Data Entry Quality Assurance
Resume:
AKIRA HILTON
***** ******* ** • Detroit, MI ***** •313-***-**** • ************@*****.*** • https://www.linkedin.com/in/akirahilton
PROFESSIONAL SUMMARY
Administrative professional with over 8 years of experience in a variety of settings including higher education, healthcare, finance and call center. Expertise in providing customer support in high-calls volume environments. Noted attributes:
• Exceptional computer aptitude and telephone etiquette; highly skilled in office administration, data organization, proofreading, and database management.
• Possess IT/Quality Assurance - UST Certification of Achievement PROFESSIONAL SKILLS
Microsoft Office and MS Access Medical Terminology System Network Administration J Unit / Software Testing Oracle JAVA Script
Scratch and Blue J Banner HP App Life Cycle Management Data Entry –15,000 KSPM SAP Training Credit Card Reconciliation Payment Processing EPIC System Referral Request/Health Services Mainframe Idoc Passport Insurance Verification
Tele tracking FirstNet Wayne Buy
Care Advance Content Manager Medical Care Management System NASCO WebDenis
EDUCATION
American InterContinental University Schaumburg, IL Bachelor of Business Administration Completed10/23/18 PROFESSIONAL EXPERIENCE
Fresenius Kidney Care Secretary Receptionist 10/2024 to current
• Under direct/close supervision, performs a variety of basic and routine clerical and secretarial duties. These may include but are not limited to: Preparing and typing routine correspondence, form letters and reports
• Answering telephone & routing calls to the appropriate person,
• Greeting visitors and patients as applicable and conducting them to the appropriate location or person as needed.
• Setting up and maintaining filing systems and basic databases as applicable.
• Completing forms and reports as required by the various company offices and outside vendors and agencies.
• Recording the minutes of meetings and providing the resulting documents as necessary.
• Making copies of correspondence and other printed matter as required by manager.
• Preparing purchase orders using the appropriate software application.
• Assisting with department/facility accounts receivable and accounts payable functions and responsibilities as needed.
• Distributing incoming mail. Maintaining calendar and daily schedules.
• Scheduling appointments & arranging meetings. Maintaining inventory of the necessary office forms and supplies.
• Assisting with various basic personnel administrative functions as needed. Acting as backup to other clerical personnel in office as needed.
• Assists in the collection of Patient Statistical Profile and Continuous Quality Improvement Data.
• Assists with month-end reporting requirements
• Assists in auditing records for ongoing compliance with medical records standards.
• Maintains accurate records of hospitalization, patient travel, etc. to facilitate coordination of patient scheduling, ancillary testing, etc.
• Prepares medical records for facsimile or mail related to travel, transplant, disability and others.
• Organizes travel for patients by contacting and providing requested medical records.
• Coordinates with transient patient paperwork.
• Coordinates transfer placements and confirmations along with Clinical Manager.
• Confirms admissions paperwork is completed and sent to designated department(s), such as billing, by collecting, faxing and scanning. Assist with medical appointment referrals and scheduling.
• Assist with transportation coordination and referrals.
• Ensures data entry has been completed for Crown Web. Related to ESRD 2728. ESRD 2746 and PART.
• Other duties as assigned.
Henry Ford Health Patient Registration Clerk 10/2023 to 3/2024
• Face-to-face check in preregistration, confirmation of insurance eligibility and cash collections.
• Performs new patient registration; updates registration and insurance information; responds to inquiries from all callers/customers.
• Advocates on the caller/customer behalf to ensure their needs are met.
• Acts as a welcoming front door for all callers/customers, instilling loyalty and anticipating needs, while providing efficient, effective customer relationship management.
Harmony Center for ENT Administrative Assistant 08/2023 to 9/2023
• Interviews patients and gathers information to assure accurate and timely claims submission.
• Interprets information collected to determine and create comprehensive visit-specific billing records.
• Determines need for and obtains authorization for treatment/procedures and assignment of benefits as required. Maintains competency by participating in on site and external training opportunities.
• Utilize skills gained from training sessions to improve and enhance their work processes and customer interactions. Provides information to patients concerning hospital policies and regulatory requirements utilizing effective interpersonal and guest-relations skills. Answer multi phone line direct to the appropriate department
• Provides assistance to other Health System or physician offices staff regarding registration, insurance verification and authorization requirements and processes.
• Determines appropriate payment required at point of registration (deposits, co-pays, minimum charges and non-covered services.) Collects payment at time of registration or check-out.
• Based on planned services provides estimated costs and patient responsibility for both procedural and complex services.
• Documents communication with patients related to estimates within the patient accounting record.
• Verifies procedural and diagnosis codes submitted by service departments and physicians to assure accuracy for claims submission and adjudication of reimbursement.
• Verifies insurance eligibility. Determines benefits and ensures authorization requirement are met.
• Interacts with ordering practitioner and patient to coordinate service and insurance requirements.
• Contacts patients to discuss eligibility and benefits and requirements specific to clinical services.
• Creates appropriate registration record. Communicates with patients their financial responsibility, benefit and authorization status prior to clinical services.
• Facilitate cash collection as appropriate prior to and at the time of service, including copays, deductibles.
• Obtains insurance authorization, patient liability acknowledgement, acknowledgement of non-covered services and advance beneficiary notices and consent forms. Explains the purpose of these forms to patients and responds to question elated to their intent. Completes as required; obtains signatures and approvals; verifies that information is complete and Blue Cross Blue Shield of Michigan Precertification Specialist 9/2018 to 6/2023
• Authorize and/or Approve MAPPO (Medicare Advantage), URMBT (UAW Retired Medical Benefits Trust) and Commercial Acute Members Inpatient Hospital Admissions
• Provide Authorization Number
• Verify Authorization Number Given to Hospital / Facility
• Documentation (Care Advance and Content Manager)
• Assist in Follow-Ups / Problem Solving / Proactive Solutions
• Precertification Inquiries pertaining to Authorizations Status
• Assist / Answer questions from Provider Inquiry CSR Level 3 pertaining to Precertification
• Verify ICD 10 codes for authorization
• Answer Precertification Calls for MAPPO and Commercial (Acute) Members, but ONLY from Providers
• Process Appeal Request for nonpayment of services
• Process Request for referral of preauthorization for services and supplies
• Process and respond to UM Communications for both internal and external servicing requests via email, fax and phone.
• Manage and assign work assignments to specialist for daily processing.
• Precept and provide on the job training for new specialist Arrow Strategies (BCBSM) Precertification Specialist 1/2017 to 9/2018
• Authorize and/or Approve MAPPO (Medicare Advantage), URMBT (UAW Retired Medical Benefits Trust) and Commercial Acute Members Inpatient Hospital Admissions
• Provide Authorization Number
• Verify Authorization Number Given to Hospital / Facility
• Documentation (Care Advance and Content Manager)
• Assist in Follow-Ups / Problem Solving / Proactive Solutions
• Precertification Inquiries pertaining to Authorizations Status
• Assist / Answer questions from Provider Inquiry CSR Level 3 pertaining to Precertification
• Verify ICD 10 codes for authorization
• Answer Precertification Calls for MAPPO and Commercial (Acute) Members, but ONLY from Providers
• Process Appeal Request for nonpayment of services
• Process Request for referral of preauthorization for services and supplies
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