Alice Kearse

Administrative Asst.-HEDIS Project

Jacksonville, FL 32218

adhjeh@r.postjobfree.com

(904) 305- 7137

A seasoned administrative and medical billing professional with a solid understanding of providing exceptional customer service experiences. Demonstrate a high level of integrity and ethics along with a unique drive for excellence, and the ability to consult with clients to determine how to assist with their requests.

#readytowork

Authorized to work in the US for any employer

Work Experience

Referral Coordinator

University of Florida Jacksonville Physician - Jacksonville, FL January 2016 to Present

I call and verify eligibility for all patients and make sure all procedures are covered before they are preformed by the provider

Administrative Asst.-HEDIS Project

Florida Blue-Incepture Staffing - Jacksonville, FL April 2014 to May 2014

Performed a variety of administrative functions: Scheduled online audio meetings.

• Inform providers in handling multiple projects and generated daily reports.

• Electronically maintained and secured medical records form EMR.

• Request medical records for various measures via medical records retention policy and procedures.

• Researched provider information utilizing the use of Inovalon Inc site.

• Spoke with providers to ensure compliance with the HEDIS project and contract agreement.

• Experience with Diamond, Siebel, PIP, CMCA, Sharepoint, and Provider 360.

• Knowledge and awareness of HIPPA and PHI regulations Referral Specialist

St. Vincent's HealthCare - Jacksonville, FL

October 2007 to January 2014

10/2013- Current

• Actively ensure referrals and authorizations are made in an orderly and timely manner.

• Maintains knowledge of referral requirements, which includes but not limited to verifying patient insurance information is current, patient benefits for services are ordered, and updating demographic and insurance information in the appropriate database.

• Schedules referral appointment with patients in a timely and effective manner.

• Verify the referral documentation is complete by preparing, maintaining, and completing detailed documentation for each referral processed in the patient's electronic medical record. Pre- Access Associate

St. Vincent's HealthCare

March 2013 to October 2013

Registered all patients in a timely and accurate manner.

• Acquired timely and accurate authorization, precertification, and insurance verification to ensure appropriate reimbursement was received.

• Complied with departmental collection/ cash handling procedures.

• Provided timely and effective customer service to all incoming calls. Patient Accounting Representative II

St. Vincent's HealthCare

December 2009 to March 2013

Adhered to established time frame when processing incoming work, with all claims processed daily.

• Monitored and made necessary changes to daily reports to ensure prompt processing of accounts, creating a positive cash flow.

• Worked closely with registrars, billers, cashiers, collectors, and physician's offices or clients to ensure all activities that lead to collection of accounts are completed in a timely and thorough manner.

• Actively communicated with insurance companies, Medicaid and Medicare about coverage and benefits.

Financial Specialist

St. Vincent's HealthCare

December 2008 to December 2009

Keyed claims for Neurology physicians.

• Consistently followed- up on pending claims with providers.

• Made certain self-pay accounts were evaluated for financial assistance.

• Ensured Medicaid follow-up was thorough and consistent.

• Worked closely with Patient Accounting and physician office staff on attempts to resolve eligibility and coverage issues on referrals received prior to the patient's date of service or discharge from hospital.

Human Resources Assistant

St. Vincent's HealthCare

October 2007 to December 2008

Assisted 3- 4 designated recruiters with applicant processing and applicant follow-up.

• Answered applicants' questions accurately or if unable to provide assistance routed to appropriate recruiter.

• Processed employment references on pre-screened applicants from designated recruiters.

• Processed criminal background screenings, sanctions and license verification.

• Prepared materials and attended career fairs with recruiters. Administrative Assistant

River Region Human Services

April 2005 to October 2007

Compiled and prepared reports and documents pertaining to personnel activities.

• Processed, verified, and maintained personnel related documentation, including staffing, recruitment, training, performance evaluations, and employee leaves of absence.

• Recorded data for each employee, including such information as addresses, weekly earnings, absences, and dates of and reasons for terminations.

• Processed paperwork for new employees and enter employee information into the payroll system.

• Issued and recorded adjustments for pay related to previous errors or retroactive increases.

• Verified hours worked, pay adjustments, and post information onto designated records. Enrollment Specialist

Florida State College of Jacksonville - Jacksonville, FL January 2003 to April 2005

Assisted students with course enrollments which included program selection, class scheduling, and registration.

• Conducted follow-up interviews with students to determine if their needs were met by the guidance counselors.

• Scheduled appointments for Placement Testing and for meetings with guidance counselors.

• Represented the institution at community and campus events with other Florida State College personnel to increase student enrollment.

Education

High School Diploma in healthcare

St Augustine High School

Certificate in Medical Billing and Coding

North Florida Institute

Skills

• All (10+ years)

• All (10+ years)

• HEDIS

• Insurance Verification

• Medical Records

• Medical Terminology

• Medical Coding

• Medical Billing

Assessments

Typing — Completed

April 2020

Transcribing text using a standard keyboard.

Full results: Completed

Electronic Medical Records Knowledge — Completed

July 2019

Knowledge of EMR data, associated privacy regulations, and best practices for EMR use. Full results: Completed

Customer Focus & Orientation — Proficient

July 2019

Responding to customer situations with sensitivity. Full results: Proficient

Sales Skills: Influence & Negotiation — Completed

May 2019

Using influence and negotiation techniques to engage with and persuade customers. Full results: Completed

Verbal Communication — Proficient

April 2020

Speaking clearly, correctly, and concisely.

Full results: Proficient

Organizational Skills — Familiar

April 2020

Arranging and managing information or materials using a set of rules. Full results: Familiar

Medical Billing — Proficient

April 2020

Understanding the procedures and forms used for medical billing. Full results: Proficient

Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.

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