Process Improvement Data Entry

M. Pettus *

MARQUITA PETTUS

615-***-**** *********@*****.*** Cedar Hill, TN 37032

EXECUTIVE PROFILE

Motivated and dependable professional with years of expertise in fast-paced environment utilizing excellent Patient Relations and Service Satisfaction. Highly valued and respected for expertise and keen insight in negotiating policy, developing and implementing strategic plans, and obtaining desired results. Proficient in job execution and proven track record of success in compliance, detail responsiveness, process improvement and leadership. AREAS OF EXPERTISE

Health Assessments Insurance Knowledge Treatment Planning Surgical Best Practices Diagnosis & Prognosis Disease Prevention Patient Education Preventive Care Treatment Plan Development Schedule Management Data Entry Critical Thinker Reports/Documentation Result Execution Customer Relations Communication Skills Attention to Detail Problem Solving Technical Support Conflict Resolution Time Management Process Improvement Microsoft Office Documentation & Control Strategic Planning Quality Control & Assurance Staff Management Leadership PROFESSIONAL SUMMARY

Billing & Precertification Specialist (Remote) June 2020 – Current Advanced Ortho & Spine

Assists in managing the day-to-day department operations including but not limited to resolution of department payer questions, payer updates, teamwork, financial counseling and communication to Management of potential patient scheduling concerns.

Liaison to Financial Clearance Management regarding but not limited to changes in payer requirements, staff performance, process improvement and positive patient experience.

Involves with orientation and training process of staff. Fosters positive team collaboration and staff development to obtain efficient operations, employee engagement and positive patient experience.

Confirms accuracy of CPT and ICD-10 diagnoses in the procedure order.

Obtains timely precertification/authorizations by contacting the payer and/or physician office to ensure outcome prior to the patient’s service.

Maintains current knowledge of governmental and non-governmental payer requirements and communicates changes to staff.

Medical Assistant/Precert Specialist/Clinical Coordinator / FMLA Coordinator Jan 2015 – Jun 2020 Southern Joint Replacement Institute

Consistently praised for efficient handling of administrative duties (e.g., answering phones, scheduling appointments, collecting co pays, maintaining medical records, patient processing) that allowed doctors and nursing staff to focus on the health concerns of their patients.

Responsible for reviewing scheduled procedures and insuring that necessary precertification or authorization for services is obtained promptly and accurately.

Scheduling appointments, answering phones, insurance verification, ordering supplies, collecting copays, greeting incoming patients, scheduling procedures

Handled all aspects of case planning and case management including triage, updating clinical records, prior authorizations, drug testing, and complying with licensing requirements.

Trained and supervised all clinical staff on all topics relative to duties and responsibilities. Public Health Officer Supervisor II Jan 2014 – Dec 2014 Department of Health

Increased accuracy of pre-booking, scheduling, and registration activities such as collecting patient’s demographic and insurance information, perform insurance verification, and determine medical necessity by providing front end training to staff members.

Established job performance plans; made recommendation to County Director in relation to hiring, promotions, demotions, dismissals, and other human resource transactions; completes performance evaluations of subordinate office staff.

Trained, supervised and evaluated a county health department office staff and its work. M. Pettus 2

Reconciled client ledgers to reflect claim denials and generate statements for unpaid balances.

Calculated charges, electronically or manually, to initiate the billing process.

Prepared medical record for services to be provided, which may include attaching necessary forms, encounter labels, or any special instructions from the medical provider or laboratory.

Developed and maintained an on-going, working relationship with county government, hospitals, as well as other entities such as the Board of Health, the Department of Human Services, and Child Support Services. Surgery Scheduler/Medical Assistant Apr 2013 – Jan 2014 Tri-Star Gynecologic Oncology of Middle TN Nashville, TN

Obtained thorough patient information regarding health history, medications, etc. and entered case data into a computerized scheduling system.

Interacted with many departments ensuring a proper level of equipment and supplies were available for surgery, communicated daily with the OR desk regarding scheduled surgery times.

Handled incoming calls and acted as a liaison between patients and medical staff, scheduled appointments, scheduled diagnostic testing, and served as backup to the Front Desk Coordinator.

Worked with insurance companies and compensation carriers to obtain authorization for tests and procedures.

Scheduled patients for surgical procedures and ensure all proper testing and results are in the patient's chart.

Processed all medical records request, legal correspondence request, and insurance data for other facilities. Medical Assistant/Office Manager Feb 2008 – Apr 2013 Regents Medical Center Pleasant View, TN

Organized patient records and archived to comply with Health Insurance Portability and Accountability Act of 1996 (HIPAA) guidelines.

Supervised the day-to-day functions of the staff that included receptionist, medical assistants, phlebotomist, and medical records clerk.

Established and maintained working relationship with vendors, insurance companies and other health care facilities/organizations.

Answered multi-phone lines completing all requests for scheduling patients, receiving insurance authorizations, or making any changes to provider's schedules

Submit all prior authorizations and provide pertinent information for medical procedures. OTHER POSITIONS HELD:

HEALTHSPRING INSURANCE PHARMACY REPRESENTATIVE 12/2007-02/2008 MILLBROOK MEDICAL CENTER MEDICAL ASSISTANT 11/2006-12/2007 H.G. HILL FOOD STORES OFFICE MANAGER 01/2007-02/2007 STAFFMARK-CONVERGY’S CUSTOMER SERVICE 03/2005-01/2006 EDUCATION/CERTIFICATION

Medvance Institute Nashville

Medical Assistant Diploma – 11/2006

National Certified Medical Assistant

BLS Certification

Jo Byrns School

High School Diploma-05/2002

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