Theresa Ford
St Louis
Summary
Dynamic Patient Support Specialist with United BioSource, skilled in patient advocacy and benefit verification. Proven ability to enhance patient satisfaction through effective communication and meticulous documentation. Successfully resolved complex insurance issues, ensuring compliance and optimal coverage for patients. Committed to delivering compassionate care while navigating intricate healthcare systems.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Patient Support Specialist
United BioSource (UBC)
St.louis
11.2023 - Current
- Applied general knowledge, front-desk administration skills and clinical skills to patients in hospital, improving response to issues.
- Collaborated with hospital staff members to ensure quality care was provided at all times.
- Created reports summarizing cases handled by the Patient Advocacy Department each month.
- Organized patient records and updated information in the hospital database system.
- Informed patients about their rights under HIPAA regulations.
- Facilitated communication between patients, family members, and healthcare professionals.
- Ensured that all necessary documents were signed prior to any procedure being performed.
- Processed patient co-pays, deductibles, and other payments, ensuring accurate financial records.
- Handled high volume of incoming calls, providing exceptional customer service to patients and families.
- Assisted with the completion of insurance paperwork for patient coverage.
- Guided patients through the completion of consent and other required medical forms.
- Provided emotional support and counseling to patients and their families.
- Gathered and analyzed patient information to determine special program eligibility.
- Attended meetings with physicians and other healthcare professionals to discuss cases.
- Facilitated patient registration, verifying all required documentation is collected and filed properly.
- Explained policies, procedures and services to patients.
- Conducted research on health insurance policies to ensure compliance with laws and regulations.
- Documented patient activities, problems with coverage, and hospital actions.
- Documented patient counters in hospital system and initiated follow-up actions.
- Worked with patients to appeal insurance decisions and coordinated with providers to resolve problems.
- Advocated for patients' rights when dealing with third party payers or other healthcare entities.
Benefit Verification Specialist
United Healthcare Group
St.louis
03.2021 - 11.2023
- Administered leave programs such as FMLA, PTO, and disability leave, ensuring compliance and proper tracking.
- Facilitated communication between providers and payers when there were disputes over claim payments.
- Produced detailed reports and data models to help clients pick optimal plans.
- Advised customers about different types of coverage options available through their insurer.
- Resolved customer inquiries regarding benefit eligibility in a timely manner.
- Checked accuracy and completeness of benefits applications and documents.
- Coordinated benefits processing, including enrollments, terminations and claims.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Reviewed and verified health insurance benefits for patients prior to their scheduled appointments.
- Monitored changes in regulations related to healthcare benefits verification processes and procedures.
- Processed requests from physicians' offices for pre-authorization of tests or treatments.
- Provided assistance with claims processing when needed, including filing appeals as necessary.
- Explained the requirements for obtaining pre-authorization from insurers.
- Identified needs of customers promptly and efficiently.
- Professionally handle a high volume of incoming calls
- Thoroughly and efficiently gather customer information, assess and fulfill customer needs and educate customers where applicable regarding products and services
- Ability to utilize and navigate multiple systems simultaneously
- Be dependable and meet all attendance requirements
- Resolve customer issues via one-call resolution guidelines and/or escalated process
- Meet or exceed company and client performance metrics
- Maintain a balance between company policy and client benefit in decision making
- Continuously evaluate and identify opportunities to drive process improvements that positively impact our client and its customers
- Responsible for call disposition or compiling and documenting customer information as required
- Ability to accept and embrace changes within the current business environment
United Cerebral Palsy
Direct support specialist
St.louis
02.2019 - 08.2023
- Assisted with customer requests and answered questions to improve satisfaction.
- Conducted system analysis and testing to identify and resolve technical issues or inefficiencies.
- Managed household errands and other essential duties.
- Assisted individuals in learning and developing new skills.
- Drove clients to doctors' appointments and social outings.
- Supervised medication administration, personal hygiene and other activities of daily living.
- Helped clients communicate with loved ones by typing written messages and relaying verbal messages.
- Tracked and reported clients' progress based on observations and conversations.
- Recorded client status progress and challenges in logbooks and reports.
- Encouraged independence by teaching daily living skills such as budgeting, cooking, cleaning.
- Monitored medication administration and provided support to ensure proper use of medications.
- Documented current patient information to update vital signs, behaviors, and eating habits.
- Assisted clients with maintaining good personal hygiene.
- Monitored client's well-being, safety and comfort under physician direction.
- Acted as an advocate for clients when communicating with outside agencies or organizations.
- Provided direct care to individuals with intellectual and developmental disabilities, fostering activities of daily living.
- Developed individualized plans for clients based on their needs and preferences.
- Maintained clean and well-organized environment for client happiness and safety.
- Facilitated communication between clients, their families, and other service providers.
- Partnered with registered nurses and physiotherapists to provide care to patients.
- Used approved crisis intervention techniques in emergency situations.
- Conducted recreational activities such as outings or field trips.
- Helped clients get in and out of beds and wheelchairs.
- Maintained accurate records of client's progress.
- Consulted with client care team to continually update care plans.
Education
High School Diploma -
Vashon High School
St.louis, MO05-2012
Skills
- Patient advocacy
- Benefit verification
- Insurance coordination
- Patient documentation
Certification
- CPR certified
- CPR certified
Timeline
Patient Support Specialist
United BioSource (UBC)
11.2023 - Current
Benefit Verification Specialist
United Healthcare Group
03.2021 - 11.2023
United Cerebral Palsy
Direct support specialist
02.2019 - 08.2023
High School Diploma -
Vashon High School