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Click here or scroll down to respond to this candidateCandidate's Name
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PHONE NUMBER AVAILABLE EMAIL AVAILABLESummary of QualificationsI have over 30 years of experience of applying advanced knowledge of medical terminology and a wide range of clinical flow processes relating to access to care across multiple clinics, specialties, and/or community resources. Utilizing numerous advanced patient systems in support of multiple clinics in an interdisciplinary setting.Most recently, I have been working as a AMSA Supervisor for at Robley Rex Veteran Medical Center since May 2023. Managing staffing requirements and workflow priorities and adjusting the flow of work to meet team and patient needs. This includes the ability to follow-up on pending issues and demonstrate an understanding of the impact of incomplete work across multiple clinics.EducationUNIVERSITY OF PHOENIX, PHOENIX, Arizona Jun 2015 Sept 2016Master of Science in Accountancy3.52 GPAUNIVERSITY OF PHOENIX, PHOENIX, Arizona Nov 2009 - Jan 2014Bachelor of SCIENCE in Business with a concentration in Accounting2.91 GPACITY COLLEGE, LOUISVILLE, Kentucky Jan 1997 - Dec 1998Associate of SCIENCE in Medical AssistantAdditional InformationSkills: Microsoft word,ERISA,Andair,IDX,HIS,GroupWise,Kronos,Wordperfect,Microsoft powerpoint,ICB, Medical manager,Vista,Peoplesoft,Intergy,46 wpm, some Microsoft excel, Amazing Charts, Sage, ICD 9, CPT 4, PLEX, CTI, ACSS, Hcentive, CSR Lite, Outlook, My Workspace, Cisco, ICMS, Workflow, Search America, CAPS, Onbase, CPRS, HSRM, PPMS, Streem Print, SP350 and Certified Pharmacy TechnicianProfessional ExperienceRobley Rex VA, Louisville, Kentucky May 2023-Apr 2024AMSA Supervisor Supervises AMSAs in Community Care Service Department. Process all service consults for veterans that need assistance out in the community by creating an Authorization for care in the Community using HSRM. Training new employees and delegating the new roles by providing SOPs and different training manuals. Provides full range of administrative and supervisory duties which include assignment of work and auditing productivity. Research healthcare and business customer service best practices through literature review. Networking and site visits for potential Community providers for GO LIVE with Optum implementation at the medical center. Performs program support work such as correspondence control, communication, training program administration, special projects, and board/committee-related work. Work with Share point software applications. Experience analyzing evidence (medical, benefit and legal documents), interpreting, and applying laws, regulations, and official guidance sufficient to evaluate the adequacy of collected information to determine claimant eligibility for benefits and services related to benefits. Gather evidence and create solutions for Suspenses from National Community Care. Departments and White House Calls, applying laws/regulations/policies in the management and processing of medical service claims. Review and analyze medical/legal evidence to make determinations as to the entitlement and eligibility for medical services. Develop case file records and reports to support claim decisions for authorization of claims. Self-Assessment reviews with each employee twice a year one mid-year review and an end of year review. Work closely with Nurse Managers and Chief of Community Care by building and managing the workforce based on organizational goals, budget considerations, and staffing needs. Ensures that employees are appropriately recruited, selected, appraised, and rewarded. Evaluate systems to make recommendations for improved operations, identifying educational or training needs, evaluating performance, and taking disciplinary action when necessary. Appointment management and the coordination of all administrative information between the professional staff and the patient. Assigns work to be accomplished by subordinates; establishes and adjusts short-term priorities. Resolve complex problems. Provide mentoring, coaching, and takes disciplinary action when appropriate. Make recommendations for improved operations. Keeps time and attendance records.International Service Contractors, Louisville, Kentucky Aug 2022 May 2023General Clerk Level III Reviewed medical records to resolve issues with patient eligibility and prepares authorizations for community care. Scan, index, and upload medical record documents to the Veterans medical chart. Handle phone calls from physician and patients to resolve issues with appointment authorizations. Scheduling, canceling, re-scheduling patient's appointments and/or consults; entering no-show information. Follow up with Veteran/Provider to fulfill a variety of requests that consist of getting veteran approved for Community Care Services Assign workload for staff daily. Assign workload for staff daily. Appointment management and the coordination of all administrative information between the professional staff and the patient. Display knowledge of VA priorities and mission statements to recommend improvements to policy and procedures