Customer Service Patient Care

Veraniese Winbush

**** ********* *****, ******* ** 77083* 832-***-**** *****************@*****.***

Professional Summary

Highly disciplined and problem-solving Quality Improvement Specialist with a strong customer service orientation. Possesses robust analytical and strategic abilities, capable of effective collaboration with board members and staff. Adaptable and culturally aware, with experience in managing Electronic Health Records (EHR) and ensuring data integrity. Skilled in gathering, sorting, and reviewing documents for accuracy before uploading to EHR systems, including prior records, imaging results, consultation reports, and laboratory analyses. Proficient in procuring external patient data and entering it into EHRs using Centricity and EPIC software. Experienced in editing EHRs with appropriate permissions and utilizing patient portals. Ensures the integrity of releasing information requests and delivers high-quality products and customer service. Committed to safeguarding patient privacy by adhering to HIPAA regulations and company policies.

Skills

Excellent Communication and Computer Skills: Proficient in conveying information clearly and effectively, both verbally and in writing. Skilled in using various computer applications.

Deadline-Oriented: Consistently meets deadlines while maintaining ambitious standards of work.

Multicultural Awareness and Adaptability: Works effectively in diverse environments, demonstrating cultural sensitivity and adaptability.

PHI Compliance: Dependable and competent in handling Protected Health Information (PHI) with strict adherence to privacy regulations.

Medical Billing Expertise: Experienced in medical billing processes, including data entry and customer service.

Meticulous: Highly meticulous and driven, with strong problem-solving and management skills.

ROI Request Management: Efficiently date stamps and processes daily Release of Information (ROI) requests from patients and other medical facilities.

Critical Thinking: Excellent critical thinking skills, capable of analyzing situations and making informed decisions.

Patient History Documentation: Skilled in documenting detailed patient histories accurately.

Telephone Etiquette: Demonstrates proper telephone etiquette, ensuring professional and courteous communication.

Customer Service Excellence: Provides superior customer service, ensuring client satisfaction.

Software Proficiency: Proficient in Kofax, Excel, Adobe Pro, Simple Practice, Therapy Notes, and Availity.

Report Development: Develops and analyzes reports daily to support operational efficiency.

Team Building: Strong team-building skills, fostering a collaborative and productive work environment.

Insurance Verification: Confirms patient insurance benefits and checks claim statuses accurately.

Work History:

Superior Health Plan/Ambetter & WellCare

Quality Improvement Specialist 1/Risk Adjustment

Duties: Clinical Documentation Improvement (CDI):

Collaborated with healthcare providers to ensure accurate and comprehensive clinical documentation.

Utilized Amysis software to verify patient demographics, point of sale (POS) information, and claim numbers.

Verified provider demographics and retrieved charts through various secure methods, including email, confidential mail, US Postal Service, facsimile, or vendor release.

Documented all actions taken to retrieve charts in Q-Pends, ensuring a clear and traceable record of activities.

American Intercontinental University

Career Services Advisor

Duties: Establish and maintain effective communication with employers and recruiters to facilitate student employment opportunities.

Establish and maintain effective communication with employers/recruiters to facilitate student employment opportunities.

Guide students through the career development and planning process, helping them acquire knowledge about companies, current job openings, and recruiting practices.

Assist students in navigating the transition from academic to professional life.

Implement strategies for successful campus recruiting events and job fairs, enhancing student-employer engagement.

DLB Medical Outsource Billing, LLC

Assistant Medical Biller and Coder

DeAndrea Burroughs, Owner CEO

Medical Coding: Accurately assign appropriate codes for diagnoses, procedures, and services using ICD-10, CPT, and HCPCS codes, ensuring compliance with current guidelines.

Billing Processes: Prepare and submit claims to insurance companies, government payers, and patients. Follow up on unpaid claims and resolve billing discrepancies efficiently.

Medical Records Management: Review and analyze patient medical records for completeness and accuracy, ensuring all required documentation is present to support coding and billing.

Claims Management: Monitor and manage rejected and denied claims, collaborating with payers and healthcare providers to resolve issues. Resubmit claims as necessary to ensure timely reimbursement.

Insurance Verification: Verify patients’ insurance coverage and eligibility prior to services being rendered. Provide clear information on patient financial responsibility.

Compliance and Regulations: Adhere to applicable laws, regulations, and standards affecting billing and coding practices, including strict HIPAA compliance.

Reporting: Generate and analyze billing reports to identify trends, discrepancies, and opportunities for improvement in the revenue cycle process.

Communication: Collaborate effectively with healthcare providers, patients, and insurance representatives to address billing inquiries and foster strong working relationships.

Continuing Education: Stay updated on changes in coding guidelines, billing procedures, and healthcare regulations through ongoing education and training.

Legacy Community Health Southwest Clinic

Documentation Technician

Julio Ortiz, Supervisor

Duties: Documentation (EHR) Maintenance

Gathered and sorted paper documents and rejected documents from Superuser, including reports, imaging results, consultation reports, and prior records, for scanning into the EHR system.

Promptly imported documents into the appropriate patient’s chart.

Utilized Adobe Pro to sort eFaxes and eDocuments, such as lab reports, imaging results, and provider referral results, for timely review.

Communicated daily with HealthMark Outsource to manage the release of information requests.

Completed release of information requests by retrieving and returning patients’ medical charts, accurately scanning medical records, and transmitting them according to established procedures and quality standards.

Legacy Community Health Montrose Clinic

Medical Records Clerk

Ford Stuart, Supervisor

Duties: Managing patient information

Daily Schedule Management: Review the daily schedule and pull the appropriate charts for each patient’s visit.

Multi-Visit Coordination: Ensure that charts for patients scheduled for multiple visits on the same day are retrieved and prepared accordingly.

EHR Transition Support: Assist in the transition from paper charts to the Electronic Health Records (EHR) system by scanning and uploading paper charts into the EHR system daily.

Archiving and Retrieval: Archive and retrieve charts to and from the Safesite storage facility as needed.

EDUCATION

American Intercontinental University

Master of Healthcare Management, MHSA

American InterContinental University

Bachelor of Healthcare Management, HSA

Sanford Brown College Graduated with honors at a 3.53 GPA.

Associates of Applied Science Degree

Medical Billing and Coding Certification – National Health Association (NHA)

US Army Veteran

From 9-9-1981 to 9-9-1984

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