Athens Texas

Available to interview ASAP

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Professional Summary:

CANDIDATE has amassed a decade of extensive experience in the medical industry, specializing in billing and coding for medical claims. Her expertise encompasses the approval process for medical claims, as well as effectively handling appeals to ensure claims approvals. CANDIDATE is adept at managing billing summaries sent to patients, accurately documenting billing fees, and thoroughly researching the reasons behind claim denials. She diligently reviews claim history and coding to resolve issues efficiently. Furthermore, CANDIDATE exhibits a commitment to excellence by recording all calls meticulously and achieving individual performance goals aligned with call center objectives. She is also skilled in assisting callers with Web Portal registration and guiding them in its effective utilization. Her comprehensive knowledge and dedication make her an invaluable asset in the medical industry.

Education:

•Albuquerque Job Corps, Albuquerque NM GED-Business Management Certification 1991

•Tyler Junior College, Tyler Tx 1991-1992 courses completed Accounting, Accounts Payable, Medical Coding, Medical Coding -

•Tyler Junior College, Tyler Tx 2000-2001- Business Administration -2 Semesters

Skills:

•Practice Management: Leadership & Management, Organizational Improvements, Practice Structure, Human Resource Management, Medical Office Operations:

•Medical Terminology: Business Office Operations, Medical Office Procedures, Appointment Scheduling, Charting, Filing, Processing Co-Payments, Office administrative functions, Conflict resolution, Compliance, and Records Management:

•HIPAA Compliance: Healthcare Law, Electronic Health Records (EHR), Electronic Medical Records (EMR), Greenway (Specific practice management software), Healthcare Computer Information Systems, Medical Practice Management Systems,

•Financial Management: Accounting, Payroll, and Banking Systems, Financial statements, Insurance Billing Procedures, Insurance Verification, Healthcare Claim Cycle, Maintaining Prescription Line

•Claims Reconciliation - Claims Processing, Claim refund, Claims Coding, Claims correction,

Professional Summary:

Roi Conexus/Included Health - Remote

September 2021 to Present

• Answer phones promptly and professionally using company phone etiquette protocols using Salesforce, Amazon Workspace Okta Verifier and CX one to properly execute my job.

• Return voicemails in a timely manner

• Schedule appointments with the appropriate provider and resource

• Answer patients’ questions over the telephone regarding insurance in a timely, accurately, and

enthusiastically on a continuous basis by using all resources.

• Independent self starter with strong computer and organizational skills

• Ability to effectively communicate over the phone in a professional, positive and friendly manner

• Medical scheduler with the ability to handle high call volume

• Ability to stay focused on the computer monitor for extended periods of time

• Highly motivated and well organized with attention to detail

• Empathetic with patients’ needs and concerns

• Substantial knowledge of general medical office procedures and terminology

• Able to convey a positive attitude in all dealings with patients and staff members

• Takes initiative to solve problems and complete tasks

• Enters and/or verifies chart information is correct and up to date

• Collects scheduling deposits and billing statement balances as needed

• Activate patient portals

• Checks and responds to online appointment requests in a timely manner

• Maintains proper call center opening and closing procedures

• Must be aware of all company business policies

• Follow and respect employee policies

• Document electronic changes to patient records accurately

• Document communication to the patient and provider while conforming to all HIPPA guidelines

on a daily basis without exception

Regional Office Coordinator/Customer Service Representative

Lorica' Inc -Regional Office coordinator

August 2019 to November 2021

Coordinated all administrative and customer service functions of Life, Accident and Health insurance payments/ claims and billing issues.

• Handles customer’s administrative needs and requests, delivering first-rate service to meet or exceed their expectations (i.e., Billing, AP, Service Agreement Administration). Provides technical assistance to Partners as needed

• Trouble shoots and resolves customer disputes. Actively seeks customer feedback and ensures timely resolution of customer’s issues.

• Serves as subject matter expert and provides guidance and training to less experienced team members as needed.

• Communicates effectively to guarantee prompt and responsive services to the customer’s immediate and long term needs.

• Reads, interprets and processes work orders, invoices, credits, project billings and correspondence. Audits and reviews all work orders to ensure accuracy

.• Analyzes the cost and inventory impact of work processed and ensures any billable item is approved and directed to the correct customer. Resolves discrepancies and handles special billings as needed (i.e., multiple service agreements on one invoice, credits, and progress billings).

• Troubleshoots the gross margin analysis report and tech production report.

• Ensures all weekly, monthly and annual customer service and accounting processes are followed

according to company procedures/deadlines with accurate and timely results.

• Builds and maintains relationships with internal and external customers.

• Maintains a system of customer documentation requirements and adherence processes for all aspects of the service call process. Starts with customer requests through billing, including use of customer portal procedures.

• Reviews current processes and procedures in order to improve and strengthen the customer

experience and increase overall efficiency

ISO COORDINATOR/ENVIRONMENTAL SPECIALIST

CLAYTON HOMES - Athens, TX

April 2015 to July 2019

Supervised and inspected the company projects for storm water compliance.

• Provided program input into environmental management processes, including the Environmental

Management System (EMS) requirements based on the International Organization of Standardzation (ISO)

• Responsible for interpreting and communicating ISO 9000 and 14001 EMS requirements, City

Ordinances, state and federal regulations orally and in writing to new employees

• Characterise soil samples to be sent to (EPA) Environmental Protection Agency

• Reported to Corporate office on weekly basis of storm water and soil sample results

• Order all supplies needed for the environmental department

• Scheduled vendors to pick up Hazmat waste and Non-Hazmat waste

Team Leader Customer Representative

Carrier United Technologies - Tyler, TX

February 2008 to June 2015

Team leader for production line 692, production and inventory control

• Supervised 17 people for production line 692

• Coordinated pick-ups and drop-off for units needing repair

• Assisted with inventory control

• Created an Escalation team for clients with extreme issues with there units after 30 day purchase

• Ordered parts for compressor line and production test area

• Communicated with different vendors about good and bad parts sent to plant

• Weekly and quarterly reports done and sent to corporate office

• Assisted clients in ensuring they received the right parts and supplies

Contact this candidate