Customer Service Medical, Medical Receptionist

Rondella Joyner

*****************@*****.***

757-***-**** (mobile)Portsmouth, Virginia

Summary

A diversified background in medical office administration, billing and management, complemented by

clinical training and experience as a medical assistant. Applied organizational, communication and

leadership skills on various assignments. Performed a wide range of functions, including ICD 9 and CPT4

coding, billing, scheduling, patient relations, specialist referral processing and preparation of reports,

records maintanence, staff recruitment, training and supervision. Developed rapport with physicians,

nurses, support staff, and vendors

Experience

Customer Service Specialist

Hexaware Technologies, Inc.

September 2014 - January 2015 (4 months) • Virginia Beach, Virginia

Handle patient account inquiries for this outsourced billing company. Track payment history for inpatient

and outpatient claims for various hospitals through-out the country. Contact insurance carriers to obtain

payment information, claim adjudication and processing status. Calculate contractual payout by insurance

carrier. Notate patient accounts for accuracy.

Skills: MS Windows, Outlook, Excel, Citrix, FACS, Soarian, STAR

Referral Coordinator

JenCare Neighborhood Medical Center

July 2011 - March 2014 (2 years 8 months) • Norfolk, Virginia

Schedule appointments internally and externally, patient check-out, referrals processing ( all sub-

specialities radiological testing, durable medical equipment, surgical procedures) obtain authorizations

through insurance company for all CTs, MRIs, Nuclear Stress Test etc. Manage patient documents,

provide exceptional service in person and via telephone, review phone messages to forward to

appropriate physician and/or department. Respond to all referral inquiries from patients and other

sources.

Skills: ICD-9 -CPT-4 Coding, eMedRec, Dashboard, CSS- Central Scheduling System

Financial Counselor- General Surgery/ Internal Medicine

Sentara Healthcare

November 2007 - May 2009 (1 years 6 months) • Hampton, Virginia

Accountable for daily operational tasks associated with the charge and claim editing, billing follow-up and

account inquiries for assigned physicians. Ensure timely adjudication of insurance and third party claims

0-60 days, while providing excellent customer service. Assist patients with account inquiries, collection of

outstanding balances and, as needed arrange budget plan agreements. Collaborates with assigned

providers, office managers and other clinical/ non clinical staff, in an effort to resolve denials or to respond

to inquiries. Identifies opportunities for additional charge editing or educational needs associated with

activities for physician coding, front desk, charge entry, billing follow-up, payment posting and customer

service. Responsibilities also includes resolving daily claim and coding edits. In addition, effectively

utilizing available resources during the performance of daily activities via on-line coding tools and payer

enabled physician web portals in order to verify claims status, view referrals, patient eligibility. Excellent

written and oral communication skills as well as the ability to effectively organize and present ideas,

problems, solutions and results. Serves as liasion between the practice site and the Centralized Business

Office.

Skills: IDX

Institutional Provider Services Coordinator

Horizon Blue Cross Blue Shield of New Jersey

February 2006 - October 2007 (1 years 8 months) • Newark, New Jersey

Handles all lines of business for contracted network facility providers ; Hospitals, Surgical Centers, Skilled

Nursing Centers and Rehabilitation facilities. Advise provider of product knowledge, benefit inquiries,

claim status. Provide detailed information on facility contract, member liability, plan coverage, primary and

secondary coverages(if applicable), medicare, and more. Investigate information on authorizations, pre-

certifications, referrals and other necessary documentation for inpatient stays, outpatient services and/or

surgical procedures to facilitate proper pay-out by organization. Analyze provider contract to determine

rate of payment. Review member enrollment. Locate status on appealed claims. Assist in training

nestors/new employees hired by the unit. Price UB92 claims per facility contractual rate for correct

payment. Systems used: Nasco, UPS, RCOE, Bluecard, Med Decision, IMAGE, Q-Blue, UCSW,

EDIPROD, Erisco

Medical Billing Supervisor-Pediatrics

THE BROOKLYN HOSPITAL CENTER

March 2004 - June 2005 (1 years 3 months) • Brooklyn, New York

Supervised staff of six, Transmission of claims via MD on-line, Responsible for billing claims. Train staff in

billing department to use Office Practicum- medical data software, Troubleshooting denied medical

claims, Verification, eligibility and authorizations of patients insurance. Medicaid claims transmission via

HCFA 1500 form. Access in and out patient data for daily billing processing using Eagle System.

Physicians enrollment to managed care programs, private and commercial carriers via Garnet Health

Corporations Systems. Update physicians credentials, Licensures, DEA Certifications, Malpractice

Liability Insurance, CME Credits and Privileges. Evaluate staff performance, rotation, and schedules.

Office Manager

Downstate Pediatric Associates

September 1997 - March 2004 (6 years 6 months) • Brooklyn, New York

Built a progressive career path and advanced to a position with responsibility for the day-to-day operation

of a high-volume clinic, comprised of 10 pediatricians, 13 pediatric specialists and 7 assistants. Serves as

liaison to the Pediatric Chairman, Medical Director and staff administrators. Performed physician

credentialing. Obtained or updated physician licenses, registration, CME credits, DEA certificate in order

to enroll in various health plans.pre-authorizations, tracking of specialty referrals and preparation of

statistical reports for physicians. Applied diligence and attention to detail to ensure correct posting of

payments on a consistent basis. Acquired a strong understanding of third party billing, which includes

HMO, PPO, and Child Health Plus programs, and insurance companies policies and regulations. . Utilized

the Internet to secure outside lab and diagnostic reports. Ordered office supplies and medical equipment

including vaccines. Maintained records of all premature infants born at the University Hospital to pre-

register into Synagis program. Coordinate visiting nurses services and prescription delivery. Order lab test

via Cerner system.

Education

Brooklyn College

Some College Coursework Completed

2001 - 2002

Nutrition, Ecology and Health, Epidemiology, 3.0 G.P.A

The Career Resource Center

Certification

1997 - 1997

Administrative Medical Assistant: completed intensive 400-hour program: medical terminology, anatomy

and physiology, office practical and procedural, clinical theory and lab, clinical procedures, business math,

keyboarding- 3.5 G.P.A

The College of New Rochelle

Bachelor's Degree

1990 - 1997

B.A. Liberal Arts /Communications, G.P.A 3.34

Skills

• MS Word, Microsoft Office

• Excel

• Eagle/Cerner systems

• IDX

• ICD-9 Coding

• dashboard

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