CW CHARRIYSE WAITERS MHSA, CPC

ad03vy@r.postjobfree.com 205-***-**** 900 HILLCEST AVE, BIRMINGHAM, AL, 35235, US Enthusiastic Healthcare Professional eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Adept in coding/billing, collections, records management and maintenance, provider and customer service, seeking an opportunity with an organization that will allow potential for statbility and advancement.

Medical insurance

IT professional with a broad base of technical skills including system integration

Works well independently as well as a part of a team Advanced customer service skills

Highly motivated

Secret Security Clearance

Medical Terminology

Demonstrated ability to multitask

Application Troubleshooting

Demonstrated ability to be flexible and allow changed in work assignments

Knowledgeable with Healthcare laws and regulations Familiar with Medicare and Medicaid process

Proficient with Microsoft Office

CPR Certified

Experience with inventory control.

Demonstrated ability to enter data accurately

Demonstrated high level on communication

The ability to exercise flexibility, initiative, good judgement and, discretion

Demonstrated time management skills

Comfort in working in a fast-paced environment

Implemented, as directed, appropriate response

measures to security threats

Phone skills, including familiarity with complex or multi-line phone systems

Information Technology - Certification - 2022

Jefferson State Community College - Jefferson Campus - Birmingham, AL Cybersecurity SYO601 CompTIA 06/2022 Certification (TestOut Security Pro Certified) Medical Insurance Coding - 2019

American Association of Professional Coders - Birmingham, AL Health Administration - Master of Science - 2017

Strayer University - Birmingham, AL

Health Administration - Bachelor of Science - 2014 Columbia Southern University - Orange Beach, AL

High School - 1997

Huffman High School - Birmingham, AL

PROFESSIONAL

SUMMARY

SKILLS

EDUCATION

Non-Clinical Intake Coordinator - July, 2022 to Present Kern Family Health Care - Bakersfield, CA

Reviewed and corrected claim errors to ensure smooth processing. Obtain referral information from providers and members to implement and facilitate the authorization process.

Act as liaison to KHS members, community providers, and employees to the UM clinical staff. Assigns diagnostic and procedural codes using ICD-9 and CPT coding classification system for service requests. Requests input from the Clinical Intake Staff when needing direction or clinical expertise. Reviews specified referral types using KHS workflow and protocols for purposes of pre-authorization of payment; routes requests when indicated to Clinical Intake Coordinators for approval or autoauthorizations. Benefits interpretation to include coordination of care for medically necessary services that are not covered under the KHS Plan (e.g. CCS, Long Term Care, and State Waiver Programs.) Verifies accuracy of components of referral request (i.e., eligibility, network provider status, facility type) for clinical staff for preparation of authorizations for Clinical Intake Coordinator review. Coordination of Health Plan services between KHS UM Department and KHS Member Services and Provider Relations. Reviews member history and eligibility and previous referral authorizations. Monitors, tracks, and processes provider service appeals. Ensures accurate data entry of authorizations in the KHC system. Adheres to KHS’s Code of Ethics and Business Conduct and all company Policies, e.g., confidentiality, attendance, safety/security, use of equipment and technology, appearance, and demeanor.

Medical Coding and Billing Specialist - December, 2019 to Present Innovative HIM Solutions, LLC - Pinson, AL

Double-checked the data's accuracy and integrity.

Was able to effectively respond to customer requests via phone and email, as well as answer questions and inquiries.

Used classification manuals to learn more about disease and diagnosis processes. Kept a detailed record of all requests for medical records and information. Local, state, and federal agencies provided me with documents, clearances, certificates, and approvals. Lead, coordinated, and monitored the reviews and analysis of the practitioner application and accompany documents, ensuring applicant eligibility accompanying documents and ensuring applicant eligibility. Submitted bills for reimbursement to private insurers such as Medicare and Medicaid. Performs primary source for verification, record information received and provided follow up as necessary according to established policies and procedures.

Participates in month-end reconciliation and payer analysis process. Participates in month-end reconciliation and payer analysis process. Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10- CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes. Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits

(MUEs), and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers. Resolve payer denials and respond to inquiries from revenue cycle teams, processing charge corrections as appropriate.

WORK HISTORY

Advanced Medical Support Assistant - January, 2020 to March, 2022 VA Medical Center-Birmingham - Birmingham, AL

Improved patient outcomes by educating them about procedures, medications, and other doctor's instructions.

Mailed appointment letters to patients.

Implemented care and efficiency improvements to support and improve office operations. Received and input applications, maintained supply files for nursing personnel, track referrals, selections, and non-selections.

Provided administrative support services with 8 specialty clinics. Responsible for determining eligibility and benefits. Provided direct administrative procedures and resources for 70-120 patients daily. Conducted ongoing reviews of MSA’s work product to ensure quality of work is maintained and that patient’s appointments are scheduled accurately and in a timely manner. Worked with a variety of patients with but not limited to; physical, mental and emotional behaviors using a variety of techniques.

Intake Care Senior Associate - May, 2016 to May, 2020 Cigna - Birmingham, AL

Completes review of non-authorized medical claims • Improved and implemented customer risk rating criteria with Cigna management and procedure for both consumer or and corporate customer. Served as a SME (Subject Matter Expert) to other Care Senior Associates within the department and other applicable departments.

Interface with the clinical teams for collecting information and submitting to the appropriate responsible parties.

Processed denial letters to include mailing correspondence to AOR (Appointed Representatives, patient, facilities, and applicable contracted providers.

Maintained benchmark standards for TAT (turnaround time) as established by the organization; Assisted with the meetings including but not limited to; Grade A Service, Average Handle Time, Average Speed to answer and Abandonment Rate.

Served as SME (Subject Matter Expert) for audits that require knowledge of National Committee for Quality Assurance (NCQA) and Independent Provider Association (IPA) Responsible for implementing a remediation process that was not fully designed for thousand of records to meet compliance standards that were not fully defined. Insurance Verification Coordinator/Preregistration Rep - May, 2015 to May, 2016 Accretive Health - Birmingham, AL

Answered 50-60 calls per day to help customers with their questions and concerns. Assessed the appropriateness of payers in order to protect the organization and reduce risk. Ensured that insurance benefits were verified in a timely manner prior to any patient procedures or appointments.

Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.

Collected premiums on all direct collection files. Medical Records Coordinator - June, 2013 to May, 2015 Noland Health Services - Birmingham, AL

Was in charge of inventory management, which included materials monitoring, ordering or requisitioning, and stocking or restocking supplies.

Kept a detailed record of all requests for medical records and information. Handled phone and email correspondence, made copies, and handled incoming and outgoing mail and faxes as part of my administrative duties.

Provided/reported death certificates to Vital Statistics Medical Records Assistant - November, 2005 to June, 2013 UAB Hospital - Birmingham, AL

All aspects of the nursing assessment, treatments, medications, discharge instructions, and follow-up care were meticulously documented.

Started the auditing process to assess the thoroughness of the documentation and the upkeep of facility standards.

Ensured that medical records and health information were accurate, complete, and secure. Aided in the resolution and fulfillment of client requests as well as internal operational issues. Medical Logistics Specialist - April, 1999 to March, 2004 Army National Guard - Birmingham, AL

Local, state, and federal agencies provided me with documents, clearances, certificates, and approvals. Examined departmental documents to determine how they should be distributed and filed. Conducted research in order to address shipping and packaging errors. Perform inventory and financial management procedures, including ordering, receiving, and storing medical supplies.

Required to pull, pack, and ship orders related to medical supplies. Responsible for purchasing.

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