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Click here or scroll down to respond to this candidateCandidate's Name
Roswell, GASummary:Review clinical documentation to facilitate the accurate representation of the severity of illness. Computer oriented: Microsoft Office, Microsoft Office Outlook (E-Mail), Citrix, Sage, BMS, Excel Spreadsheet, Misys, Tiger/EMR.Strong Customer Service in Patient Care, Healthcare SectorsSkilled use of HEDIS software for data entry, over reading, QA queries.Review medical records to ensure standards were met as defined by NCQA. Identify standards met and gaps against external auditor standards (where different) Conduct additional QI audits through medical record review.Escalate error patterns to QA Supervisor/Mgr. in timely way so corrective actions can be considered.Organizational skills with the ability to handle multiple tasks and/or projects at one time.Customer service skills with the ability to interact professionally and effectively with plans, corporate, providers, third party payers, physicians, and staff from all departments within and outside the Company.Knowledge of HIPAA rules and regulations, Joint Commission on Accreditation, medical record retrieval standards, policies & procedure.Pre-certifications, tracking of Physicians Licensure for validity and other requirements. Commitment to confidentiality of patient health information.Education & Training:Paralegal & Compliance Debt Collection courseAssociate of Applied ScienceAssociate of Business AdministrationAffiliations:AHIMA/ American Health Information ManagementNATP/National Association of Tax ProfessionalsASN/American Society of NotariesProfessional Experience:Anna Sales LLC, RemoteCSR/Supply Chain Operations, Aug 2020 to Jul 2023Duties include receiving and examining packages via FedEx Labels. Maintain accurate accounts of items shipped and received.Making inbound and outbound calls. Verified and keep records on incoming and outgoing shipments, then prepare items for shipment.Determine the method of shipment, using knowledge of shipping procedures, routes, and rates.Compare the quantity and identification numbers of merchandise against orders.Insert items into container/box. Prepare records of merchandise shipped. Post weight and ship charges.Keep files of shipping records. Trace missing or misplaced shipments. Verify receipt against bill of lading, invoices, or other records.Robert Half/Delta Dental, Alpharetta, GACustomer Support/Re-credentialing Specialist, Nov 2018 to Mar 2020Duties included processing re-credentialing applications for dental providers.Requested missing information from providers; resolved discrepancies between information supplied and findings of other sources (NPDB, State Dental Boards, etc.).Ensured the provider's credentials comply with requirements of contracted payers and well as preparing providers files for the credentialing committee according to NCQA regulations.Maintained up-to-date physician database, including but not limited to medical licenses, drug enforcement administration certificates, and professional liability insurance. Prepare committee cases for adverse actions occurring within five years of re-credential date and are over $50,000.Confirmed all required verifications were complete and have been performed according to required standard and within required timeframes.Express Employment Services/Sharp Business Systems, Alpharetta, GACustomer Service Representative, May 2018 to Sep 2018Duties included coordinating new customer file setup and existing customer profile maintenance with Master Data.Ensured complete and accurate order of documents, including leasing requirements and maintenance contracts.Entered orders and maintenance contracts in SAP and CRM while ensuring the proper recognition of revenue accordance with company policy and GAAP.Tracked and timely reporting of order status per sales potential (ZOFT) report from entry to final invoicing. Instructed customers on how to retrieve meter reads from their printers for billing purposes. Entered monthly meter reads into SAP for month end billing cycles.Coordinated with Sales Reps regarding issues relating to billing, customer inquiries as well as assisting RMS with accounts receivable issue resolutions. Provided administrative and system support for assigned sales representative. Able to interact with a variety of customers demonstrating poise, tact, and professionalism always.AppleOne/CIOX HEALTH, Alpharetta, GAMedical Customer Support, Records Auditor, May 2017 to Feb 2018Duties included but not limited to Analysing medical records and ensuring complete confidentiality and security from non-authorized individuals.Ensured compliance with JCAHO and Medicare/Medicaid standards.Worked with hybrid medical record and understood complexity of record types and locations of various documents.Managed requests for medical record information from patients, third party payers and others. Familiar with laws and regulations governing release of information, and the content of the medical record. Worked confidently as an individual and as a part of a team.Upheld high ethical standards and cognizant of the patients right to privacy.Excellent organization, oral and written communication skills. Able to interact with a variety of customers demonstrating poise, tact and professionalism at all times.Express Employment Services/BAKO Pathology Services, Alpharetta, GA Medical/Pathology Transcriptionist, 2018Duties included transcribing of pathology results, printed, routed, and filed pathology and cytology reports. Flagged abnormal pathology reports for immediate attention for physician review. Performed miscellaneous secretarial duties and typing. Set work priorities.Answered the telephone. Maintained logs for referred specimens or procedures.Maintained documentation for departmental consultations with primary physicians.Worked with the laboratory in a professional manner. Answered the telephone in a prompt and courteous manner.Poinsette Tax & Accounting Services, Decatur, GARemote Compliance/Executive Assistant/Income Tax Preparer, Jul 2014 to Apr 2017Duties included but not limited to preparing and filing personal Income Tax Returns and Amended Tax Returns.Prepared and scanned all files for Compliance department for filing. Oversaw the work of the Data Entry Clerks. Made sure that everything was in place for the office to function smoothly.Kept up with office supply, inventory and purchasing agreements.Responsible for incoming and outgoing mail. Responded to general assistance emails, attaching files to messages. Answered correspondence from the I.R.S. and updated clients with information.Remx/Outcomes Health Network, Alpharetta, GARemote Access Specialist, Feb 2014 to May 2014Duties included but not limited to conducted research in the OPM/online to determine which LID contained the correct information/clean-up.Worked with the Chart Level to access additional information pertaining to Member.Verified Demographics, of Provider and Members in OPM system.Utilized a secure internet portal to access medical records. Pulled Electronic Medical Records from various medical sites for HEDIS and PIA reviews. Consolidated sites that were Unscheduled with Scheduled or Completed sites. Updated information accordingly prior to releasing the charts to the Schedulers.Provided quality assurance reports for general medical reports. Ensured the accuracy and quality of medical reports to the QA Department.Spectrum Services, Norcross, GAMedical Record Reviewer, Sept 2011 to Dec 2013Duties included but not limited to reviewing medical and pharmacy records to establish proof of injury and usage of the drug Avandia to satisfy the requirements of a court order, settlement agreement or litigation standards for mass tort cases.Reviewed medical records to classify each file according to predetermined list of cardiac conditions.Reviewed CPT Codes to verify if injury was a result of drug usage.Requested medical records from medical care providers and pharmacies to establish appropriate classification of diagnosis. Identified potential fraudulent claims and reported them to the appropriate person. Updated the status of the file in the client data base, etc... |
