Data Entry Administrative Assistant
Resume:
Sandra Knudsen
Administrative Assistant
Albuquerque, NM 87121
*********@*****.***
Work Experience
Customer Service Representative: Presbyterian Health Care - Temp to hire. Albuquerque, NM. December 2021 to June 2022
Remote - Work From Home: Medicare line of business for NM. Always protecting PHI & HIPAA information. Took calls to quote benefits, for INN & OON; check on health and dental premiums and pharmacy. Quoted Copays and coinsurance. Ability to take payments over phone on secure line. Check on medical claim payments, dental claims, vision and mental health. Submit forms to update POA, demographics, requests to send materials to members, select or change providers. Assists members choosing specialists or requests for home health, care coordinator or submission of prior authorization. Assisting members in Filing for an appeal or grievance. Assist members when calling about their appointment with providers and transfer call. Skilled in multiple computer applications used to access several areas and quote helpful information. Patient Scheduler
Family Medicine PC - Albuquerque, NM
September 2021 to October 2021
Responded to patients request from the electronic website by contacting them and scheduling an appointment time that worked for them. If the patient requested an urgent time or had a question, it would be forwarded to the provider. Also the provider would forward an electronic request to contact the patient because they needed to be seen for a physical or lab work etc.
Next I would contact patients from a physical list that the patient used to be seen at the clinic but it was a couple of years or so - I would contact them to find out they moved or switched insurances, etc.
Caregiver/Personal Assistant
Inteli-Care - Albuquerque, NM
April 2018 to March 2020
Assisted Elderly woman in day to day needs. Preparing her breakfast, getting her clothes to wear for medical appts. Prepared other meals she could eat for lunch and dinner. Took her grocery shopping, cleaned her apartment as needed. Tossed trash, sewed garments if button was lost or the seam came apart. Picked up cigarettes for her. Sprayed for bugs, contacted maintenance if needed. Picked up medications as needed. Scheduled Dr. Appointments for her. Made sure she was safe and ok by herself before leaving for the day.
Administrative Assistant / records Management
Bernalillo County Mats detox - Albuquerque, NM
September 2009 to July 2010
Worked as Admin to Director of Mats Detox. Took phone calls, relayed messages. Data entry Compliance Related Criteria: Adheres to the components of the Compliance Program. Ensures that job tasks are performed in a legal and ethical manner. Actively assesses work for non-compliance issues and notifies supervisor of any breech of confidentiality. Maintained and processed medical records, history and data and review record completeness in order to prepare reports used for Quality and Compliance, Fraud and Abuse. Compiled information for any DRS (designated record set) received to be forwarded to the consumer and/or attorney. Worked with providers to obtain records for the Compliance Audit. Assisted the Compliance Department in coordinating documents for the NMR Audit in 2008 and 2009. Organized previous years internal audit files/documents. Assisted all departments involved with the RFP process for the 2009 contract.
Participates in most department meetings for Compliance, Communications and Region 3/ Provider Operations to take minutes - electronically, some handwritten. Minutes typed and saved on the N: Drive for that particular department and/or training.
Abilities: Detail oriented. Concentrate for long periods of time. Communicate concisely and understandably. Shift priorities readily. Ask questions to gather information. Access procedures and follow them. Work with minimal supervision and maintain a high degree of productivity. Communicate information and share training so that other co-workers are receiving same information at the same time. Understand operations and technical operations of equipment, printers, scanners, copiers, faxes and any other equipment provided to me.
Environment: Understanding of storage procedures. Organized spreadsheets, labeling & Transmittal sheets along with boxing up of materials to be sent to for storage.
**Currently helping Facilities Manager and Compliance Director with transition of closing the offices in New Mexico.
Administrative Assistant
ValueOptions of NM - Albuquerque, NM
January 2008 to August 2009
Provided a variety of administrative and support staff services to ensure department operations ran smoothly. Recorded, scheduled and maintained calendar of appointments, meetings and travel itineraries. Responded to routine internal and external correspondence. In all duties, demonstrated the ability to adapt to various requests with minimum instruction. Reserved meeting spaces, prepared agendas, ensured rooms were prepared including necessary supplies, refreshments, set up and clean up. Typed and distributed minutes from departmental meetings as necessary. Examined documents for completeness and accuracy, edited and clarified vocabulary and sentence structure to communicate ideas. Answered phones courteously and professionally, took messages as necessary and handled matters as directed. Exercised tact and diplomacy in interfacing with both internal and external personnel. Organized projects that involved collating, distribution, filing and processing of mail, internally and externally. Received invoices from consulting firm for audits. filed forms and sent to finance for payment.
