TAMEKA R SPARKS

214-***-****

adx518@r.postjobfree.com

Career Objectives

Dedicated administrative professional with excellent customer service skills and extensive knowledge of customer care. Interested in opportunities in utilizing conflict resolution skills via phone, email, mail, or social media.

Summary of Qualifications

Work History

SCHUMACHER CLINICAL PARTNERS, DALLAS, TEXAS

ACCOUNTS RECEIVABLE SPECIALIST /MENTOR - August 1,2017 – Current.

• Locate and notify customers of delinquent accounts by mail, insurance carrier and telephone or to solicit payments.

• Arrange for debt repayment or establish repayments schedules, based on customers’ financial situations.

• Advise customers of necessary actions and strategies for debt repayment.

• Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiation with others.

• Contact insurance carrier to discuss details of denial or rejections and how to get claim resolved for payment or further review.

• Submit medical records for pre-pay or post payment audits.

• Provide information or documentation for reconsideration or appeal to the carrier for claims processing.

• Adjust account balance based on patient responsibility, non-covered charges, or contractual adjustments.

• Develop specific goals or work plans to prioritize, organize, and accomplish daily work task.

• Provide information to supervisors, co-workers, and subordinates by telephone, on written form, e-mail or in person regarding mass adjustments and/or denial trends based on ER physician emergency group or billing code.

• Provide credentialing information to carriers in regards to denials based on providers on- boarding status.

• EPIC, Athena (Centricity) IDX,

• HIPPA laws and regulations

• Avality, Salesforce

• Alpha and Numeric filing

• Customer Relationship Management

• Report Writing

• Tech savvy with knowledge of Microsoft Office,

Excel Word and Outlook,

• Knowledge of Government and Commercial

(Managed Care, PPO's, Medicare) Reimbursement

methods ·

• Knowledge of Anatomy, Physiology, and Medical

Terminology, Disease Processes

• Fee scheduling, EOB,ERA

• State policies /Specifics Regulation covered Andnon covered services

• Account Receivable Aging Reports

• Companion Guides for electronic claims specific

CMS-1500 Billing Guideline

• Healthcare Knowledge, Time Management, High

Volume Workload management NCCI edits, CMS

1500.

• Claims Research, Problem Solving Resolution

Critical Analytical Thinking,

• Written and Communication skills

• Organization and Time Management to meet

deadlines

• Attention to Detail

• Investigate and direct patient inquiries or complaints to appropriate medical staff members and follow up to ensure satisfactory resolution.

• Explain policies, procedures, or services to patients using medical or administrative knowledge.

• Provide consultation or training to new hires and" assist the new hires with getting acclimated to their position.

• Analyze patients' abilities to pay to determine charges on a payment plan.

• Refer unresolved customer grievances to designated departments for further investigation. AETNA LIFE INSURANCE COMPANY, ARLINGTON, Texas

SENIOR CUSTOMER SERVICE REP / FLOOR WALKER /NEW HIRE MENTOR / INTERNET CORRESPONDENCE Mar 22, 2009 - Nov 18, 2016

• Utilizing conflict resolution skills via phone, email or mail.

• Check to ensure that appropriate changes were made to resolve customers' problems.

• Complete contract forms, prepare change of address records, or issue service discontinuance orders, using computers. (provider contracting and credentialing)

• Confer with customers by telephone or in person to provide information about products or services, take or enter orders, cancel accounts, or obtain details of complaints.

• Determine charges for services requested via McKesson based on Tax Identification number, billing location and service code being billed.

• Review claims adjustments with patients, providers and insurance carriers.

• Review insurance policy terms to determine whether a particular service is covered by insurance.

• Review plan sponsor tool for updates based on plan policies and renewals.

• Acclimate new hires to their position and conduct side by sides to assist with quality assurance.. Baylor Dallas, DALLAS, Texas

Unit secretary / Pre – Transplant Coordinator and Scheduler Oct 04, 1999 - Oct 03, 2008

• Scheduling coordinator

• Office secretary/ Unit Clerk

• Analyze patients' abilities to pay to determine charges on a sliding scale.

• Collect and report data on topics such as patient encounters and inter-institutional problems, making recommendations for change when appropriate.

• Coordinate communication between patients, family members, medical staff, administrative staff, or regulatory agencies.

• Explain policies, procedures, or services to patients using medical or administrative knowledge.

• Investigate and direct patient inquiries or complaints to appropriate medical staff members and follow up to ensure satisfactory resolution.

• Provide consultation or training to volunteers or staff on topics such as guest relations, patients' rights, and medical issues..

• Refer patients to appropriate health care services or resources.

• Setup conference for transplant pre-qualification meeting on a weekly basis. Education

Letourneau University

Six Sigma – yellow belt certified

Toastmasters International Club participant (nonprofit educational organization that operates clubs worldwide for the purpose of promoting communication and public speaking skills) Ogle school of hair skin and nails, Arlington, TX -Licensed Teaching Cosmetologist References

Upon Request

Contact this candidate