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Clinical Administrative Coordinator Resume Samples
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0-5 years of experience
- Provided expertise claims support by reviewing, researching, and investigating all types of preventive and clinical claims to ensure members received appropriate critical measures
- Effectively multi-tasked shifting back and forth between two or more activities at a time
- Developed and maintained business relationships with providers’ offices
- Completed multiple high priority projects before deadline
- Provided superior customer service for incoming and outgoing telephone calls to or from members, providers, employer groups and other persons deemed necessary by management
- Documented all outcomes by maintaining records, reports and statistics as required
0-5 years of experience
Easily establish rapport with people of all ages, cultures, and beliefs. Dealt tactfully and effectively with difficult members. Ethical,
skilled communicator. Can establish individual and group rapport. Setting appointments for Practitioners
- Assisted members with questions regarding their membership
- Communicated with customers daily
- Communicated information clearly and accurately
- Committed to the assistance and support of others while maintaining a cheerful and helpful attitude
- Assisted customers with inquiries and provided all pertinent information
- Answered inbound calls and assisted members with concerns.
0-5 years of experience
Train junior staff how to use company specific excel sheet; patient care opportunity report, on ICUE, how to track work and hours, refresher on EEOC and benefits, trained on company specific phone system, how to deal with adverse and diverse members.
- Serve customers by providing information on coverage and benefits
- Maintained detailed documentation of case information on ICUE, PCOR; patient care opportunity report, CareOne, and Health Collaborative
- Adhere to corporate requirements based on CMS, ADA, False Claims Act, UnitedHealth Group Compliance, Total information management, and Health Collaborative
- Partner with practice's staff to manage appointments and share relevant data
- Thrive in a fast-paced, quick-changing environment that requires multitasking tasking skills
- Recognized for outstanding service with Opal, Aquamarine, and e-Bravo awards for Productivity, Innovation and team building
- Created a team specific spread sheet to help track and show the teams work towards helping members meet their health goals
- Built and maintained relationships with Providers by reaching out and working with their office management team to help members meet their health goals
0-5 years of experience
Provides routine administrative and clinical support. Position involves frequent interaction with insurance policy holders.
- Enrolled participants into disease management, life coaching and maternity programs.
- Completed health risk assessments for newly diagnosed participants.
- Worked with various insurance companies and registered nurses to ensure positive participant outcomes.
- Followed up with maternity program participants to monitor their progress and anticipate needs.
- Linked maternity participants with case managers as needed.
0-5 years of experience
Provided administrative support to Project Manager/Director of current study in addition to the whole project team
- Coordinated and supported external client meetings, including the organization and arrangement of meeting materials, catering and any necessary travel arrangements, as requested
- Provided routine administrative support for clinical projects (e.g., correspondence to sites, mailings, faxing, photocopies, filing, arrange and attending client / team meetings, taking of minutes etc.)
- Maintained administration systems (tracking and other in-house systems) for the clinical projects and/or department
- Screened/directed incoming calls to appropriate person/department from internal and external clients; respond to inquiries as required
- Maintained incoming/outgoing queries
- Completed special projects assigned via supervisor or department
- Acted as liaison between support staff and department management by providing feedback on performance and training/mentoring needs, including training and mentoring of support staff
- Assisted in identifying and implementing best practices between/across project teams
- Assumed a coordinating role for the department concerning administrative matters
- As applicable, acted as liaison with Administrative/Office Services, coordinating all aspects of internal moves (office/workstation assignments)
0-5 years of experience
Develops and enforces policies and procedures and ensures optimal patient relations
- Receives approval of budgets and pay scales in clinical settings that specialize in specific treatments
- Possesses knowledge of insurance processes, new medical treatments and government guidelines
- Processes admission notifications; enters cases in Facets and Q; sends face sheets to clinical team and files documents
- Inputs data of census updates and discharged cases, including entry of correct dates, room type codes, discharge disposition and status; filing of documents; runs Q daily update report daily
- Processes enrollment forms upon notification
- Verifies insurance eligibility; bills cases; flags cases for LOB potential
0-5 years of experience
- Served as a day to day contact to address client requests, contractual obligations, work procedures, appointment request for MD's, Scheduling and other elements of supporting assigned clients.
