Medical Customer Service

EDUCATION & CERTIFICATIONS

Johnson C. Smith University Charlotte, NC

Bachelor of Arts in Communication Arts with a minor in Public Health May 2012

*Cum Laude

CONTINUING EDUCATION

Strayer University Charlotte, NC

Master of Science in Health Administration Candidate

PROFESSIONAL EXPERIENCE SUMMARY

Integrated Holistic Solutions

Huntersville, NC

Medical Office Manager Nov 2015-Present

-Greet Clients in a warm and inviting way and keep receptionist area organized

-Remain updated on the office software

-Register and schedule new clients in the practice management software

-Check and respond to all admin account emails within 48 hours

-Occasionally assist in training clients with the online scheduling system

-Obtain benefits, eligibility, and precertification information from insurance carriers

-Update client accounts with any changes to their insurance policies or authorizations

-Correction and re-submission of all denied claims; Submission of all secondary claims

-Maintain updated provider files with all payers and coordinate these efforts with their provider relations departments

-Perform marketing activities to include: calling clients that have not been seen in 90 days, sending marketing materials to local doctor's offices, creating/editing quarterly newsletters, sending surveys (via email) to current clients to monitor client's satisfaction

-Assist all new providers in the credentialing process for insurance panels and maintain the company’s credentialing information within the required federal database.

MedCare Urgent Care

Columbia, SC

Medical Office Assistant April 2015-July 2015

-Initiated first interaction with patient by preforming reception and greeting responsibilities

-Input patient registration and other forms of documentation

-Verified various insurance policies

-Completed and submitted insurance claims

-Collected payments of outstanding balances and current accounts

-Secured required authorizations and coordinated specialist referral appointments

Amerisource Bergen Lash Group

Charlotte NC

Sanofi Patient Connection Coordinator July 2014- April 2015

-Oriented and educated patients and their families by explaining the role of the patient care coordinator while initiating the care plan

-Monitored delivery of care by identifying progress toward desired care outcomes

-Maintained ongoing communication with utilization review staff regarding variances from the care plan to discharge plan

-Triaged patients to other services and vendors as needed

-Respected patients by recognizing their rights and maintaining their confidentiality

-Maintains patient plus care database by entering new information as it becomes available; verifying findings and reports as well as backing up data

Melange Health Solutions Charlotte, NC

Medical Records Coordinator January 2013-October 2013

-Compiled, processed, and maintained medical records for the facility consistent with medical, administrative, ethical, legal, and regulatory requirements

-Instructed staff on medical record processes, work flow and maintain work performance levels

-Assisted with hard copy and electronic medical records by providing needed documentation for coding, completing, and billing of patient privacy records

-Complied with current medical records regulatory requirements, policies, and procedures in accordance with all payer and regulatory agencies (e.g. HIPAA)

Connextions Charlotte, NC

Customer Service Healthcare Agent August 2012-December 2012

-Provided objective information pertaining to coverage, annual notice of change, pharmacy/network coverage and drug formularies

-Addressed inbound service calls from members and/or providers with questions related to, but not limited to, health benefits, eligibility status/issues, and claims inquiries, requests for member materials, primary care physician changes, prescription coverage, prescription benefits, and ID cards

- Functioned as a liaison between vendors and employees while advising employees on eligibility, coverage, and other benefits matters

-Researched customer issues and resolve problems efficiently

The Ellis Firm, LLC Norfolk, VA

Community Health Advisor January 2011-December 2011

-Worked with local and state agencies to find clinical support for low income families utilizing a wide variety of community partners and leaders to address AIDS Awareness objectives

-Organized community and organizational forums on key ethnic and social health issues

-Acted as a key advisor to administration on social, ethnical and generational health issues

-Implemented a strategic and objective lobbying agenda for the firm on Health Legislation

State of Connecticut

Hartford, CT

African American Affairs Commission Liaison Intern August 2009-January 2011

-Reviewed and prepared routine correspondence and documents to ensure correct grammar, spelling, capitalization, punctuation, and appropriate format were applied, and returned such communications to the originator for correction when not in conformance with policies or correspondence regulations

-Received visitors and phone calls, determined the nature of the request, and referred callers to appropriate staff. Answered routine and non-technical requests for information and provided correct information.

-Assisted the Commission leadership with implementation of the vision and objectives by drafting letters, correspondence, and briefings on issues

-Implemented a productive and inclusive relationship with the public on health issues using social media

Charter Oak Health Center

Hartford, CT

Intern Case Manager August 2008-January 2011

-Administered services to individuals living with HIV/AIDS while developing resources to assist clients in locating relevant HIV services available in the community

-Performed human resources intake interview and established plans of care with clients for case management services based upon priority of needs

-Collaborated with medical and behavioral health providers for client assessment and care plan management

-Maintained confidential records on all clients and statistics according to Department of Public Health (DPH) requirements

CERTIFICATIONS & KNOWLEDGE BASE

First Aid

Cardiopulmonary Resuscitation (CPR)

Automated External Defibrillator (AED)

Nonviolent Crisis Intervention (NCI)

Completed seminars in Critical Care, Case Management, Domestic Violence, HIV/AIDS testing, and Family Counseling

COMPUTER SKILLS

Microsoft Office Suite, Arc Geographic Information Systems (mapping and spatial analysis), Basic HTL Coding

REFERENCES

Tristan Breaux, U.S. Congress, District Director- 202-***-****

Ashleigh McNeil, Management Analyst - Contractor – US Department of State - 202-***-****

Shaketia Barnes, Mecklenburg County Deputy Sherriff - 704-***-****

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