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Unitedhealth Group - Senior Clinical Administrative Coordinator Resume Example

Noah Smith
XXXX XXXXXX XX, Mesquite, TX 75149
Ph: XXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXX
Summary
CAREER OBJECTIVE I am seeking a position that will allow me utilize my professional and interpersonal communication skills. SUMMARY OF QUALIFICATIONS Skills in planning, organizing and managing special projects Possesses over 16 years of customer service and call center experience Experienced in working with ICD-9-CM and CPT-4 classification systems Knowledge of medical database computerized systems Experience in Insurance Verification and Precertification Proficient in Microsoft Word and Excel Worked closely with Utilization Management staff and registered nurses regarding case specific information. Detailed oriented, able to prioritize and use resources available and able to multi-task

Accomplished and energetic [Job Title] with a solid history of achievement in [Type of Work]. Motivated leader with strong organizational and prioritization abilities. Areas of expertise include [Skill 1], [Skill 2] and [Skill 3].

Skills
  • Customer and Personal Service
  • Complex Problem Solving
  • Time Management
  • Clerical
  • Time Management
  • Judgment and Decision Making
Experience
Senior Clinical Administrative Coordinator Jan 2006Jan 2014 UnitedHealth Group Richardson, TX
  • Assist with Program Eligibility verifications Appropriate Referrals to Case Management staff Review medical benefit policy to determine if a patient meets the medical policy criteria, forward case to Clinical Nurse or Medical for coverage determination Review cases for Morbid Obesity Surgery, BRCA Genetic Testing, Botox, Synagis Contact provider to verify or obtain clinical information for requested procedure Utilize online tools to research physician data as well as in-house databases to research eligibility and in/out of network status of providers Review GAP request for gap exception Assist with Program Eligibility verifications.
  • Appropriate Referrals to Case Management staff.
  • Complete notification wizard along with ICD-9 and CPT coding Provide excellent customer service to both providers and enrollees Constantly meet established productivity, schedule adherence, and quality standards while maintaining good attendance Special Projects BRCA Genetic Testing Assist with training new hires.
Adm. Assistant Jan 2003Jan 2006 Baylor Institute for Rehabilitation - Outpatient
  • Received and screened visitors/routine telephone calls and notified the appropriate staff members Prepared charts daily for therapy and medical staff Responsible for being a liaison between outpatient and access services staff Schedule follow-up visits for returning patients in a timely and professional manner Discharged patient charts and prepared charts for medical records Maintained an open line of communication with patients regarding scheduled appointments and helped resolve issues as they arise Establish and maintain updated patient information in the system Accurate and timely tracking and reporting for insurance verification, reauthorization and treatment plan reviews.
  • Obtained insurance authorizations for the clinicians to avoid failed claims.
  • Processed medical records inquiries and information requests from external sources (referents, legal system, etc.) on a timely basis in full compliance with HIPAA and federal and state confidentiality regulations.
  • Maintained client records in acc.
Administrative Assistant Jan 2002Jan 2003 Kelly Temporary Service/All Medical Personnel Ba
  • Maintained inpatient census, put together charts and performed various clerical duties.
Pre-certification Analyst Jan 2000Jan 2002 Blue Cross Blue Shield Pre-certification
  • Processed inpatient and outpatient client information using various computer programs to track client information.
  • Performed data entry duties inputting client information into the Novell software system.
  • Answered calls regarding medical service and physician referrals in a high volume call center.
General Clerk III Jan 1998Jan 2000 Parkland Memorial Hospital Surgery
  • Responsible for coordinating and maintaining scheduling for main operating room along with emergent surgery cases.
  • Performed CPT, ICD-9 and HCPCS coding.
  • Performed various clerical duties to include answering the telephones, data entry and customer service.
Customer Care Specialist Welcome Calls Jan 2015 Life Synch, a Humana Company
  • Provides service and guidance to organizations healthcare members who participate in Humana's Medicare Advantage programs, receive, document and resolve member and provider inquiries.
  • Manage inbound and outbound contacts; including conducting a Health Risk Assessment to eligible members.
  • Educate members, providers and employers about products and services via inbound/outbound calls and online.
Insurance Verification Coordinator Zale Lipshy University Hospital
  • Responsible for coordinating patient care with proper intermediaries and insurance companies.
  • Verified insurance for new admits.
Education
High School Diploma Dallas County Community College
CERTIFICATIONS Insurance Verification and Coding Certificate
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Resume Details

This is a real resume for a Senior Clinical Administrative Coordinator in Mesquite, Texas with experience working for such companies as Unitedhealth Group, Baylor Institute For Rehabilitation Outpatient, Kelly Temporary Service. This is one of the hundreds of Senior Clinical Administrative Coordinator resumes available on our site for free. Use these resumes as templates to get help creating the best Senior Clinical Administrative Coordinator resume.

Previous Companies:

  • UnitedHealth Group
  • Baylor Institute for Rehabilitation Outpatient
  • Kelly Temporary Service

Previous Job Positions:

  • Senior Clinical Administrative Coordinator
  • Adm Assistant
  • Administrative Assistant
  • Pre certification Analyst
  • General Clerk III

Schools:

  • Dallas County Community College

Level of Education:

  • High School Diploma
  • CERTIFICATIONS\nInsurance Verification and Coding Certificate

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