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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Big Creek CtHigh Point, NC Street Address
Day Phone: PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLEJob Type:PROFESSIONAL SUMMARY Highly skilled career professional with more than 15 years practical experience in healthcare, insurance verification, insurance analyst, customer service, insurance authorization, Epic and Six Sigma Lean Purple belt (Received Purple Belt Pen for Kaizen Completion). Established in Transplant patient support including assessment, counseling, education regarding transplant benefits, immunosuppression medication costs, medical benefits, travel and lodging benefits and fundraising procedures. Computer skilled, managing heavy daily patient volume including patient referral and return to clinic account reconciliation. Proficient in all documentation/record maintenance/paperwork to ensure accuracy and patient confidentiality.KNOWLEDGEProject PlanningData Entry/ProcessingMedical Record-keepingCourageous LeadershipTraining and DevelopmentOrganizationEffective CommunicationTeam BuildingCustomer ServiceMicrosoft Office SuitePowerBITimekeepingPayrollRelationship ManagementProcess ImprovementMS SharePointAdobe CSTMSEPICPhoenixAnalystGoogle SheetsGoogle AnalyticsCybersecurityHuman ResourcesSix Sigma LeanInventory ManagementBudget ManagementQuality ControlRisk ManagementAgile MethodologiesCollaborationTeam ManagementProject SchedulingIssue ResolutionScope ManagementProject CoordinationQuality AssuranceProject Risk AnalysisNegotiationFederal ContractorNetworkingDelegatingCritical ThinkingPublic SpeakingContract ManagementProcurementProject DeliveryRegulatory ComplianceStakeholder EngagementProposal DevelopmentMarket ResearchRelationship BuildingLogisticsQA TesterWORK EXPERIENCEQuaesitumtech Healthcare Solutions, LLC July 2021 Present874 Big Creek Ct,High Point, NC 27265 20 Hours per weekProcurement AnalystAnalyze procurement data to identify trends, cost-saving opportunities, and areas for improvement.Prepare detailed reports and presentations on procurement performance metrics.Develop and maintain procurement databases and dashboards for real-time tracking.Evaluate and monitor supplier performance, including delivery times, quality of goods/services, and adherence to contractual terms.Conduct supplier audits and assist in supplier selection and qualification processes.Develop and maintain strong relationships with key suppliers to ensure reliable supply chains.Assess current procurement processes and identify areas for improvement.Implement best practices in procurement to enhance efficiency and reduce costs.Collaborate with cross-functional teams to streamline procurement workflows.Review and analyze contract terms and conditions to ensure compliance and mitigate risks.Assist in negotiating contracts with suppliers to secure the best terms and conditions.Maintain a centralized repository of all procurement contracts and related documentation.Conduct cost analysis and support budgeting activities to ensure alignment with financial goals.Identify opportunities for cost reduction and process optimization.Assist in the development and monitoring of procurement budgets.Ensure procurement activities comply with organizational policies, industry standards, and legal requirements.Identify and mitigate risks associated with procurement activities.Stay updated on regulatory changes and ensure the organizations procurement practices remain compliant.Kernersville VA HCC- GS-08-02 September 2020- Present1695 Kernersville Medical PkwyKernersville, NC 27284 40 Hours per weekSupervisory, Medical Support AssistantMonitors and makes work assignments for MSA GS-6 and GS-7 positions in the Mental Health and Eye Clinics.Provides input to maximize MSA GS-6 and GS-7 performance and resolves workplace issues affecting clinical operations.Supports clinics regarding clinic profile management and utilization via various reports.Is responsible for the daily staffing of in the Mental Health and Eye clinics and assures adequate support staff is available; this includes coordination of leave amongst MSA staff assigned to the in the Mental Health and Eye clinics.Resolves complex problems to ensure patient services are met.Identifies educational or training needs (includes coordinating on-the-job training to all new and established MSAs).Evaluates MSA GS-6 and GS-7 performance and completes mid-year and annual Performance AppraisalsCollaborates with the in the Group Practice Manager in developing and delivering disciplinary action when necessary.Is responsible for preparing and providing reports in support of performance measures to Medical Service leadership.Communicates and interacts with patients in a manner appropriate to cognitive, emotional, and chronological maturation needs of the adult and/or geriatric patient.Assures that all appropriate VA forms are used correctly and that VA, VHA, and VABHS regulations and directives are followed.Covered for PAS Section Chief and Assistant Section Chief in their absence.Responsible for supervising remote MSA initiative for Mental Health.evaluating the work of subordinate staffresolving complex problems to ensure patient services are