Clara Hayes
Chicago
Summary
More than 20 years of healthcare administration, patient services, and non-profit leadership experience. A self-directed, well-organized, and detail oriented professional who is conscientious and dependable. Equally comfortable in an individual contributor role as in a leadership role. Highly knowledgeable of the laws, best-practices and organizations that regulate and influence healthcare administration functions.
A solid team player with excellent communication skills.
Overview
43
43
years of professional experience
Work History
Thresholds Mental Health
Chicago
02.2016 - Current
- Pre-Certifications, Authorization, Payment Poster Specialist-Revenue Cycle
- Obtain authorizations for all mental health services provided by clinicians at various sites
- Accurately enter all demographic /authorization request on authorization forms to be faxed for approval
- Ensure all procedure codes and diagnosis codes are correctly entered for timely filing and processing
- Follow up with various MCO/MRO payers to ensure claims paid according to contract and fee schedule as outlined by the State of IL
- Process and manually post payments from MCO/MRO payers and lockbox
- All other related duties as requested.
Pre-Certifications/Authorization Specialist
University of Illinois Hospital at Chicago
Chicago
04.2015 - 11.2015
- Department of Opthalthomology
- Obtain Authorization/Pre-certifications for outpatient surgical procedures
- Verify and update all insurance information
- Make sure all referral/authorizations are obtained from Primary care physicians
- Accurately input authorization information on surgical case tracking log for claim processing
- Make sure all procedure codes and diagnosis codes are correct for accurate claim processing
- Set up and over see any case appeals/peer to peer reviews as needed for accurate claims processing
Insurance Follow – up Representative
NorthWestern Medical Faculty Foundation
Chicago
11.2011 - 04.2015
- Follow-Up with all contracted and non contracted insurance companies on medical claims
- Ensure all claims are paid in a timely and accurate manner according to contract and guidelines
- Ensure Medicare reimbursement guidelines are met and paid accurately
- Front desk back-up for scheduling, phone coverage, and in-person payment processing
- Resolve all claim reimbursement and procedure inquiries from insurance carriers, patients and other medical professionals
- All other related duties as requested.
Poster
NorthShore University Health Systems
Skokie
05.2011 - 08.2011
- Process and post all patient credit card payments received from lockbox
- Process and post all hospital patient payments received from lock box
- Process all incoming checks from patients and insurance companies for posting
- Print patient statements from Base Recover archive system
- Sort all BlueCross / BlueShield in-coming mail for scanning and processing
- Correct and update addresses on all returned correspondence.
Medical Billing/ Insurance Specialist
Sobel Medical Associates, LTD
Chicago
05.2008 - 10.2010
- Sobel Medical is an award winning family health services facility that follows a philosophy of preventative medical care
- This role supported a busy practice with eight providers and was responsible for all aspects of the medical billing function through the development and maintenance of reimbursement procedures and processes to ensure providers are reimbursed at the highest rate possible
- This includes:
- Overall claim and patient account management
- HCFA 1500 form processing for physician entity
- Ensure Medicare reimbursement guidelines are met and coding is accurate
- Confirm third-party reimbursements meet federal and state policies
- Resolve all claim reimbursement and procedure inquiries from insurance carriers, patients and other medical professionals
- Coordinate daily electronic submissions to Medicare, BlueCross, and other organizations
- Preparation for monthly, quarterly, and annual reporting and audits
- Front desk back-up for scheduling, phone coverage, and in-person payment processing
Patient Services
Fertility Centers of Illinois, S.C
Glenview
07.2008 - 02.2009
- Liaison-
- New patient call center
- Fertility Centers of Illinois, S.C., is a leading Infertility treatment practice, providing advanced reproductive endocrinology services for over 25 years
- Consistently exceeded monthly goals – average conversion of at least 82%, average show rate of at least 85%, and error rates less than 6%
- Position was responsible for ensuring customer service, conversion of prospective patients into satisfied customers
- Preparing and reporting new patient scheduling results and accurately maintaining customer database
- Coordinated with all locations to ensure seamless transition and the highest level of patient satisfaction
- Verified patient coverage and ensured billing visiting patient accommodations and policy compliance
Case Manager/Job Developer-Employment Resource Developer
Howard Area Community Center
Chicago
12.2007 - 07.2008
- For over 45 years the Howard Area Community Center has assisted low-income families and individuals to stabilize their lives and develop the skills necessary to become productive community members
- This role was accountable for establishing relationships and executing activities designed to develop, locate, and secure employment for Fresh Start, a program that serves ex-offenders
- In addition, this position was charged with:
- Administer and facilitate Fresh Start reintegration and job readiness curriculum
- Management of the job resource bank
- Record keeping, grant compliance, and contract and budget management
Parent Resource and Development Coordinator
Family Matters
Chicago
11.2002 - 07.2007
- Family Matters is a non-profit organization that seeks to build and strengthen the community through programs that support personal growth and leadership
- Recruited to this grant-supported leadership position generated as one solution to the academic probation status of CPS’ Gale Academy
- This role was charged with developing and implementing programs focused on improving the school rating by increasing parent involvement, parent-staff interaction, and student accountability and decision making skills
- Increased parental involvement in school programs over 35%
- Developed bi-lingual committee to support the needs of the Hispanic parents and students
- Provided parent workshops on financial self-sufficiency, AIDS awareness, nutrition, etc.
