Data Entry Customer Service
Resume:
Cheryl Price
Richmond, VA *****
adwdm3@r.postjobfree.com
To obtain a career in healthcare services and be financially stable for my family. Work Experience
Care Coordinator
The Judge Group
January 2022 to Present
Main responsibility is to support the continuum of care for TRICARE Beneficiaries by scheduling a variety of medical services in accordance with customer availability, Military Treatment Facility (MTF) capabilities and contract guidelines.
• Respond to a variety of inquiries and resolves issues with regard to TRICARE eligibility in a timely manner while maintaining sensitivity toward military culture.
• Conduct customer contacts related to beneficiary support, referral follow-up, education and resource inquiries. • Identify potential emergent concerns and follow contract specific protocol connect beneficiaries to the TRICARE NAL clinical team.
• Maintain constant awareness of service level and queue status in order to meet contractual requirements. • Support the continuum of care related to Global Nurse Advice Line contacts Overnight Living Coach
Grafton Integrated Health Network
December 2022
•Provides direct care to those with intellectual and developmental disabilities.
•Performs personal care tasks, including assistance with basic personal hygiene and grooming, feeding, and ambulation, medical monitoring, and health care related tasks.
•Fosters positive relationships between caretakers and individuals served.
•Ensures client safety and maintaining a safe environment.
•Reminds and assists clients with self-administration of medications (with proper training). •Encourages self-help activities.
•Reports changes in client’s condition or family situation to administrators and supervisors. •Documents services provided.
•Performs home management functions such as light housekeeping, laundry, bed making, and cleaning. •Plans meals, shopping for groceries, preparing and serving food/meals, feeding and clean- up. •Accompanies clients to scheduled appointments and transports clients or running errands for clients. •Assists with toileting, including bedpans, urinals, and commode chairs as necessary.
•Other duties as assigned.
Occupational Health Coordinator
Patient First - Glen Allen, VA
November 2020 to December 2021
• Responsible include collection calls and/or correspondence in a fast-paced goal-oriented collections department. • Providing customer service regarding collection issues, process customer refunds, process, and review account adjustments, resolve client discrepancies and short payments. Responsible for monitoring and maintaining assigned accounts- Customer calls, account adjustments, small balance write-off, customer reconciliations, and processing credit memos.
• Accountable for reducing delinquency for assigned accounts.
• Perform other assigned tasks and duties necessary to support the Accounts Receivable Department. • Enlist the efforts of sales and senior management when necessary to accelerate the collection process. • Must communicate & follow up effectively with the sales department regarding customer accounts on a timely basis. Establish and maintain effective and cooperative working relationships with dealers and sales. Concierge
Crossings of Bon Air - Bon Air, Virginia
April 2016 to July 2020
● Greet visitors seeking information about the property. Be responsive to the needs of people who inquire about the property and/or who are in the building for meetings with administrative personnel.
● Direct visitors to appropriate office or resident apartment.
● Responsible for assisting residents, family members, and guests with general requests. ● Responsible for arranging for tours of the property for individuals making spontaneous visits or those that have made an appointment for the tour.
● Answer telephones, record, and channel information, and direct calls to appropriate individuals or departments, relay messages in a timely, clear, polite concise, and professional manner.
● Display knowledge of the services and programs and other pertinent information regarding the property. ● Be responsive to residents’ concerns, including; responding immediately to emergency calls and notifying the appropriate persons or agencies as warranted, promoting resident morale by answering questions and calming distressed residents, and referring grievances to appropriate personnel.
● Performs other duties consistent with the position as assigned by the Business Office Director or Executive Director.
Patient First
Collections Specialist
Patient First - Glen Allen, VA
February 2019 to October 2019
● Responsible include collection calls and/or correspondence in a fast-paced goal-oriented collections department. ● Providing customer service regarding collection issues, process customer refunds, process, and review account adjustments, resolve client discrepancies and short payments. Responsible for monitoring and maintaining assigned accounts- Customer calls, account adjustments, small balance write-off, customer reconciliations, and processing credit memos.
● Accountable for reducing delinquency for assigned accounts.
● Perform other assigned tasks and duties necessary to support the Accounts Receivable Department. ● Enlist the efforts of sales and senior management when necessary to accelerate the collection process. ● Must communicate & follow up effectively with the sales department regarding customer accounts on a timely basis. Establish and maintain effective and cooperative working relationships with dealers and sales. Reimbursement Specialist
McKesson-Medical-Surgical - Glen Allen, Virginia
July 2018 to January 2019
● Responsible for first/third party billing utilizing the patient financial information system, adjudicating claims, follow- up reviews, processing/tracking of submissions, remittances, and rejections, inpatient/ outpatient registration, cashiering, credit and collections, charge master maintenance, follow up with insurance companies and patients to ensure that all patient accounts are paid in a timely fashion.
● Responsible for performing a wide variety of duties to provide for the efficient and effective management of accounts receivable.
Case Management/HealthCare Specialist Virginia Birth Injury Fund - Midlothian, Virginia August 2016 to November 2017
● Responsible for all inquiries made about prescriptions, inpatient and outpatient stays.
● Responsible for processing case referrals.
● Responsible for making sure all private duty nurses, certified nurse assistants, licensed practical and registered nurses keep up with their certifications.
● Responsible for all communications with outside medical organizations to make sure the claimant’s medical needs are being met.