metevaluating new products, equipment, and systems to make recommendations for improved operationsidentifying educational or training needsmaking final decisions on hiring selections; evaluating performance, and taking disciplinary action when necessary.administrative and professional responsibility for planning and directing the subordinate lead, supervisor, and MSA's activities.Responsible for extracting and analyzing data to provide reports to senior management in support of tracking measures.Assigning and evaluating the work of subordinate staff;Plans and organizes work with general assistance from the supervisor as to meet local and VA-wide time frames to complete analysis requirements, reports and special assignments and only refers to the non-routine and high technical problems to his/her supervisor.Responsible for reporting backlogs, difficulties in meeting deadlines, uncooperative physicians, or difficulty in securing information from clinicians or the record.Responsible for maintaining the confidentiality of information obtained to carry out required duties.Routinely communicate with physicians, case managers, and other allied health professional staff using sound interpersonal skills and is constantly aware of the sensitive information.Plans and completes advance level tasks based on observance of protocols and accepted clinical practices while exercising full supervisory responsibility over subordinate staff that includes at least one subordinate team leader or subordinate supervisor.Handles directly or delegates responsibilities for resolutions of problems or unusual situations and makes decisions on appropriate action to be taken.Work is reviewed on an overall basis by the Service Chief for conformity with VHA Directive and Medical Center policies and procedures.Has thorough knowledge of VHA Directives for: VHA Outpatient Scheduling Processes and Procedures, Knowledge of VA regulations, Systems Redesign Principles, local Medical Center Memorandum/policies, and standard operating procedures.Provides supervisory medical administrative support and, is an integral member of Mental Health, Ophthalmology and Optometry leadership to effectively carry out day to day administrative operations of each department.Knowledge of eligibility for VA medical care, priorities for care, release of information, health Information Portability and Accountability Act (HIPAA) Law. The Supervisory MSA must be conscientious regarding the confidentiality of the variety of material that will be handled. The position requires a practical knowledge of an extensive body of the organization's rules and regulations governing confidentiality, including but not limited to the Privacy Act, HIPAA, the Freedom of Information Act (FOIA).Authorization, Scheduling, Referral Management, Records and Care Coordination: Incumbent is responsible for preparation of community care official authorizations and correspondence with vendor and patient associated with pre-authorized and unauthorized care for both inpatient and outpatient episodes of community care.Skilled in compiling readily available data from prescribed sources; knowledge of the organization to search records, files, or electronic data banks to locate information needed, and to verify information given. Utilizes computerized programs and databases in order to enter, modify and retrieve sensitive information and various data into or from electronic medical records, scheduling system, and/or reporting formats.Communicate effectively with both professional and nonprofessional employees in a variety of occupations and at various levels of responsibility. The Supervisory MSA performs a variety of supervisory administrative functions associated with patient care and treatment in community clinics performing a variety of medical services.Ability to delegate authority, evaluate and oversee people and programs, accomplish program goals, and adapt to changing priorities. Serves as contact point to resolve scheduling problems from patients, clinic staff, and other medical center departments; ensures customer service goals are met; represents service line on various facility committees or workgroups, communicating the goals and priorities of the service line and work unit; may be assigned or rotated to special assignments as determined by immediate supervisor or next higher-level supervisor.UNC Rex Healthcare- Chapel Hill January 2018 -September 2020101 Manning Dr.Chapel Hill, NC 27514 40 Hours per weekAdministrative Associate, Pediatric Audiology Team LeadServe as the first point of contact for UNCH patients by offering a positive patient experience both face to face and over the phone.Verifying demographic information including address, contact numbers and insurance information.Explaining and obtaining signatures for legal documents such as consent for treatment, Tricare and Medicare Rights.Helping patients navigate the hospitals to get to their appointment locations.Serves as a second level of response to customer inquiries and complaints in person, by phone and/or electronic communication. This may include working with third party providers.Performs more complex scheduling of providers, staff, facilities, home care and/or patients.Ensuring proper entering and