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Click here or scroll down to respond to this candidate5611 Colonial DrColumbia, SC Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLEMarquitta HughesObjectiveManagerial support professional interested in sharing my experience working in a fast paced environment demanding strong organizational, time management and interpersonal skills. Trustworthy and discreet and committed to superior customer service. Detail oriented and resourceful in completing tasks and projects in a timely fashion.ExperienceSeptember 2021-PresentEpworth Childrens Home Columbia, SCDonation Services SpecialistConduct research on individuals and corporations for giving and sponsorship opportunities.Greets donors and visitors and provide assistance if neededDiscuss benefits and necessity of donations for the communityAssist in coordination of volunteer programsPrepares Development Committee and Boead Meeting materials/reports as needed.Process all donations and send acknowledgements for tax purposes to all donors in Raiser's Edge.Maintains database with weekly, monthly and yearly reportingManages ongoing pledges and send updates a set aside in pledge agreementsOctober 2020 - May 2021AloricaCustomer Service RepresentativeTake customer calls and provide accurate, satisfactory answers to queries and concernsDe-escalate situations involving dissatisfied customers, offering patient assistance and supportInforms and offer customers about the companys new products, services and policiesGuide callers through troubleshooting, navigating the company site or using the products or servicesReview customer or client accounts, providing updates and information about billing, shipping, warranties and other account itemsCollaborate with other call center professionals to improve customer serviceDecember 2018 - December 2019Blue Cross Blue Shield Columbia, SCClaims ProcessorReviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff membersExamines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Verifies that claims have been keyed correctlyEnsures that claims are processing according to established quality and production standards. Corrects processing errors by reprocessing, adjusting, and/or recouping claimsResearches and resolves claims edits and deferrals. Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas. Responds to routine correspondence and completes spreadsheet if applicableMarch 2018 - July 2018Apple One Columbia, SCAccounts Receivable SpecialistMonitor / research outstanding claim balances using online resources via insurance company portals, telephone calls and e-mailsCommunicate with insurance companies regarding claims and eligibilityAccurately documented progress of each claim throughout payment cycleEnsured the correct ICD-10 and CPT codes were billed properlyMonitored / resolved clearing house edits, denials, rejections to ensure prompt paymentApply industry knowledge to process explanation of benefits for reduced payments and denialsUtilized industry knowledge and available resources to resolve any and all issues delaying or preventing paymentResponsible for obtaining medical records and forwarding per insurance company requestsPrepared and submitted reconsiderations and appeals as necessary to ensure paymentPrepared and worked weekly reports illustrating aging and denial trendsCommunicate effectively with patients regarding their eligibility, benefits and account balanceAugust 2017 - March 2018Kelly Services Columbia, SCEnrollment SpecialistOversees processing of and preparation of new member enrollments for Medicare AdvantageAnalyze Medicare Advantage applications to determine eligibility for enrollmentCompleted dis-enrollments as indicated by member and Center for Medicare and Medicaid ServicesVerified and corrected member eligibility issues in a timely fashion as they ariseConducted account analysis to ensure premiums are billed, paid and processed properlyAnalyze and process returned funds as indicated by banking institutionProcess payments on all member accountsProcess over payments / refunds on member accounts and with banking institutionInform members of changes to their payment methodsAnalyze member information is equivalent to information provided by Medicare and Medicaid Services and proceed as directedEnsure all communication and work processed in accordance to HIPAA guidelinesJune 2013 - December 2014Langley Provider Group Baltimore, MDCase ManagerResponsible for communication with Regional Office regarding the status of a Veterans claim for compensation and pensionCoordinate compensation appointments for claimed medical conditionsExamine received requests from Regional Office for accuracyResponsible for receiving the Veterans medical records and ensuring their availability for scheduled appointmentsProvide Veterans with detailed descriptions of the Compensation and Pension process and answer all follow-up questionsReturn of medical records to corresponding Regional Office once claim is completeEnsure all claimed medical conditions are being examined as listed on claimResponsible for closing claim once all conditions have been addressedAnalyze claims open and make sure they are closed within the specified timeframeEnsure weekly and monthly reporting of claims are accurate and communicated to management timelyMarch 2005 - May 2013Capital Podiatry Associates Washington, DCOffice ManagerResponsible for daily/weekly/monthly reconciliation of insurance and patient paymentsAnalyzed medical records to determine correct IDC-9 and CPT codes to be utilizedPrepared medical claims to be received by clearing house for processingExamined explanation of benefits for reduced and non paymentsHandled appeals with private insurance companies as well as MedicareProcessed / posted payments from insurance companies to respective patient accountsPosted patient co-payments to respective accounts on a daily basisProvided quality assurance for patient information and kept patients informed of their account status with the practiceResponsible for contacting patients regarding past due balances and collecting on those accountsEnsured patients are familiar with their rights as outlined by HIPPA lawsPerformed the credentialing process and kept all licenses up to date for all providersIn charge of employees correctly providing clinical proceduresManaged procuring and training of all new office equipment and office proceduresCoordinated outpatient surgical procedures with ambulatory surgical centers and hospitalsCoordinated travel and public speaking events as well as visual aids needed for eventsResponsible for tracking and payment of vendor invoices in QuickbooksJanuary 2002- March 2005Prince Georges Hospital Cheverly, MDIntake CoordinatorGreet and direct patients to correct department for careAnswer all inquiries regarding appointments, ordered tests and required paperworkAcquired patient information from walk-in and trauma patientsManaged the trauma patient information on an emergent basisAccurately enter all demographic information in systemResponsible for scanning clinical information into databaseWork with physicians and nursing staff to facilitate patient encounterInform patients on unpaid balances from previous visitsCounsel patients on available options to clear unpaid balancesReceived hospital copaymentsProcessed and coordinated outpatient procedures for several departmentsCoordinated morgue and funeral home paperwork for cadaver pickups1997-2002 GMAC/RFC Bethesda, MDJune 1997 - December 2001GMAC/RFC Bethesda, MDLoan AdministratorUnderstand all title reports, interest rates and compliance issues are accurate as reported by lendersCoordinated daily funding as outlined by the lendersEnsured EFTs were transferred as requested by lenderManaged the sale of loans to other mortgage warehousesManage the limits of lines of credit for several mortgage companies as assignedProvide mortgage bankers with funding at closingResponsible for the advance and wire transfer origination through electronic funding as directedResponsible for receiving and verifying original loan documents from the closing agents/mortgage companies before logging into systemFollow up with closing agent and resolving issues with incorrect notesAccurately deposit note documents according to mortgage companiesReceived Print shipping requests/commitments submitted by mortgage companiesLog out and ship note to the investor for purchase according to the instructions providedEducation1991-1994 Woodrow Wilson SHS Washington, DC 1994-1996 Hampton University Hampton, VA1996-1998 UDC Washington, DCReferences Dr. Lawrence Lazar (202)223-0500Capital Podiatry Associates Co-OwnerSabrina Nicholas PHONE NUMBER AVAILABLE ext. 57979Veterans Administration Case ManagerCharnita Mathis PHONE NUMBER AVAILABLECapital Podiatry Associates Medical Assistant |
