Quality Assurance Customer Service
Resume:
PROFESSIONAL PROFILE
A skilled and passionate healthcare professional that is talented at setting patients at ease and structuring treatment plans around each patient's strengths and is skilled in intakes and assessments, crisis management and comprehensive case
management. I am a well-rounded professional experienced in applying principles of psychology to personnel
handling, administration, management and marketing problems with strong leadership and relationship-building skills
and is committed to providing the highest level of care to patients and consumers
PROFESSIONAL HIGHLIGHTS
Experience with clinical case management Medicare / Medical Assistance
Exceptional presentation and communication skills Knowledge of legal and ethical standards
Experienced with diverse populations Experience working in a clinical setting
Experience performing assessments Proficiency with Windows and Microsoft
Highly motivated and results-oriented Strong Customer service skills
Medicare Claims/Appeals Long Term Support Services
Quality Assurance/Home Healthcare Regulations Scheduling/Insurance Billing
Human Resources HCSIS/ SAMS/PCA Portal/PROMISE
EXPERIENCE
Administered evaluation surveys as required by. Attended care conference, supervision, departmental, and outside
meetings and trainings as requested. Charted weekly progress notes and quarterly summaries. Collaborated with
other area service providers, Identified family members, social networks, and community systems that need to be
included in treatment plans for clients. Supervised professional and technical staff in implementing health programs,
objectives, and goals, Coordinated counseling efforts with mental health professionals, doctors, nurses, and social
workers. Referred clients to other support services as needed such as medical, housing, social services, employment
services and legal.
Patient / Family Education
Educated patients and families in community resources, insurance guidelines, and discharge procedures
Quality Assurance
Ensured and enforced nursing home compliance with HIPAA, regulations for maximum quality and control. In charge of
Medicare and HMO claims and appeals
EDUCATION
MASTER OF SCIENCE: HEALTH SERVICES MANAGEMENT 2014
Eastern University, St. David's, PA
BACHELOR OF SCIENCE: PSYCHOLOGY / HEALTHCARE MANAGEMENT 2003
Philadelphia University, Philadelphia, PA
PROFESSIONAL HISTORY
MIDATLANTIC REHABILIATION SERVICES (MARS CARE)
Philadelphia, PA
DIRECTOR OF LONG TERM SUPPORT SERVICE 06/2016 to 01/2017
LEAD WAIVER ACCOUNT MANAGER / SKILLED HOMECARE ADMISSIONS COORDINATOR 10/2014 to 06/2016
Manage a staff of 5 in office employees/400 field employees
Assess individuals for long term support services in the home / Obtain Insurance Authorizations
Work closely with Office of Long Term Living/Medicaid/PA Waiver Programs
Advised patients on community resources, made referrals and devised realistic treatment plans. Compiled
socio-psychiatric case histories to facilitate accurate diagnoses. Evaluated and addressed individual client
needs and concerns.
Quality Assurance
Medicaid Compliance
Networking with the Better Health Network (providing services for the consumers in underserved areas in the Tri-State Area
Interviewing/Hiring/Managing Time off Requests
Providing In-services/Training
SKYLINE HEALTHCARE: WILLOW TERRACE NURSING & REHABILITATION CENTER
Philadelphia, PA
DIRECTOR OF SOCIAL SERVICES/MEDICAID SPECIALIST 06/2012 to 10/2014
Discharge Planning
Medicare D / Medicare A Conversion Daily Charting Completing MDS 3.0 Assessments
Medicare Claims and Appeals
Participating in Care Conference, PASRR ID completion, Quality Assurance, Insurance Verification Medical Assistance Grant Completion.
Working in conjunction with the Philadelphia County Assistance Office
Interviewed clients individually and with families to determine what services would best address their needs.
Working with local Dialysis Centers to maintain continuity of care for nursing home residents.
Advised patients on community resources, made referrals and devised realistic treatment plans.
Communicated with relatives of patients about diagnoses and treatment programs
Assessed patient and delivered comprehensive case management services. Interviewed patients and their relatives to compile detailed social and psychiatric information. Communicated with public social and welfare agencies to obtain and provide information.
Admissions / Marketing Director
Marketing to local area Hospitals Evaluating Hospital Charts Census Projection Conducting Facility Tours
Completing Daily Census and Census Log Medicare D / Medicare A Conversion HMO Contract negotiating
Daily Charting Completing Medicare Logs/ Medicare Denial Letters Family Council Liaison
Working with on-staff Behavior Health Educator & Psychiatrist Completing MDS Assessments
PASRR ID Training
SKYLINE HEALTHCARE: WYNDMOOR HILLS HEALTHCARE & REHAB CENTER
Philadelphia, PA
DIRECTOR OF SOCIAL SERVICES / ADMISSIONS 11/2010 to 06/2012
Discharge Planning
Evaluating Hospital Charts
Medicare D / Medicare A Conversion, Verified Health Insurance
Patient Registration and Daily Charting
Medicare Denial Letters / Appeals and Claims
Completed MDS Assessments Participating in Care Conference
PASRR ID completion
Quality Assurance
KEARSLEY RETIREMENT COMMUNITY
Philadelphia, PA
DIRECTOR OF ADMISSIONS / SOCIAL SERVICES 09/2007 to 09/2010
Interviewed clients individually and with families to determine what services would best address their needs.
Advised patients on community resources, made referrals and devised realistic treatment plans. Compiled
socio-psychiatric case histories to facilitate accurate diagnoses. Evaluated and addressed individual client
needs and concerns. Maintained a caseload of 84 patients, working under strict deadlines.
Coordinated with hospitals and families to ensure appropriate skilled nursing home care.
Marketed in hospitals in the Tri-State area
Created and updated the daily census and working closely with hospital social workers and medical
insurance case managers.
Leader of the Quality of Life Team and Meetings / In charge of Insurance Appeals and Claims
CERTIFICATIONS
Six Sigma Certification (White Belt)
AFFILIATIONS
National Association of Professional Women (VIP)
Healthcare Executives Network
Hospital and Healthcare Administration
Eldercare Networking Group
Network of Professional Social Workers
Professional Women's Network
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