filing of active insurance policies.Collecting on same day service fees.Collecting on past balances.Working in coordination with financial counselors to help patients meet their financial obligations.Held to departmental collection standards and goals.Face to face patient interaction.Answering phones, communicating effectively with patients and internal customers.Utilization of de-escalation techniques for dealing with nervous or upset patients and their family members.Resolve ComplaintsTrainingProviding assistance and supportProviding a climate for motivationCreating supportive working relationshipsEmphasizing continuing developmentPossesses and consistently demonstrates a thorough knowledge of all rules, regulations and practices of all pay sources, including but not limited to Medicare, Medicaid, third party pay sources, and any related contracts.Possesses and consistently demonstrates a thorough knowledge of all billing systems, electronic and other, as applicable.Demonstrates and practices understanding of reimbursement rates and communicates such appropriate information to patients.Recognizes the necessity of working closely with all branch offices to ensure consistency in submission of applicable data required to maintain accuracy and timeliness in billing.Ensures daily follow up on all open accounts, maintaining accurate collection records, and efficient cash collection for each patient account.Coordinate communications with payers to ensure accurate billing practices, achieve cash collection targets and reduction of A/R is maintained at company expectationsManages the status of accounts, balances and identifies inconsistencies in payment.Performs follow-up on insurance claim status, resolve denials, submit corrected claims and files appeals.Provide counseling to patients advising them of their financial responsibilities and obtain credit agreements for outstanding balances.Requests appropriate adjustments and refunds when required.Performs other duties or special projects as assigned.Wake Forest Baptist Health April 2016 January 20181 Medical Center Blvd,Winston-Salem, NC 27157 40 Hours per weekPatient Service CoordinatorInitiates the intake process of new patient referrals received via email, fax and phone from physicians officesEnsures referral information including patient demographics, insurance information, and office assignments are accurate, up to date and entered correctly in our EMR systemMaintain patient confidentiality in accordance with HIPAA guidelinesSchedules patients for treatment and diagnostic procedures using an EMR system while creating and establishing a rapport with the patient to ensure the highest level of quality care is receivedAnalyzes, extracts and interprets pertinent information from patient medical records, and develops the medical terminology and professional acumen to ensure patient compliance with physicians ordersObtains verbal and written authorizations for patient procedures and verifies both eligibility and benefits for the patientCoordinates with referring offices as necessary for complete patient informationCreates positive experiences for internal and external customers through patience, communication and empathyProviding assistance and supportUnitedHealth Group (Optum) May 2015 April 20163803 N. Elm St,Greensboro, NC 27455 40 Hours per weekSr. Clinical Administrative Coordinator, Team LeadReview all member charts prior to a physician appointment and create alerts/triggers to highlight Star opportunities for the Provider.Partner with the Practice's Administrative and Clinical staff while managing patient appointments and data between visits.Assist members in navigating their network of Providers by assisting with follow-up and Specialist appointments as needed.Assist with Program Eligibility verifications.Appropriate Referrals to Case Management staff.Interact with patients via telephone; scheduling appointments.Perform Data collection, Data Entry and Quality monitoring activities, as applicable.Document case information completely, accurately, and in a timely manner.Demonstrate sensitivity to issues and show proactive behavior in addressing customer needs.Provide ongoing support and education to team members.Optimize customer satisfaction, and positively impact productivity.Will not conduct any evaluation or interpretation of Clinical data and will be supervised by Licensed and/or Certified staff.Adhere to corporate requirements related to industry regulations/responsibilities.Maintain confidentiality and adhere to HIPAA requirements.Determine the duties to be performed and select the best-qualified candidate. This includes taking the Fair Hiring workshop, forming a Selection Committee, writing the job description, working with the Business Office to conduct the recruitment, screening applications, interviewing candidates, checking references and documenting the selection.Give employees the information, technology and reference materials necessary to perform their jobs. Training is an ongoing activity, crucial for new staff as well as for long-term staff who take on new responsibilities or who experience changes in the way their existing duties need to be performed. Those who take on new responsibilities or experience job changes