Nicole’ Stoute

*** **** **, *** *

Largo, FL ****1

Cell 727-***-****

Email: adgwqn@r.postjobfree.com

Career Objective: To join a progressive organization where I can contribute my 15 years of experience in the medical, laboratory, claims and billing field. This position would be Full time, permanent position that would offer career growth potential.

Experience:

11/2019 to Present CCS Medical

14255 49th Street North, Suite 301, Clearwater Florida 33762

www.ccsmed.com

Insurance Verification Representative

In my position, I am responsible for contacting Medicare, Medicaid and private insurance companies, by phone or internet tools, to obtain benefit and eligibility information and claim status. My daily responsibilities include:

●Efficiently and accurately verifies, reviews, documents and completes insurance verification

●Evaluates insurance coverage in order to determine the policy’s compatibility with our program

●Determines if selected products are appropriate based on patient need and insurance benefit plan

●Communicates with operations, sales team, referral or patient, regarding insurance benefits and coordination with products and programs

●Achieves stated revenue goals, production, and performance objectives Escalates recurring problem accounts, physician groups, or other trends to the management appropriately and in a timely manner

●Maintains advanced knowledge of specialty and ancillary products to answer patient questions and assist with accurately processing complex orders, including out-of-stock items, exchanges and returns

● Maintains a high degree of confidentiality at all times due to access to sensitive information Maintains regular, predictable, consistent attendance and is flexible to meet the needs of the department

●Follows all Medicare, Medicaid, HIPAA, and Private Insurance regulations and requirements Abides by all regulations, policies, procedures and standards

●Exercises appropriate cost control measures

●Maintains positive internal and external customer service relationships

●Maintains open lines of communication Plans and organizes work effectively and ensures its completion

●Exceeds all productivity requirements

●Demonstrates team behavior and promotes a team-oriented environment

●Actively participates in Continuous Quality Improvement

●Represents the organization professionally at all times

11/2009 to 1/2017 MobilexUSA (previously employed in July, 2005)

13773 Icot Boulevard, Suite 502, Clearwater, Florida

(http://www.mobilexusa.com)

Call Center Coordinator

In my position I am responsible for overseeing four departments; ultrasound, customer service, x-ray dispatch and Telerad. Primarily I oversee ultrasound. MobilexUSA is a mobile x-ray, ultrasound and laboratory company, providing services to skilled, assisted living facilities and home patients. In the ultrasound department, I am responsible for:

●Managing 4 ultrasound dispatchers

●Ensuring all cases are distributed in a timely manner

●Dispatching cases to ultrasound sonographers

●Verifying each case with facilities

●Identifying appropriate diagnosis codes to ensure proper billing

●Problem solving

●Creating weekly reports

●Tracking daily technologists’ productivity

My position requires the ability to maintain an effective working relationship with technologists, facilities and patients. This includes being able to effectively route technologists in the most efficient manner to ensure daily productivity is met and being able to think “outside the box”.

12/2006 to 11/2009 Paradigm Health Services, Inc., 7431 114th Avenue North, Largo, Florida

(http://www.paradigmhealth.org)

Claims Department Team Leader/Supervisor, reporting to the CEO.

***Notable Accomplishments***

●Promoted to Claims Department Team Leader within 6 months of hiring

●Established successful processing procedures for A/R

●Consistently achieved an average of 95% collection rate on A/R

●Achieved exceptional production and employee rapport within the Claims Department (supervising 6 employees)

●Producing necessary departmental reports for management

●Performing the necessary functions to support the timely follow-up to unpaid secondary and third party claims

●Assisting with the development of new collections software applications and electronic medical records

●Successful resolution of all aspects of the collections process and customer service calls

●Credentialing and negotiation of Medicare, Medicaid and commercial insurances

●Streamlining Medicare, Medicaid, and commercial refunds

7/2005 to 12/2006 MobilexUSA, 13773 Icot Boulevard, Clearwater, Florida

Position held: Claims and Billing Specialist-Mobilex USA provided mobile

x-ray services to nursing homes and patients in private residences in Florida, Tennessee, Mississippi and North Carolina. My position involved extensive telephone and internet insurance verification of over 200 service requisitions daily. Each x-ray had to be coded (CPT and ICD-9). I submitted claims daily to Medicare and processed HCFA-1500 forms for the remaining primary and secondary insurances. I became proficient in and was responsible for the following tasks on a daily basis:

●Verifying insurance benefits and eligibility

●Contacting various nursing homes for patient payer information

●Inputting patient demographics into the computer system

●Coding of each x-ray requisition for billing

●Posting of radiology charges to Medicare, Medicaid, etc

●Proficiency in applying Medicare and Medicaid rules and regulations

12/2003-7/2005 Cora Health Services, 5935 4th Street North, St. Petersburg, Florida

Position held: Front Office Administrator- CORA Health Services provided physical and occupational therapy services for patients referred by local hospitals and physicians. I managed the front office operations, including being the receptionist.

Before I left CORA, I created a procedure manual for my position for the company that is currently being used as a guide for new front office administrators. As Front Office Administrator I was responsible for the following:

●Assembling new patient charts

●Obtaining authorizations/referrals for physical and occupational therapy services

●Inputting of daily charges for billing

●Inputting patient demographics information

●Compiling Medicare billing information

●Processing Workers Compensation claims with knowledge of their guidelines

●Daily scheduling of patient appointments

●Faxing evaluations and progress notes to physicians and hospitals daily

●Handling multiple inquiries daily from physicians and patients via telephone

3/1996 to 7/2003 Diagnostic Clinic P.A., 1551 West Bay Drive, Largo Florida 33770

Pasadena Family Medical Group, 630 Pasadena Avenue South, St. Petersburg, Florida

(Pasadena Family Medical Group was a group of physicians that parted from the Diagnostic Clinic and started their own group practice. I was asked to join them to aid them in the start up of the new practice. I worked with them from 1/2003 to 4/2003)

Position held: Managed Care Supervisor, reporting to Managed Care Director

Notable Accomplishments

Aided in creating the Managed Care Department to process specialist referrals and authorizations

Promoted to Front Desk Supervisor within 8 months, managed 25 employees

Promoted to Managed Care Supervisor within 2 years, managed 10 employees

Set up the Managed Care to automate when referrals/authorizations where needed by primary care physicians

●Check patients in/out for appointments and labs

●Worked in the Laboratory; scheduling labs, verifying labs matched diagnoses

●Compiled clinical documentation to support medical necessity for procedures

●Credentialed and negotiated health plan contracts

●Scheduled doctor’s appointments, procedures, and labs

●Performed monthly billing and payments analysis reports

●Processed outgoing specialty referrals/authorizations

●Entered and processed claims for payment

●Calculated surgical assistant fees for health plan billing

●Loaded & maintained provider/vendor information into the claims system

●Processed monthly check runs for providers/vendors for services rendered to our

patients

●Processed payroll for employees in my department

Education: 1990-1994 – Largo High School with a 4.0 GPA

SAT Score: 1265

Skills: Proficient in Microsoft Office, Word, Excel and PowerPoint

Knowledge of laboratory tests and diagnoses (3 years experience in Laboratory environment)

Knowledge of HCFA 1500 claims

Ability to learn quickly and think “outside the box”

References and

Further work history: Available upon request

Contact this candidate