Customer Service Medical
Resume:
Ragenia Honaker
Middle River, MD 21220
Cell #: 443-***-****
Email: r *******@*****.***
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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