Ragenia Honaker

**** ********** ****

Middle River, MD 21220

Cell #: 443-***-****

Email: r ac5f9y@r.postjobfree.com

OBJECTIVE:

Highly motivated and accomplished professional effective with administrative support skills to include customer service, problem solving of issues and complaints, multitasking and prioritizing. I am detailed oriented and a team player, who is seeking an opportunity to work in an environment that will allow me to contribute to the growth and success of the organization.

EMPLOYMENT HISTORY:

Case Management Utilization Review Specialist

07/2012 - 02/2018

MedStar Union Memorial Hospital

201 East University Parkway

Baltimore, MD 21218

Salary: $18.45 per hour, 40 hours/week

Supervisor: April Bessling 410-***-****

* Review assigned denials and EOB’s for appeal filing information. Gather any missing information

* Review case history, payer history, and state requirements to determine appeal strategy

* Obtain patient and / or physician consent when required by the insurance plan or state

* Conducts medical records review and prepares clinical appeals in response to medical necessity denials

* Gather and fill out all special appeal or review forms

* Create appeal letters, attach the materials referenced in the letter, and mail them

* Coordinate phone hearings with the insurance companies and the Medical Physician Advisor’s

* Comply with all 1st, 2nd, 3rd, and External Level Appeal process.

* Meet appeal filing deadlines by completing assigned work list tasks in a timely matter

* Report all insurance company or state requirements and denial trend changes to the Team Leader and Reimbursement Manager

* Participate in team and appeal meetings by sharing the details of cases worked

* Act as a backup on answering incoming telephone calls as needed

* May undertake special projects assigned by the Team Leader or Financial Reimbursement Manager

Medical - Surgical Unit Secretary 04/2008 – 07/2012

MedStar Union Memorial Hospital

201 East University Parkway

Baltimore, MD 21218

Salary: $15.75 per hour, 40 hours/week

Supervisor: Linette Ratay 410-***-****

*Transcribing and data enter physicians' orders accurately and in a timely manner

*Maintain communications between department personnel and other departments

*Monitor the admission and discharges for bed availability

*Recognizing and respond appropriately to emergency situations

*Train new unit secretary staff members

*Tracking and ordering supplies

*Assisting other team members as needed

*Assemble & dismantle patient medical record charts

*Public contact with patients and visitors to assist or resolve issues through the tele-tracking and call-light system.

Medical Review & Appeals Coordinator 03/2004 – 04/2008 Employer: Nationwide Better Health

300 Clubhouse Road, #100, Hunt Valley, MD 21031

Salary: $12.75 per hour, 40 hours/week

Supervisor: Darlene Fountain 410-***-****; company closed

*Process medical necessity request’s based on policies and guidelines in a timely and accurate manner

*Administer denials and appeals requests according to URAC standards

*Coordinate reviews with internal & external organizations for denials

*Collect and analyze clinical documentation and notify parties of determinations

*Process rate negotiations according to the insurance company’s requirements

*Assist the pre-certification department as needed.

Medical - Surgical Unit Secretary 06/2003 – 09/2004 Employer: Greater Baltimore Medical Center

6701 North Charles Street, Baltimore, MD 21201

Salary: $11.75 per hour, 40 hours/week

Supervisor: Maurine McGinty 443-***-****: may be contacted

*Performing clerical duties that include transcribing and entering physicians' orders accurately and timely

*Maintaining communications between department personnel and internal supporting departments

*Secretarial duties include answering several phone lines, coping, faxing and printing records

*Monitoring the bed tracking board for admissions and discharges

*Maintaining patients' medical records

*Maintaining a courteous and professional manner in a high stress and quick moving environment

*Recognizing and responding appropriately to emergency situations

*Training new team members

*Tracking and ordering supplies

*Assisting other team members as needed.

FEP Customer Service Representative 02/2003 – 03/2004 Employer: Care First Blue Cross Blue Shield

1946 Green Spring Drive, Lutherville, MD 21092

Salary: $11.50 per hour, 40 hours/week

Supervisor: Valerie Flowers 410-***-****; may be contacted

*Receive inbound calls from patient’s or facilities to verify eligibility & benefits

*Quote plan benefits based on coverage

*Reviewed claims for denials of non-payment and re-processed the claims if appropriate

*Provide assistance to members and/or providers regarding website registration and navigation

*Process written customer correspondence and provide the appropriate level of timely follow up

* Document all activities for quality and metrics reporting through the Customer Service Data Program

*Maintain performance and quality standards based on established call center metrics including turn-around times

* Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment

*Identify any trends related to incoming or outgoing calls that may provide policy or process improvements to support excellent customer service, quality improvement and call reduction

Precertification Coordinator / Therapy Technician

07/1998 – 09/2003

Employer: Spectera Healthcare

2811 Lord Baltimore Drive, Baltimore, MD 21244

Salary: $12.75 per hour, 40 hours/week

Supervisor: Chris Volkman 410-***-****: company closed

*Obtain demographics to pre-certify patient for inpatient hospital services

*Authorize therapy services based on specific guidelines

*Request clinical for concurrent stay review’s and quote benefits based on plan coverage

*Responsible for the accuracy of insurance information to determine financial responsibility

*Develop and implement, in conjunction with management, workforce improvement strategies

*Review accounts for accuracy to conform to State and Hospital criteria including referrals for the State & Local Agencies as well as Uncompensated Care Screenings

*Specialized experience in coding inpatient medical records for final diagnosis using approved References guides

*Train other medical record technicians in the proper procedures of coding

Certified Nursing Assistance 04/1993 – 10/1997

Employer: St Agnes Hospital

900 Caton Avenue, Baltimore, MD 21229

Salary: $10.75 per hour, 40 hours/week

Supervisor: Patricia Saunders 410-***-****; may be contacted

*R eceive ambo emergencies and triage patient's (VS, specimen collection, EKGs, blood draws

*Use of two-way radios to prepare the ER bay for ambo arrivals and to notify the nursing administration dept.

*Assist patients with daily hygiene such as bathroom use, showers and brushing of the teeth

*Provide assistance with feeding patients, ambulating, turning, and positioning patients

*Maintain patient stability by checking vital signs and weight and recording intake and output

*Maintains work operations by following policies and procedures

*Protects organization's value by keeping patient information confidential

*Serves and protects the hospital community by adhering to professional standards, hospital policies and procedures, federal, state, and local requirements, and JCAHO standards

Education:

Doctor’s Help

Phlebotomy Technician – Certification, 2014

Rockhurst University

How to Motivate, Manage & Lead a Team – Certificate, 2006 (On-line Course)

Baltimore City Community College

Pre-requisites Completed with 44 College Credits Earned

Automation Academy

Certified Nursing Assistance – Certification, 1992 - 1993

Edmondson Westside Sr. High School

General Studies – High School Diploma, 1985 – 1989

Computer Skills:

Microsoft Office Suite, Outlook, Cerner, Allscripts, SMS, Telligen, Opti-Freight, Med-Connect, HPF

Affiliations:

Order Of The Eastern Stars Member

Licenses Motorcycle Rider

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