interacted with consumers through phone and email, addressing their inquiries and providing them with relevant information about services.
• Updated AtHome Biller Smartsheet with accurate and current session data and status information.
• Coordinated with Care Navigation staff to schedule follow-up sessions, ensuring a smooth transition between services.
• Processed and completed records and disability requests promptly, keeping them up-to-date, organized and screened consumers for appropriateness for Inpathy services.
• Scheduled appointments, and followed up with consumers who contacted us via phone, website or live chat to answer their questions and direct them to appropriate care.
• Analyzed data and records to develop projections and cohorts, ensuring accuracy and completeness
prior to submission.
• Maintained strict confidentiality of financial, employee, and patient information, adhering to HIPAA regulations.
• Responded to phone calls and emails from patients about their statements, providing them with information and addressing their concerns and assisted consumers with selecting appropriate providers and services, explaining financial responsibility and providing support throughout the process.
• Worked in denial queues to adjudicate claims and refile them with payers ensuring timely and accurate processing of claims, and obtained prior authorization.
• Monitored and reported on ongoing performance under contract, including administrative requirements, claims processing lags, denials, bad debt, and other key indicators.
• Reconciled payments from billing platform (Athena) to bank statements, ensuring accuracy and completeness of payment records and organized and uploaded correspondence received to the
office, keeping it up-to-date and accessible.
• Facilitated the completion of ROIs (Release of Information) to expedite request processing.
• Prioritized requests by referring to trackers to enhance efficiency.
• Handled a high volume of calls, requesting assistance with accessing behavioral health services.
• Prioritize cases based on shifting needs and resources.

September 2019 to June 2020 Collateral Specialist @ Freedom Mortgage

• Audited loans.
• Reviewed closing packets to ensure all documents were present, signed and motorized where needed.
• Obtained missing documents if packets were incomplete.
• Prepared collateral packages for daily delivery to warehouse banks within strict deadlines.
• Processed between 30-100 packages a day.
• Tracked collateral via Excel spreadsheets.

February 2017 to September 2019 Insurance Coordinator @ Growing Smiles Pediatric Dentistry

• Verified insurance details and effectively communicated precise information to both staff and patients
regarding insurance eligibility and benefits.
• Demonstrated exceptional computer skills and proficiently utilized Open Dental for streamlined operations.
• Devoted daily attention to resolving insurance claim matters, including addressing requests for additional information and handling claim denials.
• Maintained comprehensive knowledge of dental insurance, employing independent judgment in assessing coverage and handling insurance claims.
• Skillfully prepared and presented financial arrangements and insurance options, aligning them with the needs of both patients and the practice for proposed treatment plans.
• Ensured that all documentation met the required standards and was completed in a timely fashion, contributing to excellent patient relations and financial success for the practice.


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