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Click here or scroll down to respond to this candidateCandidate's Name
Street Address
PHONE NUMBER AVAILABLE EMAIL AVAILABLESUMMARY: A highly skilled professional with over 17 years of experience in sales and consulting, customer service, product marketing, and customer retention, seeking a position in an organization that will allow me to utilize my experience and acquire new opportunities that will enhance my professional growth.EXPERIENCE:VENTRA HEALTH, Dallas, TX 2021-PresentCredentialing SpecialistAccurately completed credentialing and reappointment applications to be sent to payers and facilities on behalf of providers.Tracked progress of outstanding applications and report progress to Client Managers/Team Leaders.Kept current provider records electronically in Credentialing software, electronic provider folders, and in provider hard copy folders.Assisted in obtaining needed documentation from providers, such as copies of state licenses, IRS documents, NPI Notification forms, DEA numbers, board certifications, malpractice certificates of insurance, etc.Managed applications for individual providers for completion.Enrolled providers with all payors in multiple states to determine if the provider is eligible to be compensated for services rendered.Prepared professional communication to providers, payers, and facilities.Wrote professional communication to the appropriate audience.Entered data into new software OneApp, Omni Form, Intel iSOFT, and SharePoint.Completed tasks and projects by the deadline.Generated daily reports.Investigated solutions to problems and determine the best course of action.Communicated clearly and professionally with team members, providers, payers, facility credentialing representatives, Client Managers, and Team Leaders.PIVOT PHYSICAL THERAPY, GARNER NC 2019-2021AR Specialist-BillingPerformed all duties necessary to facilitate the collection of patient account balances from account guarantors.Handled account follow up with insurance payers, contact with patients, guarantors, and policy subscribers as required finalizing the collection of monies due to the facility for services already rendered.Researched and corrected denied claims to rebill.Submitted Appeals.TRIALCARD, INC., Morrisville, NC 2018-2019Reimbursement Case ManagerInitiated and referred patients to foundations, offer co-pay assistance and reimbursement vouchers; determine prior authorizations for medication and out-patient procedures.Verified patient eligibility and claim status with pharmacy benefit providers, and government and commercial insurance. Generate co-pay cards, vouchers, and titration vouchers to retail pharmacies.Researched CPT and ICD-10 coding discrepancies for compliance and reimbursement accuracy; maintained working knowledge of CPT and ICD-10 coding principles, government regulations, protocols and third-party requirements related to billing.MARY KAY CONSULTING, Raleigh NC 2001-2018Independent Sales ConsultantRecognized as a top performer in sales. Strong communication and selling skills. Develop and implement marketing strategies to maintain customer retention and to generate new clients.Analyzed and recommended skin care products and cosmetic colors for all skin types and nationalities. Conduct and host skincare educational sessions to direct clients toward the most suitable skincare products.WAKE ORTHOPEDICS, Raleigh NC 2017-2018Patient Service Representative/BillingGeneral Front Office; check-in and check-out patients; obtained and scanned new insurance information; collect and enter payments, post charges; daily cash balancing, insurance verification, and documentation and appointment scheduling.Medical Records: organized patient charts, reviewed charts for accuracy and completeness, filed and retrieve charts; tracked, send and file dictation process records requests swiftly and in compliance with HIPAA regulations.Call Center: responsible for promptly and professionally managing an 8-line phone system, obtained accurate patient information, used the information to schedule patients as outlined in Scheduling Protocol and contacted and scheduled patients using consult sheets in keeping with the Consult Sheet Process.Billing: served as a billing specialist, researched patient balances, notified patients of past due balances and set up payment arrangements; verified insurance benefits/coverage; initiated and follow-up on prior authorizations.ADT SECURITY SERVICES, Raleigh, NC 2010 & 2016Residential Sales RepresentativeRecognized as a top producing sales rep within assigned territory.Traveled more than 400 miles weekly, within a territory, to meet with clients; made follow-up meetings and phone calls to clients who needed additional input and/or guidance about ADTs products and services.Self-generated business leads using Salesforce and Salesgenie software programs to target sales leads, and social media marketing to establish client relations; used visual training aids to make presentations to clients.DUKE UNIVERSITY HEALTH SYSTEM, Durham, NC 2013-2014Appointment CoordinatorCoordinated appointment scheduling for clinic visits, using knowledge of medical terminology and strong telephone etiquette; ensure prompt service and customer satisfaction.Coordinated appointment requests, and determine appropriate services, physicians, and location.Identified correct patient in Epic, verify patient demographics and insurance.Notified patients of co-payments and outstanding balances.Scheduled and maintained physicians calendar, recorded physicians schedule using Microsoft Excel spreadsheets, and communicated schedule information to the physicians assistant.Coordinated labs and procedures according to physician orders.Notified patients of testing date, time, and location.Performed administrative duties including routine clerical and typing tasks.Prepared letters and correspondence to patients regarding their appointment reminders and schedule changes.DUKE UNIVERSITY HEALTH SYSTEM, Durham, NC 2011- 2013Patient Service AssociatePrepared for clinic visits by reviewing next-day patients and completing next-day preparation activities.Entered pre-visit orders and prepare new patient charts.Checked-in patients upon arrival; identify correct patient information in IDX.Checked-out patients.Prepared return appointments by scheduling patients into the correct appointment type, entered the primary care physician or referring physician, and scheduled tests and procedures.Filed history sheets, ancillary reports, and all other required patient record documentation.Returned medical records and attached HIPPA/Medicare documents to the encounter forms.Pick up x-rays, office charts, medical records, reports, and petty cash.Answered telephone and delivered messages to physicians, nurses, and other clinic staff.AFFILITATED COMPUTER SERVICES, Raleigh, NC 2010-2011Humana Agent/Customer Care SpecialistObtained working knowledge of insurance and managed care industries, knowledge of basic medical terminology, diagnosis, and procedure coding.Informed customers about services available and assessed customer needs, gathered pertinent information.Used a computerized system, respond to customer inquiries, and researched/resolved customer inquiries.Ensured that all necessary actions are taken to obtain the most complete insurance coverage and reimbursement.Assisted members with billing and enrollment inquiries, and research enrollment issues associated with Humana Medicare Products.Verified pharmacy benefits, assisted with pharmacist concerns and errors pertaining to the pharmacy claim submission; entered authorizations in the claims system.SIMPLY RADIANT LLC, Raleigh, NC 2006-2010ManagerManaged activities directly related to making beauty products and providing beauty consultant services.Directed and coordinated activities with production, pricing, sales, and distribution of products.Reviewed financial statements, sales and activity reports, and other performance data to measure productivity, goal achievement and determine areas needing cost reduction and improvement.Managed staff, interviewed, hired, and trained new staff.Prepared work schedules and assignments.EDUCATION: WAKE TECHNICAL COMMUNITY COLLEGE, Raleigh NCCourses in Business Management, 2016JOHNSTON COUNTY COMMUNITY COLLEGE, Smithfield, NCEstheticians Certification, 2006 |
