Tameisha Ragland

Durham, NC *****

adyxfj@r.postjobfree.com

984-***-****

Work Experience

Case Manager

McKesson - Cary, NC

November 2022 to February 2023

• Coordinate care for patients using the program

• Conduct Benefit Investigations as necessary

• Communicate with key medical practice accounts, sales representatives regarding the status of cases. Customer Service/Medical Billing

PFS Group - Morrisville, NC

June 2021 to March 2022

UB-04

HCFA-1500

CMS-150

Epic

EOB

Answer and resolve all inbound inquiries and issues regarding patient account statements, bad debt write off's, explanation of benefits,balance due, and other patient and insurance billing related scenarios. Analyze the patient's problem or issue that is presented by collecting information and data and conducting thorough research of the EPIC system and CUBS system Updating Insurance Information

Coordinate patient refund requests with the credit balance department. Take appropriate actions to billing insurance companies or patients with corrected information including accepting and inputting primary/secondary insurance information into the system and putting request out to bill correct insurance or bill secondary if not billed . Provide financial counseling to patients, guarantors, and attorneys regarding charges for health care services.

Validate that charges are correct and request medical review, charge disputes, coding disputes and audit when necessary.

Discuss and establish payment plans for patients that require extended terms to pay off a balance. Request itemized statements to be sent to patients by mail or email. Assist patients that are requesting charity care by conducting an initial screening and sending or providing that patient a copy of the charity care application when requested. Clinical Intake Specialist

Blue Cross Blue Shield - Durham, NC

November 2020 to March 2021

• HCPCS

• CPT/Procedure code

• Call Center

• Process authorization request

• Receive inbound phone calls from providers who are requesting an authorization.

• Call Center is a highly productive and functioning team that requires lots of multi-tasking and able to work in a high call volume environment.

• Must have proficient typing skill, be able type, talk and listen.

• Strong analytical skills

• Strong Call Center background

• Healthcare background

Intake Specialist/State Health Plan

Blue Cross Blue Shield of North Carolina - Durham, NC April 2019 to May 2019

Processes a variety of internal and external member/provider requests and transactions, . Receives, screens, and enters data in preparation for review. Complies with timeliness standards and reduces unpaid claims and rework by accurately processing requests. May also assist on special projects as needed. Required Skills:

• Prior experience using Microsoft Office products and mainframe programs (e.g. Word, Excel, Outlook, Power,

• Effective verbal and written communication skills

• Excellent reporting and tracking spreadsheet skills

• Excellent organizational skills and attention to detail Track provider NPI or TIN on spreadsheet Enrollment Specialist/Customer Service 1

Blue Cross Blue Shield of North Carolina - Durham, NC November 2018 to December 2018

•Enrolling Medicare eligible beneficiaries by completing applications by phone

•Data

Entry

•Ability to talk and type at the same time

•Excellent customer service approach

•Ability to listen to individuals and to pay attention

•Ability to develop speed in the process

•Monitor emails an respond appropriately

Front End Processor

Blue Cross Blue Shield of North Carolina - Durham, NC September 2018 to November 2018

•Monitor emails from internal customers (other BCBS customers) who are requesting priority requests for imaging.

• Scanning documents and claims

•Determine if the request meets the criteria for a priority imaging and then process that request.

•Most communication through email.

•Will need to monitor incoming faxes and respond appropriately. Customer Service Representative

Xerox - Cary, NC

December 2015 to March 2016

• Referrals

• Pharmacy claims (Rx)

• Medical claims

• DME

• Procedure coding

• Adjudications

• Claims

• Call center

• Insurance

• Premiums and Billing

• Covered Providers

• Pre-Authorization

• Managed customer accounts

• Resolved customer issues

• Worked in the inbound call center

• Collected and documented orders

• Responded to inquiries and issues

• Dealing with patients, pharmacies, providers •Medical and pharmacy terminology including common brand/generic medication names

• Interacting with members who may have serious chronic conditions, as well as physician practices, insurance carriers, health plans, and pharmacy operations team members

• Answering inbound and outbound calls

• Routing calls to appropriate department(s)

• Entering accurate information into a multi-screen computer application

• Verifying and Explaining Benefits

• Coverage Plan Selection

• Reviewing patient records using medical coding procedures.

• Examine claims and verify insurance eligibility

• Record any medical charges and other payments or adjustments

• Ability to work with customers to resolve inquiries.

• Benefits/co-pays/deductibles

• Ability to navigate through multiple computer applications with speed and accuracy. Patient Care Assistant (PCA)

Carillon Assisted Living - Durham, NC

September 2014 to April 2015

• Assist residents with activities of daily living, including bathing, dressing, grooming (oral care), toileting, changing of bed linens, positioning, transfer, mobility, and incontinence care. Encourage residents to be as independent as capable.

• Keep proper records of care as required by the facility. Complete all forms and documentation as required.

• Immediately report any observations of concern/changes in resident’s condition to the Supervisor in Charge.

• Vital sign monitoring will be performed as needed or directed by regulations, policy or primary care provider’s order.

• Be able to apply the home’s accident, disaster, fire safety, elopement and emergency procedures for protection of the residents.

• Be familiar with Affinity’s State Regulatory Policies and Procedures.

• Be capable of performing CPR upon successful completion of CPR certification.

• Be knowledgeable of the residents’ background, preferences, habits and interests and preserve confidential information about each resident.

• Focus on service to residents in during dining and promote meal time as an enjoyable activity of each resident’s day.

• Provide assistance to individual residents as needed or directed, who require help with eating, carrying plates, trays or beverages.

Education

High school or equivalent

Tarheel challenge academy

2007 to 2007

Skills

• Flexible

• Willing to try new things

• Expert customer service

• Listening to problems

• Looking for solutions

• Providing education to customers

• resolve any issues

• Adaptability

• Multitasking

• Teamwork

• Problem-solving

• Communication

• Customer Service

• Data Entry

• Insurance Verification

• Medical Coding

• Phone Etiquette

• HIPAA

• Medical Terminology

• Medical Records

• Analysis Skills

• Intake Experience

• ICD-10

• CPT coding

• Epic

Assessments

Receptionist — Proficient

February 2020

Using basic scheduling, attention to detail, and organizational skills in an office setting. Full results: Proficient

Reliability — Highly Proficient

January 2020

Tendency to be dependable and come to work

Full results: Highly Proficient

Medical Terminology — Completed

March 2019

Measures a candidate's ability to understand and appropriately use medical terminology. Full results: Completed

Customer Service — Proficient

September 2020

Identifying and resolving common customer issues

Full results: Proficient

Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.

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