Entry Associate Data

DOROTHY ANNETTE FLEMING

Email: *********@*******.*** Mobile/Text 404-***-**** FAX 404-***-****

PROFESSIONAL PROFILE

Experiences in Medical Benefits, Medical Claims, Medical Billing and Coding, Medical Terminology, Dental Claims Processor, Health/Life Insurance Enrollment, Certification of Electronic Health Record’s Specialist, Data Entry Associate Productive Environment. Extensive experience with patient records in the Healthcare industry and knowledgeable of healthcare databases, compliance to sensitive customer confidentially needs, with years of experience with protected patient data and good work ethics.

PROFESSIONAL SKILLS/QUALIFICATIONS

Electronic input of CMS1500, UB04, and Dental claims queue in confidential database dual screen/windows application, conforms to all applicable HIPAA provisions and OSHA regulations. Posting payments to Edits and Deferral, adheres to Plan Benefit guidelines, Coding ICD9 /CPT procedure diagnostics software, Review EOB, Remittance Advice, Electronic Health Medical Records filing, 10-key touch, Data Entry alpha/numeric keystrokes of high degree of accuracy meeting deadlines, Mid Excel, Spreadsheets, Typing, Customer Service Rep, Headset/ multi phone lines/email inquiries. Strong written and oral communication skills and highly self-motivated, achievement oriented with the ability to work in supporting teams.

PROFESSIONAL EXPERIENCE

PARAMOUNT STAFFING, Atlanta, Ga October 2021 -May 2022

CUSTOMER SERVICE REPRESENTATIVE Contracted

Respond to basic telephone, electronic, and written inquiries from dental/vision professionals, groups, subscribers and brokers

Communicate specific eligibility, benefits, claim status and forward as directed for priority resolution, documenting each customer encounter for computer tracking system

Expediently access reference materials to analyze and determine appropriate responses to identify reports and document system discrepancies

Accurately complete online/hardcopy forms, route to appropriate department, meet and maintain production standards, counts, and inquiry response turnaround times.

UFCW, THE FUND OFFICE Atlanta, Ga October 2020 -January 2021

CUSTOMER SERVICE REPRESENTATIVE Contracted

Handle and carefully respond to influx of inbound/outbound calls by building excellent rapport and confidence to all customers inquires

Validating Member, Beneficiaries, Provider, Pre-Authorization by reviewing and researching insurance claims to determine eligibility for open enrollment

Provide excellent customer service through active listening on every interaction, identifying their needs, and taking strategic action in a timely manner

Resolve customer issues, notation of all electronic claims daily by maintaining productivity goals and quality standards script or policy procedures

Provide Center coverage for teammates when necessary

NASCO, Atlanta, GA October 2018 – February 2020

MEDICAL CLAIMS EXAMINER Contracted

Responsible for the initial examining, coding, and input of CMS1500, UB04, and Dental claims, to activate claim batches by the Electronic Flexible Data Entry of Professional, Institutional and Dental claims for Federal Employee Program using FEPDirect, Flexicapture, Navigator, Onbase and NPS systems

Resolution of claim pends, initiation processing of specific adjustment types in Nasco Processing System (NPS) and retrieve claims from individual assigned work queue entering data information from submitted claim forms into the NASCO’s claim entry application

Researching and resolving claims suspense edits in Electronic Error Correction direct system and review accurate quality standards and achieve productivity and timeliness measurements by following Plan documented processes for returning claims with unidentifiable information back to Healthcare Professional/Subscriber

Completes spreadsheet template daily reports specified by Management, communicates with direct manager regarding status of deliverables and interact with clients, vendor partners when required

Excellent organization, prioritization and time management skills

Ability to manage multiple tasks with strong attention to detail and follow up

Investigates and requests additional information needed by logging notes for pending claim resolution

Med Tech Billing Solutions, Covington, GA May 2017 – June 2018

MEDICAL BILLING DATA ENTRY Contracted

Medical Billing/Patient Account Representative, review EOB’s and posting payments

Input patient’s demographics, CPT, and ICD9 codes on CMS1500 claims into patient portal database

Remained in compliance with HIPAA and OSHA regulations and confidentially

Strong written and oral communication

Strong understanding of medical terminology and insurance billing practices

Quest Diagnostics, Inc., Tucker, GA April 2000 – September 2014

Specimen Technician II, Microbiology/ Medical Billing Data Entry

Process specimens for correct lab division test results and investigated flaws with the objective of providing effective resolutions

Input confidential patient’s demographics, CPT, and ICD9 codes in a production environment

Processing a high degree of requisitions with the ability to meet accuracy standards

Maintain strong confidentiality and conforms to all applicable HIPPA provisions

Self-motivated, achievement to work in a stringent productive environment

Strong mathematical skills, attention detail, understanding of medical terminology

Data Entry medical billing of long- and short-term form requisitions that generates invoices for patient

EDUCATION

RAPID ENHANCED ACTIVE DEVELOPMENT, INC. CERTIFICATION TRAINING

Certified Electronic Health Record Specialist

CPR/BLS Certified

MED-TECH COLLEGE – College Diploma equivalate to Associate Degree

Medical Billing and Coding Specialist

CLAYTON COLLEGE STATE UNIVERSITY

Paralegal/Administrative Assistant

HIGH SCHOOL DIPLOMA AWARDED

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