Senior Patient Accounts Representative
Evanston Northwestern Healthcare
Evanston
04.1999 - 10.2002
- ENH is an award winning integrated healthcare system with a compliment of hospitals, medical practices, research institute and partnership with the University of Chicago Pritzker School of Medicine
- This position was responsible for a variety of activities related to claims processing, patient inquiries, collection management, and recordkeeping
- Lead for Medicare and Blue Cross Blue Shield, ensuring accuracy and compliance of claim submissions
- Processed HCFA 1500 forms for the hospital entity for medical services provided
Physician Billing Supervisor
Chicago Cornea Consultants
Highland Park
12.1996 - 03.1999
Patient Accounts representative
Loyola University Medical Center
Maywood
07.1992 - 12.1996
Collection Specialist II
University of Illinois Hospital
Chicago
06.1988 - 07.1992
Personnel Records Specialist & Accountant
US Army
01.1989 - 01.1992
Reservist, Staff Sergeant
US Army, Lebanon
01.1982 - 01.1985
Personnel Records Specialist & Accountant
Revenue Department
Education
IL Certificate Medical Terminology -
University of Illinois
BA - Accounting
Roosevelt University
U.S. Military Academy
Skills
- TECHNOLOGY
- Proficient in
- MS Office applications, MS Publisher, Medical Manager, Epic, IDX, Tiger, and Mysis
Additional Information
- COMMUNITY INVOLVEMENT & AWARDS , Family Matters Volunteer 2007 - Present School Council Community Representative 2008 - 2009 School Council Chair 2002 – 2007 City of Chicago Community Leadership Policing Award 2006 City of Chicago School Safety Award 2006
Timeline
Thresholds Mental Health
02.2016 - Current
Pre-Certifications/Authorization Specialist
University of Illinois Hospital at Chicago
04.2015 - 11.2015
Insurance Follow – up Representative
NorthWestern Medical Faculty Foundation
11.2011 - 04.2015
Poster
NorthShore University Health Systems
05.2011 - 08.2011
Patient Services
Fertility Centers of Illinois, S.C
07.2008 - 02.2009
Medical Billing/ Insurance Specialist
Sobel Medical Associates, LTD
05.2008 - 10.2010
Case Manager/Job Developer-Employment Resource Developer
Howard Area Community Center
12.2007 - 07.2008
Parent Resource and Development Coordinator
Family Matters
11.2002 - 07.2007
Senior Patient Accounts Representative
Evanston Northwestern Healthcare
04.1999 - 10.2002
Physician Billing Supervisor
Chicago Cornea Consultants
12.1996 - 03.1999
Patient Accounts representative
Loyola University Medical Center
07.1992 - 12.1996
Personnel Records Specialist & Accountant
US Army
01.1989 - 01.1992
Collection Specialist II
University of Illinois Hospital
06.1988 - 07.1992
Reservist, Staff Sergeant
US Army, Lebanon
01.1982 - 01.1985
Personnel Records Specialist & Accountant
Revenue Department
IL Certificate Medical Terminology -
University of Illinois
BA - Accounting
Roosevelt University
U.S. Military Academy
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