- Managed process improvement projects at a department level.
- Coached and trained staff in areas such as building relationships, providing quality resolution to internal and external customers, process improvement efforts to improve current processes and reduce and/or eliminate inefficient practices.
- Collaborate with other operational areas to identify client scenarios that were not meeting mutual needs and recommended appropriate course of action(i.e. unfavorable business solutions & unprofitable business practices
- Evaluated & analyzed client satisfaction metrics/data and direct feedback to identify opportunities for improving client outcomes, and took appropriate action to remediate as warranted.
- Worked with support teams such as member services for capacity planning, claim processing to ensure service level agreements are met, employer reporting when special report packages are warranted, as well as area such as internal pharmacy benefit manager and other areas to ensure the proper operational support can be offered pre/post renewal and/or pre/post installation.
- Participate in risk assessment activities by working with senior leadership to develop cost saving initiatives.
- Facilitate relations with various Behavioral Health facilities and MD's
- Responsible for the service level of 300+ customers.
0-5 years of experience
- Provided telephonic support to health plan members in a call center environment.
- Established a personal plan focusing on members' preventative health screenings.
- Worked as liaison between members, physicians' offices and functional team include nurses, social workers and medical directors.
- Supported new hire training as team leader.
0-5 years of experience
- Educate members about preventative healthcare and schedule them for programs available to them through their individual health care plans.
- Achieve performance metrics for production, quality assurance, and adherence goals, on a daily basis, showing consistency and often making top performer and high quality assurance scores within the call center.
- Offer outstanding support for members by coordinating services with heath care facilities and providers
- Find different strategies and solutions when handling members' reluctance to participate in various programs.
- Work independently and with team members to collect data and pilot new innovative programs and practices.
0-5 years of experience
- Educate members about preventative healthcare and schedule them for programs available to them through their individual health care plans.
- Achieve performance metrics for production, quality assurance, and adherence goals, on a daily basis, showing consistency and often making top performer and high quality assurance scores within the call center.
- Offer outstanding support for members by coordinating services with heath care facilities and providers
- Find different strategies and solutions when handling members' reluctance to participate in various programs.
- Work independently and with team members to collect data and pilot new innovative programs and practices.
6-10 years of experience
Responsible for general supervision of the Nursing Department and hospital during non-business hours.
- Oversee hospital staff to ensure quality care and compliance of hospital policies.
- Provide professional guidance and health education to nursing personnel.
- Manage disciplinary complaints and prepare administrative reports.
- Provide and ensure adequate staffing within the hospital.
- Manage crisis and emergency situations.
- Respond to hospital consumer complaints.
0-5 years of experience
- Managed administrative intake of members or the physician office for request of prior authorization.
- Worked with hospitals, clinics, facilities and the clinical team to manage request for services from members and/or providers.
- Managed the referrals process, processing incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles.
- Receive care coordination notification cases for non-clinical assessment/intervention and provide appropriate triage.
- Review requests for adverse determination, approval notification and processing notification requirements.
- Reviewed and processed prior authorization denials.
0-5 years of experience
- Coordinate disease management, depression management, and Woman and Children programs on behalf of various insurance companies.
- Manage 150+ outbound and inbound calls per day.
- Perform data entry on new patient information.
- Strong customer service skills
- Experience using Internet, Windows applications (Word, Excel) and e-mail services (Outlook)
- Excellent verbal and written skills
0-5 years of experience
- Received department awards for outstanding customer service.
- Received team awards for achieving personal monthly goal.