● Responsible for reviewing claims and making sure they are coded correctly.
● Responsible for determining eligibility regarding benefits/insurance., verifying and calculating income for the families household.
● Responsible for all authorizations on all durable medical equipment, nursing hour renewals, and increases if permitted.
Broad Path Healthcare Solutions - Remote
October 2015 to June 2016
● Researches member information in response to difficult inquiries, including, but not limited to authorizations, payments, denials, coordination of benefits.
● Resolves difficult issues to achieve member satisfaction.
● Prepares files for review by the health plan Medical Director and/or Appeals Committee. ● Ensures all timeframes are met throughout the grievance process.
● Works closely with medical management staff to obtain clinical information for appeals related to the denial of services.
● May develop monthly appeals reports including but not limited to the number of appeals by category, the number of denials upheld, and confirmation that timeframes were met.
● Gather, analyze and report verbal and written member and provider complaints, grievances, and appeals. ● Assist with the member grievance process.
● Prepare response letters for member/provider complaints, grievances and appeals.
● Conducted Inbound/Outbound Calls to obtain clinical information for member’s appeals and or grievances. Virginia Premier Health Plan - Richmond, Virginia
April 2014 to October 2015
● Responsible for organizing and controlling the workflow of the grievance and appeals coordinators, assigning grievances, appeals, claims, and other duties to coordinators and nurses, responsible for assisting members with Coverage Determinations, Redeterminations and Reconsiderations, quality of care, and/or quality of services complaints against providers and/ or their practicing facilities, assisted members and providers, with appealing denied services which stemmed from a denied authorization.
● Responsible for scheduling and attending state fair hearings for the Department of Medical Assistance Services
● Responsible for assisting members and providers with getting their claims reviewed and processed. ● Responsible for reviewing criteria for (DME) Durable Medical Equipment. Responsible for training new hires. Reports directly to the Director of Medical Management.
● Customer care and Call Center environment for Inbound and Outbound Calls Prior Authorization Specialist for Magellan Health Services Medix Staffing Solutions - Glen Allen, Virginia
December 2013 to April 2014
● Ensures the optimal use of medications, including effectiveness, safety, and cost considerations for all patients in the assigned practice or geographic areas, including pediatric, adolescent, adult, and geriatric patients. ● Assists pharmacy staff with processing claims for Medicaid members.
● Approve or deny medications for members based upon the clinical criteria received. Responsible for receiving and transferring calls from members and answering general questions about their plan and/or claims. Appeals and Grievances Coordinator
Coventry HealthCare - Glen Allen, Virginia
July 2012 to July 2013
● Responsible for collecting, organizing, and tracking information to facilitate and expedite member appeals. ● Reviews appeal to determine what additional documentation is needed to make an appropriate decision. ● Contacts providers to request information or a more detailed explanation of services rendered.
● Researches administrative or non-clinical aspects of the appeal.
● Researches member information in response to difficult inquiries, including, but not limited to authorizations, payments, denials, coordination of benefits.
● Resolves difficult issues to achieve member satisfaction.
● Prepares files for review by the health plan Medical Director and/or Appeals Committee.
● Ensures all timeframes are met throughout the grievance process.
● Works closely with medical management staff to obtain clinical information for appeals related to the denial of services.
● May develop monthly appeals reports including but not limited to the number of appeals by category, the number of denials upheld, and confirmation that timeframes were met.
● Gather, analyze and report verbal and written member and provider complaints, grievances, and appeals. ● Assist with the member grievance process.
● Prepare response letters for member/provider complaints, grievances and appeals.
● Conducted Inbound/Outbound Calls to obtain clinical information for member’s appeals and or grievances. Substitute Overnight Residential Instructor
Grafton Integrated Health Network
January 2004 to December 2006
•Provides direct care to those with intellectual and developmental disabilities.
• Performs personal care tasks, including assistance with basic personal hygiene and grooming, feeding, and ambulation, medical monitoring, and health care related tasks.
•Fosters positive relationships between caretakers and individuals served.
•Ensures client safety and maintaining a safe environment.
•Reminds and assists clients with self-administration of medications (with proper training). •Encourages self-help activities.
•Reports changes in client’s condition or family situation to administrators and supervisors. •Documents services provided.
•Performs home management functions such as light housekeeping, laundry, bed making, and cleaning. •Plans meals, shopping for groceries, preparing and serving food/meals, feeding and clean- up. •Accompanies clients to scheduled appointments and transports clients or running errands for clients. •Assists with toileting, including bedpans, urinals, and commode chairs as necessary.
•Other duties as assigned.
Education
BA in BSHA
Strayer University - Chesterfield, VA
January 2024 to December 2024
St. Barnabas High School - Bronx, NY White Plains, NY Skills
• McKesson Vital
• Accounts receivable
• MS Dynamics (Customer Relationship Management) CRM and ERP
• Customer Service and Analytics
• Case management
• Sales
• Cold calling
• Citrix
• Microsoft Excel
• SharePoint
• CPT Codes and Medical terminology. A/R proficient
• Invision
• AS400
• Cerner
• Customer service
• Proficient in MS Word Office
• Quick
Look Reporting Data Entry
• Maintenance
• medical and business office.
Experienced in ICD9CM
• Cashiering
• Medical office experience
• Medical terminology
• Office experience
• Epic
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