Prior Authorization/ Medical Records Entry Specialist Data
Resume:
Cynthia Neal
Columbia, TN *****
*************@*****.***
Objective
Seeking a position as a Medical Records Technician II & Health Care Patient Representative using well-hon skills in standard coding systems compiling patient’s information as well as compliance with all state federal regulations such as U.S Drug Administration (FDA), (OSHA), (CLIA), (cGMP) and (PHI). Looking for long-term opportunity w/room for growth @ established, fortune 500 organization. Experience in Prime Suite, Excel, Epic, NextGen, Athena, Onbase, & Zenith.
Education
oVirginia College Healthcare Reimbursement 2011
oCalhoun Community College Phlebotomy 2004-2006
oColumbia State Community College Prerequisites of Nursing 2004
oBusiness Technology Center Office Administration 1995
Experience
Aetna/CVS Health Concierge Specialist I/Highpoint, NC/Sept 2022-Nov2022*Contract
oEnrollment insurance for eligibility for insurance Medicare & Medicaid Part A&B
oEngage client which coverage would benefit best for them &Verification of PHI through via telephone.
oPrior Authorization of medical records/approval or denial of benefits.
Team Health/Chart Capture Operations/Knoxville, TN/May2022- Present
oDaily reconciliation of patient PHI charts within a set time frames/productivity standards.
oContact clinicians to obtain additional clinical information on incomplete/missing outstanding charts.
oIdentify and report Onbase chart flow issues.
oCollect, analyze, and report out on departmental data, maintain adherence to confidentiality standards established in accordance with legal, ethical and hospital standards.(ex: HIPAA compliance)
Monogram Health/Care Coordinator/Brentwood, TN/April 2022-May2022
oResponsible for the administrative tasks associated with delivering transformative kidney care.
oInbound/Outbound PCR enroll prospective patients.
oResponsible for scheduling telehealth appointments/Knowledge to operate device complete virtue visit.
oReports all data information directly to the Enrollment and Operations Manager/Assists the District Managers of their care team as needed
Aetna/CVS NB Policy Processor/Franklin, TN/ October 2021- January 2022* Contract
oComply Multiple administrative & customer service layers determine plan eligibility.
oPolicy processor position is review, investigation,adjustment IF necessary remittance or denial of the claim.
oKnowledge of Medicare benefits, enrollments, and LIS assistance.
oSelf- directed, able to problem solve, execution focus.
Call 4 Heath/Inbound Patient Care Representative/Spring Hill, TN/December 2018- August 2021
oAnswer 100+ Inbound calls professionally, courteously, and compassionately.
oProvide accurate, appointments for services as requested by scheduling, canceling, rescheduling, and confirmed appointments with clients.
oVisualized/Proofread and updated (PHI)while practicing HIPPA Laws.
oCommunicated with clients(Reminders)for next day appointments-Daily
oEnter/report all calls and contacts in timely, accurate, complete and efficient manner.
oStrategized appointments for(Ten) physicians account’s communicate effectively with upper management with any situation with clients and co-employee’s.
o1st Implemented (Telemedicine)”Video Chat’s” appointment in the state of TN for out of state account.(Call4Health) AIT Scheduling *Letter/Acknowledgement
Saargummi Automotive / Production Tech / Pulaski, TN / January 2017-September 2018
oServed as work leader, assuring the product met quality standard for the customer.
oMaintain records/logged dates/Data Entry into the Microsoft word system.
Meadowbrook Nursing Home / House Keeper / Pulaski, TN / March 2013-March 2014
oEnsured maintain the facility & patient room was cleaned.
Home Health Care / Care Giver / Spring Hill, TN / Oct 2011-August 2012
oHelped patient’s with everyday basic living for as personal hygiene/cleaning.
oPromoted healthy eating habits, exercise according to Doctor’s orders.
Universal Screen / Phlebotomist & Drug Screener / Columbia, TN / Oct 2011-September 2012
oPrep customer for DNA testing, background checks, & drug testing.
oMaintained confidentially of customers information/ Documented on data base.
Crockett Hospital / Phlebotomist & PRN / Lawrenceburg, TN / January 2011-Feburary 2011
oHandled patient admission, prep for drawing of blood from patient.
oRetrieved patient’s blood, & documented analyze information using appropriate computer software system.
Board of Education / Substitute Teacher & PRN / Pulaski, TN / November 2010-April 2011
oInteract with student’s with curriculum subjects of that day @ task.
American Red Cross / Medical Records Tech II / Nashville, TN / April 2006-Feburary 2011
oReviewed client medical records for accurate(PHI)
oProperly file, & track blood products management & product,& document control.
oDonor Management & Component Distribution Information Systems Software.
oProtect the security of medical records, & ensured confidentiality.
oQuickly, & accurately enter detailed successfully registered 2500+ donor’s a day (3) different regions(KY,TN,IN).
oHighly adept donor’s diagnosis-related information to individuals, agencies in compliance with appropriate regulations.
oProperly sends (PHI) medical records to the correct mailing addresses or Fax number as stated on the medical record copying requested. Process(PHI) onto CD.
oCorrectly identify patient by searching correct(PHI) number in Company EMR system/Placed (MDH) if needed.
oAbility to communicated clearly & professionally, & excellent attention to detail.
References:
Courtney Katevas 1105 Clearview Ave
Lawrenceburg, TN. 38464
Cell: 931-***-****
Milton Oregon, IT & Data Entry Specialist American Red Cross
1441 Lebanon Rd. Apt.#165
Nashville, TN. 37210
Home: 615-***-****
Cell: 615-***-****
Kathy Whitworth, Charge Nurse Meadowbrook Nursing Home
1117 Iris St.
Pulaski, TN. 38478
Cell: 931-***-****
Brindy Fuson 224 Longmeadow Circle
Pulaski, TN. 38478
Cell 931-***-****
Contact this candidate