- Intake of members discharge information post-notification
- Manages incoming calls and call requests from Providers/members
- Manages the referrals process, processes Incoming and Outgoing Referrals, and Prior Authorizations
6-10 years of experience
Analyze, create & update business workflows
- Training assistant & mentor to new team members
- Experience in audit, quality & pharmacy lines of business
- Claims and benefits explanation & inquiry customer service
- Enrolled members in wellness programs
- Exceeds quality and business metrics
0-5 years of experience
- Assist with member inquires in a call center environment including healthcare professionals on Medicare/Medicaid accounts
- Aware and knowledgeable of medical terminology, explanation of benefits and eligibility of HMO, PPO and POS plans for medical insurance policies
- Provide support to clinical managers, team managers and RN case managers as needed on prior or non-prior authorizations cases for Inpatient admits and discharges of medical level of care
- Generate prior open authorizations for Outpatient/Inpatient admit cases and/or STAT request including procedure CPT/ICD-10 codes and cases such as home health, skilled nursing facility, DME service orders
- Verify healthcare accounts and assessment from callers and document information including researching information in patients charts and/or transfer calls to appropriate extension if necessary
- Provide licensed professional provider referrals to members as recommendations and/or requested
0-5 years of experience
- Conduct a high volume of outbound scheduling calls to members of the health plan for their in-home visit with a practitioner.
- Answer inbound calls from members and assist with their inquiries.
- Follow system scripting and validate member demographic information.
- Follow HIPPA guidelines and regulations.
- Document the member's record with accurate information obtained on the call.
- Ensure appointments are scheduled accurately by using excellent communication skills
- Resolve scheduling issues by demonstrating attention to detail, patience and enthusiasm
0-5 years of experience
- Accurately enter required information (non-clinical & structured clinical data) into computer database
- Review structured clinical data matching it against specified medical terms and diagnoses or procedure codes and follow establish procedures for authorizing request or referring request for further review
- Attach incoming information to Careone database and follow established procedures for distributing information for further review
- Call back providers with precertification numbers as needed and file completed precertification requests as per established procedures
- Call hospitals for admit and discharge dates as needed
- Print and send form letters from Careone system as directed
- Maintain patient confidentiality as defined by state, federal, and company regulations
- Establish effective rapport with other employees, professional support service staff, and providers
- Support company Quality Assurance (QA) and Quality Improvement (QI) initiatives
0-5 years of experience
Registration Intake Specialist; Provides information on available Network services and transferring members to appropriate Clinical staff, while ensuring privacy and confidential laws are met per HIPAA. Responsible for call triage and maintaining contracts with various members.
- Managing requests for services from Provider/members
- Processes Incoming and Outgoing Referrals
- Resolve Customer Service Inquiries
0-5 years of experience
- Drafting approval, denial, termination, and reduction of service letters for Medicaid/Medicare program clients.
- Evaluate clinical documentation to ensure it meets regulatory requirements.
- Apply knowledge of the State and Federal regulations concerning the services and benefits.
- Follow department Standard Operating Procedures for handling cases.
- Resolve routine cases.
- Facilitate timely review and closure of cases.
- Assist in special projects as needed.
0-5 years of experience
- Answer inbound calls from members exhibiting excellent telephone etiquette
- Receive electronic referral form requests for medical/behavioral/clinical services.
- Plans, prioritizes, organizes and completes work to meet established objectives.
- Able to create, edit, save and send documents utilizing Microsoft Word and Excel and SharePoint.
6-10 years of experience
- Help support Supervisor in daily activities (work escalations, take over primary duties if supervisor is absent)
- Answer in depth question in regard to standard operating procedures
- Gather and relay information to and from various group and individuals
0-5 years of experience
- Set up, coordinate, and manage Home Health cases for injured workers as directed by nurse lead.
- Locate vendors within network or in patient's area to provide home health services.
- Obtain notes, reports and authorization documents from medical providers.
- Triage information from emails, faxes, and enter new referrals information into the system, and assign cases accordingly to coordinator or nurses.
- Manage email and phone inquiries from vendors, patient, case manager, and adjusters.
- Ability to work effectively in a fast paced environment while consistently meeting deadlines.
- Demonstrate positive and effective time management, prioritization and organizational skills.
- Coordinate and manage monthly spreadsheet for patient's home health status.
- Entered daily status notes in the patient's home health cases files.
- Skilled in effectively communicating/interacting with diverse groups of individuals/management.
0-5 years of experience
- Perform internal quality audits and metrics review for Medicare and Medicaid Prior Authorization cases for multiple health insurance platforms
- Compile data to support external audits
- Work across interdepartmental teams to improve their compliance to CMS regulations
