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Click here or scroll down to respond to this candidateCandidate's Name
Chesapeake, VAEMAIL AVAILABLEPHONE NUMBER AVAILABLEPassionate, dedicated employee successful in producing and multi-tasking within a fast pacedenvironment using exceptional interpersonal and communication skills looking to secure aposition that will effectively utilize my communication, analytical, administrative, and collection skills. Authorized to work in the US for any employer.Work ExperiencePharmacy Cust Associate II02/13/2024- currentHandles patient prescription requests with HIPPA guidelines and refill orders for processing.Troubleshoots to obtain missing prescription information and interpret medical abbreviations (SIG codes).Resolve all data entry related exceptionsUtilization Management Rep 1 (Project Position)03/01/2024-06/30/2024Processed in-patient admissions, outpatient services, non-covered services, etc.Assisted providers with getting the approval or denial letterAssisted providers with the Grievance & Appeal processCustomer Care Rep (GBD Provider Data Services Dept.)07/11/2024 -02/12/2024Help providers check members benefitsReviewed claims with providers for denialReviewed the Grievance & Appeal process and providedReimbursement Specialist lllConduent - Chesapeake, VAAugust 2018 to PresentExperience Assisted new patients onboard into designated support programs Assisted new and continuing patients with co-pay related questions Provided customer with appropriate order status, next refill date, and enrollment end date Input prescriptions into CRM to process enrollments, initial orders and refills Responsible for monitoring and reporting the effectiveness and any adverse effects or side effects ofpharmaceutical products on the market in the general population and in hospitals and research trials. Maintained quality standards of 97% and above and delivery of satisfactory outcomeQuality Assurance AssociateWrite, maintain, and disseminate quality manuals and other documentation. Investigate anddiagnose quality complaints, track down components, and recommend corrective actions. Verify logs,databases,and other data to track and flag quality concerns and improvements.Medical Records ClerkArvon Staffing - Chesapeake, VAMarch 2018 to August 2018 Pulled and route records to appropriate personnel or department. Prepare reports and forms as directed and in accordance with established policies. Proven knowledge of medical records regulations and release of health information Received incoming correspondence and review/forward to appropriate department or staff. Received, screened and coordinated telephone calls from patients and healthcare providers. Communicated with Medical Staff, health care team members and patient departments. Perform a variety of administrative duties including but not limited to: answering phones; faxingand filing of confidential documents; and basic Internet and handled court subpoenas and quash formedical records request Provided excellent customer service to all internal and external customersMedical ReceptionistSMOC - Suffolk, VANovember 2016 to March 2018 Operate telephone switchboard to answer, screen, or forward calls, providing information, takingmessages, or scheduling appointments. Receive payment and record receipts for services. Transmit information or documents to customers, using computer, mail, or facsimile machine. Schedule appointments and maintain and update appointment calendars. Perform administrative support tasks, such as proofreading, transcribing handwritten information,or operating calculators or computers to work with pay records, invoices, balance sheets, or otherdocuments.Document SpecialistMedical Services of America - Chesapeake, VAFebruary 2016 to November 2016 Responsible for minimizing Suspended Revenue, Revenue on Hold, and Stopped Revenue byensuring that all WOPDs, PARs, CMNs, F2F and other required documentation is received, valid, andsubmitted timely to the Corporate Billing Department. Reviewed Held Revenue Detail Report weekly, researches each account and corrects issues (i.e.,submits correct CMNs to MD, verifies insurance, etc.). Followed up with physician's office if CMNs are not received within 7 days and every 7 days after. Developed and maintained working knowledge of current home care products and services offeredby the company and all applicable insurance guidelines regarding eligibility for coverage andreimbursements Complies with all organizations policies regarding ethical business practices. Contributed to team effort by accomplishing related results as needed.Call Center ReceptionistSecretariats, IncFebruary 2015 to August 2016VA Greet customers warmly and answer any inquiries they may have. Date stamp time of each call received and record in computer system. Transfer calls to the appropriate party or department. Record and deliver messages. Arrange conference calls. Schedule or cancel appointments. Monitor alarm system to determine if a true emergency exists or if it's an error. Sort mail and any other clerical duties as necessary.Collection SpecialistSecretariats, Inc - Virginia Beach, VAAugust 2015 to May 2016 Communicate with students by telephone and written correspondence to attempt to bring resolutionto delinquent accounts. Comply with the Fair Debt Collections Practices Act at all times and maintain compliance with allfederal, state and local collection regulations. Provide thorough, efficient and accurate notation of account updates and debtor communicationforeach call/transaction. Consistently ranked in the top 5 percent of collection agents. Was responsible for the recovery of over $750,000 from a delinquent client that had previously beenconsidered a write-off. Consistently met or exceeded monthly goals. Flourished in a high volume, fast paced environment. Evaluated accounts and recommended appropriate action throughout the collection cycle.Business Office Associate InternRiverside Regional Medical - Center, VA, USMay 2014 to September 2014 Handled inquiries from customers and patient intake. Proofread all forms to ensure they are properly filled out and put into system. Collected balances due at the time of check-in. Directed patients to relevant areas of the building. Recorded all payments received. Performed insurance data entry.Customer Service RepExpress Check Advance - Portsmouth, VAAugust 2012 to July 2013 Greeted customers. Cashed checks. Made bank withdrawals and deposits. Made collection calls on 30, 60 and 90 day past due accounts. Processed payday and title loans and made decisions for approvals and denials based on customerapplication/credit history. Solicit additional company products to customers. Performed marketing to solicit new business. Obtained referrals from current/prospective customers to obtain new customers. Maintained division goals of 18% write off loans. Exceeded division goals of $35-40 thousand dollars per month in revenue collected. Completed legal review for delinquent accounts.Clinical CoordinatorEastern Virginia Ear - Chesapeake, VAOctober 2011 to October 2011 Greet patients. Check in/out patients and collect co-pay. Set up and cancel appointments thru Nterprise. Prepare clinical notes for patient appointments thru EMR. Schedule appointments with another specialist. Index Lab reports, MRI, CT Scan, ETC. in the patient medical chart thru EMR.Patient Account RepresentativeSentara Home Care Services - Chesapeake, VAApril 2007 to July 2011 Collected balances outstanding from third party payers. Processed mail and rejections from the Insurance Carrier. Posted and handled write off adjustments in accordance with company guidelines. Processed payments by credit card. Answered calls received by patients.General Office ClerkAMERIGROUP - Virginia Beach, VAAugust 2006 to January 2007 Processed all contracts, provider group changes, amendments, etc. Typed correspondence. Worked with business solutions and credentialing departments to resolve contract issues. Updated and maintained Metrics, K-stat report, and mail merge, manual tracking, reconciliation, andPIP databases as well as the PIM Contract Inventory spreadsheets.EducationAAS in BusinessBryant & Stratton College Hampton - Hampton, VAJune 2015Booker T. Washington High SchoolJanuary 1997Skills BILLING (5 year) ACCOUNTING (5 year) BILLING SYSTEMS (5 Year) ELECTRONIC BILLING (5 Years) EPIC (over 5 years)Additional InformationSkillsKnowledge and experience in Microsoft Word, Excel, PowerPoint, and Outlook; Quick Book experiencePractical experience in ADL and PBS accounting applicationTyping 40-45 w.p.m.Active ListeningCustomer and Personal ServiceTime ManagementExperience in a performance-based metric driven environmentMedical skills, Electronic Medical Records (EMR), Ntierprise, EPIC, and electronic billing systemsCPR+ experience and infusion billing experience |
