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Medical Customer Service

Roswell, Georgia, United States
March 06, 2018

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Roswell, GA ***** 770-***-****


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, Outlook, Needles, Misys, and Tiger/EMR.

Skilled 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 Physician’s Licensure for validity and other requirements.

Commitment to confidentiality of patient health information.


AppleOne/CIOX HEALTH, Alpharetta, GA

Medical Records Auditor, May 2017 to Feb 2018

Duties include but not limited to Analyzing medical records and ensuring complete confidentiality and security from non-authorized individuals. Ensuring compliance with JCAHO and Medicare/Medicaid standards. Work with hybrid medical record and understands complexity of record types and locations of various documents. Manage 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. Work confidently as an individual and as a part of a team. Uphold high ethical standards and always be cognizant of the patient’s 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.


Remote Compliance/Executive Assistant/Income Tax Preparer, Jul 2014 to Apr 2017

Duties 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.


Freelance/Paralegal, May 2014 to Jun 2014

Duties included but not limited to gather information, researched case background, drafted/summarize legal documents. Managed administrative duties.


Remote Access Specialist, Feb 2014 to May 2014

Duties included but not limited to conducted research in the OPM/online to determine which LID contained the correct information/cleanup. 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. Met personal productivity and quality goals. Worked other projects and duties as assigned. Prepared Excel Spreadsheet reports.


Income Tax Preparer, Jan 2014 to Apr 2014

Duties included but not limited to develop and maintained all account reconciliations. Searched and solved tax account balance problems with different tax agencies. Handled personal property tax as well as real estate tax payments. Compiled data essential to prepare federal as well as state income tax returns. Prepared federal along with state income tax returns. Responded to different government tax agencies inquiries associated with above items.


Credit Repair Specialist, Sept 2012 to Jan 2014

Duties included but not limited to prepared dispute letters; handled special projects with diplomacy and client responsiveness. Successfully concluded assignments with 70% increase in settlements with credit Bureaus and Creditors. Multi task in a fast pace environment meeting all required deadlines.


Document Specialist, Jun 2012 to Mar 2013

Duties included but not limited to preparing daily Excel spreadsheet reports for the call center, and

Employee Scheduling, etc...


Medical Record Reviewer, Sept 2011 to Jun 2012

Duties included but not limited to reviewing medical and pharmacy records to establish proof of injury and

usage of the drug called Avandia in order 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...


Paralegal & Compliance Debt Collection course

Associate of Applied Science

Associate of Business Administration


AHIMA/ American Health Information Management

NATP/National Association of Tax Professionals

ASN/American Society of Notaries

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