Process Improvement Patient Care

RF

RHONA FLEMING

*****.***********@*****.*** 301-***-**** Upper Marlboro, MD 20772

Accomplished Medical Administration Technician with a proven track record at Irmac, enhancing operational efficiency and patient care through expert management of healthcare software and compliance standards. Skilled in data analysis and process improvement, demonstrated by a significant reduction in coding errors. Exceptional in fostering team accuracy and resolving claims inquiries, showcasing strong problem-solving abilities and attention to detail. Active Clearance for Public Trust

Experience with MHS GENESIS and DEERS Systems

Claims Processing & Reconciliation

ICD-9, CPT/HCPCS Coding

Medical Terminology & Healthcare Coding

HCFA 1500 & UB92 Claims Forms

Healthcare Software (Epic, etc.)

Data Analysis & Quality Assurance

HIPAA Compliance

Process Improvement & Problem-Solving

Irmac Bethesda, MD

Medical Administration Technician

01/2025 - Current

Applied AVAYA ACD system to handle appointment requests for the National Capital Region. Maintained compliance with over 600 clinic SOPs while managing appointment scheduling processes.

Validated patient eligibility using MHS GENESIS Revenue Cycle and DEERS. Coordinated patient outreach to schedule PCM and specialty clinic appointments efficiently.

Conduct referral reviews, and consulting with product line nurses and the healthcare team as needed. Review Specialty Referral Guideline (SRG) compliance for disposition per IRMAC guidelines.

Completes and returns Clear Legible Reports (CLR) to the ordering civilian provider within the required ROFR timelines.

ResultsCX Washington, DC

Help Desk Supervisor

11/2021 - 12/2024

Supervised a team responsible for processing healthcare-related claims inquiries, improving first-call resolution rates by 95% Implemented training on CPT/HCPCS coding and claims processing, resulting in a 15% improvement in team accuracy

Analyzed healthcare claims data to identify trends and recommend process enhancements, reducing errors by 20%

Washington Hospital Washington, DC

Telecommunication Dispatcher

06/2019 - 11/2021

Processed claims data and utilized healthcare software (Epic) to ensure the accurate submission of HCFA 1500 and UB92 forms

Verified ICD-9 and CPT codes for emergency services, reducing coding errors by 25% and improving claim acceptance rates Managed claims and medical records for over 1,200 emergency cases monthly, ensuring HIPAA compliance and regulatory adherence Collaborated with cross-functional teams to enhance claims processing workflows, reducing delays and increasing efficiency

Summary

Skills

Experience

American Public Training Washington,

DC

Data Analyst

04/2016 - 10/2018

Conducted quality control audits on claims data to ensure accuracy and compliance with ICD-9 and HCPCS standards

Used healthcare software to analyze discrepancies in claims data, reducing inconsistencies by 20%

Created performance and compliance reports to identify opportunities for process improvement and claims accuracy

Southern New Hampshire University Hooksett, NH

Associate Degree in Health Administration

Expected in 05/2026

Dynamic Phlebotomy Temple Hills, MD

Certification in Phlebotomy

Expected in 06/2025

Dr. Henry A Wise High School Upper Marlboro, MD

High School Diploma

06/2015

Graduated: June 2015

Certified Health Data Analyst (CHDA)

HIPAA Compliance Training

Education and Training

Certifications

Contact this candidate