Customer Service Medical
Resume:
Anika Ambrose
*** *.*. *** ** Unit ***
Miami, FL. 33179
************@*****.***
PROFESSIONAL PROFILE
• Dedicated professional with over ten years of business office experience and ethic.
KEY COMPETENCIES
• HIPAA Laws
• ICD-9-CM and CPT coding
• Strategic Management
• Citrix
• Business Communication
• Insurance/Reimbursement
• Microsoft Office to include Publisher and Access
• HPF Web Station
• Office Procedures
• Customer Service
• Problem Solving
• Medical Terminology
• Web Tool
• Medi-Tech
• CRM
PROFESSIONAL EXPERIENCE
Sun Shine Health Insurance, Sunrise, FL. 8/2013-Present
Member Services
• Responds to 50 or more calls regarding Medicaid, MMA, and LTC members in a timely and professional manner.
• Provide members with applicable information regarding benefits.
• Document members' account following the policy and producers of Sun Shine Health.
• Utilize available systems, materials and parties to assist and resolve any member inquiries.
• Fax member's information to the doctor’s office to verify eligibility of members.
• Assist providers to verify if prior-authorizations are needed for members.
• Confirm member’s information utilizing HIPAA guidelines.
• Converse with other enteritis such as doctor office, transportation, pharmacy etc. on the member's behalf.
• Solve complex problems for members.
• Collaborate with colleague on large and small projects.
• Ensure work area is professional keep.
Health Port South, FL. 4/2009 - 8/2013
Release of Information Medical Records
• Generated up to 125 medical records requests by phone, walk-ins and mail, which results in 100% records being disclosed to patients, physicians, legal offices, government agencies and insurance company.
• Validated requests and authorizations for release of medical information according to Florida Statue Laws.
• Retrieved patient's medical chart and returning chart accurately in a timely manner.
• Conversed with doctors, patients, insurance companies and law offices using medical terminology.
• Copied/scanned medical record precisely and in the proper manner.
• Performed quality checks on all work to assure accurateness of the release and confidentiality of patient medical records.
• Logged patient information in system once requests are received.
• Adhered with HIPAA Laws on a daily bases to protect and preserve the patient's information.
• Composed electronic medical records such as CD's and USB's.
• Faxed records to doctor's offices.
• Maintained work space sanitary and effectively.
Palm Garden Nursing Home, Aventura, FL. 8/2002- 4/2009
Activity Assistant
• Updated patient activity roaster on a daily basis as changes occurs with census.
• Conducted initial assessments for short and long -term patient of a 120-bed facility.
• Coordinated large and small groups for patients with 75% of the patients in the facility.
• Wrote monthly and quarterly notes on patient activities.
• Collaborated with Director on activities to prepare monthly calendar.
• Attended weekly care plan meetings on the Director behalf.
• Inputted patient information into the computer database.
• Complied with HIPAA Laws with patient information.
• Conversed with patients, family members and professionals effectively on patient activities.
• Assisted with planning and conducting daily activities.
• Spoke with entertainers and vendors regularly.
• Composed strategic plans with a demanding budget.
• Received Employee of the Month 3 times.
Practicum
Advance Healing Options, Pembroke Pines, FL. 8/2008 - 12/2008
Business Office Assistant
• Selected, assigned and audited diagnostic procedure codes to patient records.
• Completed charts by assigning ICD-9-CM and CPT coding/abstracting.
• Assembled analysis and filed charts properly.
• Admitted patients to be seen by doctor.
• Complied with privacy/security to patient information according to HIPAA Laws.
• Obtained accurate billing information to patient for service renders.
• Conversed with insurance companies on patient policies and claims.
• Reviewed and consulted medical documentation with doctor when it is inadequate for coding purposes.
• Labeled, organized and filed the medical records in alphabetical order.
• Answered phones and scheduled appointments for patients.
EDUCATION
Bachelors of Science in Technical Management/Concentration in HealthCare Management 2011
DeVry University Miramar, Florida
Associate of Applied Science in Health Information Technology 2009
DeVry University Miramar, Florida
Certified Activity Professionals 2005
Collins Healthcare Education Miami, Florida
REFERENCES Available upon Request
Anika Ambrose
Contact this candidate