related to budget and administrative operations. Ensures that employees are appropriately recruited, selected, appraised, and rewarded. Participate on project teams in lead or support roles identifying and improving operational processes impacting services of the VA health care system. Train new employees and ensure that employees under my supervision have complete understanding of policy procedures. Actively participates in meetings and training sessions and is expected to lend his/her expertise in developing skills as they relate to evidence gathering ability to perform administrative duties in an inpatient and outpatient setting.Intuit/Turbotax, Louisville, Kentucky Dec 2020 PresentSeasonal Tax Professional Prepare tax returns for individual or small business.. Conducting tax interviews with clients. Serving clients with diverse tax needs. Providing IRS audit and tax support.PharmaCord, Louisville, Kentucky Jul 2019 Aug 2022Case Manager Determining the nature of the call and assisting with communicating needs regarding, appointments, medication refills/renewals etc. Prioritizing calls and making decisions on caller needs.Provides personalized case management to patients and HCPs including outbound communication to HCPs and patients to communicate benefit coverage and next steps in obtaining coverage. Proactively communicates needs for reverification of prior authorization or re-enrollment for patient assistance program. Performing basic eligibility. Coordinates nurse teaching with field-based nurse educators, as applicable to program. Schedule shipment for patients medication.Rx Crossroads, Louisville, Kentucky Jul 2017 Jul 2019Case Manager II Serve as a liaison between the patient and the pharmacy. Monitors processing of cases for patients with specialty pharmacy vendors and home health agencies to overcome delay in turnaround times and other obstacles. Contact with vendors regularly. Insurance verification and schedule shipment of prescriptions to patient. Occasionally, contact physician offices, payers, specialty pharmacies, and pharmaceutical company representatives.NTT Data, Bowling Green, Kentucky Sept 2016 Jun 2017Customer Service Work in our inbound service call center for Massachusetts Healthcare Marketplace and represent our clients Build trust and make positive connections happen with customers over the phone Listen carefully, help customers resolve issues and get their questions answered. Update customer accounts and communicate clearly. Meet and exceed monthly customer experience goals.Afni, Bowling Green, Kentucky Jan 2016 Sept 2016Agent/Customer Service Work in our inbound service call center and represent our clients Build trust and make positive connections happen with customers over the phone Listen carefully, help customers resolve issues and get their questions answered. Update customer accounts and communicate clearly. Meet and exceed monthly customer experience goals. Earn bonuses for great performanceKmart, Bowling Green, Kentucky Dec 2015 - Mar 2016Service Desk Associate * Ensures customer care and selling are #1 priority * Answers telephone professionally; monitors incoming calls to ensure timely associate response. * Processes returns on a continual basis and call associates as needed to return stray merchandise to its designated location on the sales floor * Understands the processing of Western Union transactions and money orders. Adheres * Understands precise register functions including, but not limited to: processing all transactions, forms of tender, tax exemptions, rain checks, refunds, exchanges, and paying off credit card and layaway payments. Assist in training checkout service and service desk associatesWhite Staffing, Bowling Green, Kentucky Sept 2015 Dec 2015Account Payable Use PLEX accounting software to record, store, and analyze information. * Collect invoices. * Prepare invoices for data entry by assigning appropriate codes. * Enter invoices into computer system. * Prepare refund checks and post to general ledger. * Verify accuracy of billing data and corrected any errors. * Perform general office duties such as filing, answering telephones, and managing routine correspondence.Family Medicine PA, Gainesville, Florida Apr 2008 - Aug 2015Office Manager Supervise, trained and coordinate the activities of clerical and administrative support workers. Maintains appointment schedules for one or more outpatient clinics. Evaluating performance, and taking disciplinary action, when necessary. Perform receptionist duties, customer service and other duties assigned for the proper and timely treatment of patients. Verifying and updating demographics and insurance information. Applying advanced knowledge of medical terminology and a wide range of clinical flow processes relating to access to care across multiple clinics, specialties, and/or community resources. Routinely communicate with physicians, case managers, and other allied health professional staff using sound interpersonal skills and is constantly aware of the sensitive information. Process insurance and patient's payments. Follow up on past due payments. Reconciled claim denials. Assist with medicare audits. Implemented electronic medical records. |