Assisted Managers from all departments with receipts, travel and reimbursements. Set up travel through corporate for air, hotel and rental cars.
Maintained and updated Department Policies and Procedures. assisted Compliance Officer in maintaining Procurement documents. Organized documents for HIPAA training for new staff. Ability to work independently and within a team on special projects. Provided back-up to Executive Administrative Assistant to CEO, CMO and COO, as needed including the reception desk. Assisted the Fraud & Abuse Manager in obtaining and receiving Medical Records for review. Contacted Providers for this information in a timely manner. Appeals & Grievance Consumer Assistance Coordinator Lovelace Health Plan - Albuquerque, NM
1999 to 2007
Work with multiple systems simultaneously through the day in dealing with new Grievances and Appeal issues. Multi -tasking and use of critical thinking in this position a must. While being aware of daily deadlines. Handling distribution and responses. Managed time by prioritizing and organizing in order to accomplish deadlines set for my area. Receive all incoming mail to department. Reviewed mail to ensure accurate information was included as well as coding supplied for denials. Assited Mailroom Clerk with mail distribution to each department as well as my own departments. Entered information into Access Database on all cases. Supported my department and organization by working with coworkers to make sure deadlines were met. Worked with internal-external organizations to obtain Medical Records for Appeals/Grievances received daily.
Assisted Provider Appeals Specialists with Claims, extensive research and entering of data, calling external providers for information as well as medical records if needed. Looking up status of claims, checking denied codes with CPT4, ICD9 books. Ability to keep familiar with department managers assistance with federal, state and local codes and regulations and changes. Assisted with CMS Medicare/ Medicaid & NMMRA audits during separate times of the year. (pulling files, making sure all documents needed were in file or obtained for audits. Prepared file checklist, tabbed and copied files for auditors). Sent out acknowledgement, extension and closure letters. Ability to work with little or no supervision. Ability to create forms needed to improve processes. Flow sheet and job description of duties created for position to use in cross training. Managed and coordinated Level II hearings for Appeals/Grievances and took minutes. Preparation of packets for committees and members regarding products (Commercial, Medicare, Medicaid) and on a weekly basis. Communicated to these committees as well as the members about any changes. Worked along with Appeals Manager for up-to-date information, review of up to date policies and procedures, time sensitive materials from DOI, CMS regarding any changes that effect the department.
Assisted department with data entry, billing and receiving insurance payments, entering into spreadsheets.
Creation of binders for Policies & Procedures, DOI and CMS, to keep current updated materials organized. Tracked calls for Consumer Assistance Line and created report in excel to report on a monthly/ quarterly basis. Ongoing initiative in developing positive relationship with organizational internal/external customers. Ability to communicate, analyze and interpret data and maintain confidentiality. Always making sure the department worked within the HIPAA Compliance Guidelines. Under general supervision/ direction, able to perform a variety of responsible and complex administrative / technical duties. Heavy filing, boxing up prior years cases for storage and contacted vendor for storage pickup, lifting of boxes. In charge of making sure supplies were ordered, delivered and if order received was incorrect, made sure I contacted the vendor (Corporate Express) to return item/s and the correct one was sent. Also sorted mail for several departments and logged any mail received via UPS. Maintained all machines
(ie, copiers, faxes and printers).
Member Services - Customer Service
Lovelace Health Plan Albuquerque, NM
Worked with Health Insurance Customer Call Center. Quoted health insurance benefits, handled claims, complaints, and dissatisfied customers. Contacted Providers regarding their claims/appeals. Time management and multi tasking skills enhanced. Assigned to Research position on 3 occasions at 2-week intervals as a Lead Service Representative.
Position Summary:
Provided support to the department. Ability to use independent judgment performs filing, office procedures, maintain confidentiality, and follow HIPAA privacy. Knowledge of compliance and enforcement of policies. Ability to deal politely and courteously with fellow employees, providers and public. Able to function independently and manage own time. Ability to handle multiple projects at once. Voluntarily assists others when necessary. Ability to learn new things. Very detail oriented. Motivated to produce quality work.
Maintained Confidentiality and safekeeping/protecting data. Non-disclosure of and customer, employee or business related information. Always being sincere, truthful and ethical. Ability to accept criticism and deal with stressful situations calmly and effectively. Education
2- AA, 1- AS in Integrated studies / Applied Sciences CNM - Albuquerque, NM
November 2010 to December 2014
Working on BA in Psychology
UNM - Albuquerque, NM
January 2015
Skills
• Medical Records
• Clerical experience
• Customer service
• Microsoft Office
Certifications and Licenses
CPR Certification
First Aid Certification
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