typically need additional direction and guidance for a period of time until the new work becomes more familiar.Assign certain duties to the employee, explaining how those duties are to be done (i.e. what level of performance will meet the supervisors expectations) and communicate how the successful performance of those duties will be measured. Ensure that the employee is working under a current job description and in a classification appropriate to the duties. Update job description, and submit it to the Business Office, as needed.Evaluate PerformanceResolve ComplaintsTrainingProviding assistance and supportProviding a climate for motivationCreating supportive working relationshipsEmphasizing continuing developmentUNC Center for Transplant September 2009 May 2015101 Manning Dr.Chapel Hill, NC 27514 60 Hours per weekTransplant Financial Coordinator, Pediatric and Adult Kidney and LiverPerforms financial screening/interview of all patients presenting for transplantation. Researches and verifies insurance for hospital, professional and pharmacy coverage, especially immunosuppressive medications.Acts as a contact for insurance case managers primarily, including but limited to, obtaining pre-certification. Collects and submits necessary documentation and correspondence. Performs and communicates related follow-up.Assists finance department by providing data about transplant program and financial activities to support insurance contacts. Implements and coordinates the reimbursement of approved contracts with Director of Patient Accounts.Communicates appropriately using good interpersonal skills. Serves, manages and supports internal and external customers.Participates in performance improvement activities. Participates as a team member and is accountable for own work responsibilities.Interview applicants or recipients to define eligibility for public assistanceInterpret and explains rules & regulations governing eligibility grants, methods of payment and legal rights to applicant or recipientRecord & evaluates personal financial data obtained from applicant or recipient for defining initial or continuing eligibility, according to departmental directivesInitiate procedures to grant, modify, deny, or terminate eligibility grants for various aid programs, like public welfare, employment, and medical assistanceAuthorize amount of grants, based on determination of eligibility for amount of money payments, food stamps, medical care, or other general assistanceIdentify need for social services, and makes referrals to various agencies community resources availablePrepare regular special reports as required, and submits individual recommendations for consideration by supervisorPrepare keeps records of assigned cases.Process and determine initial eligibility for the Aged, Blind and Disabled residents who apply for Medicaid.Follow-up in conjunction with intake worker to ensure all verifications have been received from applicant.Knowledge of Federal and State Medicaid policies.Calculate budgets manually and by using appropriate devices.Key in a moderate amount of data using standard office hardware and software.Collaborated with various DSS organizations outside of UNC.Department of Corrections February 2006 September 20091034 Bragg St,Raleigh, NC 27610 48 Hours per weekCorrectional OfficerMakes periodic tours of the jail to inspect for security, including head counts.Releases inmates from cell areas to outside recreation areas or other program areas; operates security doors and equipment.Receives prisoners from law enforcement officers and adheres to clearly established procedures for inmate processing including: searching, fingerprinting, photographing, and posting personal items to trust fund account cards.Releases inmates from jail on proper authorization and returns articles of clothing and other personal property to the inmate.Receives and reviews cash and security bail bonds for accuracy and authenticity.Prepares disposition reports of prisoners confined in the facility.Consults superior on requests for visits by attorneys, members of the inmates' families and other authorized persons according to established rules and regulations.Answers routine inmate questions.Supervises the distribution of meals in inmate housing areas.Transports inmates to and from court appearances as required.Makes observations of inmate attitude, behavior and physical conditions and reports problems to shift commander or treatment staff as required.Performs related duties as required.Supervises the mental health population in segregation.EDUCATIONThinkful December 2024Cybersecurity CertificateGuildford Technical Community College November 2018601 E Main St,Jamestown, NC 27282Certified Nursing Assistant IPrinceton High School May 2005101 Dr. Donnie H Jones Jr Blvd W,Princeton, NC 27569High School DiplomaAFFILIATIONSTransplant Financial Coordinators Association2014-PresentAHIMA2011-PresentPROFESSIONAL REFERENCESName: Antionette Harris-StewartTitle: PAS Section ChiefEmail: EMAIL AVAILABLEPhone: PHONE NUMBER AVAILABLEName: Suzanne Dudko,Title: Former PAS SupervisorEmail: EMAIL AVAILABLEPhone: PHONE NUMBER AVAILABLEName: Aneshia GivensTitle: Nurse ManagerEmail: EMAIL AVAILABLEPhone: PHONE NUMBER AVAILABLE ext: 32091 |
