Customer Service Criminal Justice

Bridgette Gail Vaults

Cell 619-***-****

Home 619-***-****

Education: University of Phoenix 3/2007

Bachelor of Science in Criminal Justice Administration

Work History:

Johnson Maintenence

Administrative/Estimator

11/2023 - Present

Answering and directing phone calls. Organizing meetings and appointments.

Maintaining office supplies. Submit invoices. Scheduling appointments. Coordinating meetings. Handling email correspondence and drafting documents. Maintaining filing systems and records. Producing and distributing correspondence. Preparing reports. Processing expense reports and invoices. Providing reception coverage. Assist with estimating, and other duties assigned by supervisor.

Aya Healthcare, San Diego, CA 09/2021- 08/2023

Credentialing Coordinator

•Research, analyze, and evaluate credentialing documents, ensuring all relevant information has been submitted and received by deadline. Scanning documents, uploading & electronic faxing.

•Ensure credentialing documents are tracked and monitored for adherence to timelines with all assigned paired facilities.

• Set up labs for vaccinations, provide information for upcoming expiring certifications and expiring fingerprints.

•Assists Claims Auditor with tracing sources of inaccuracies; reports and proposes remedial action to appropriate manager able to communicate effectively both orally and in writing.

•Customer service skills, research skills and skilled working from spreadsheet databases. Ability to Ability respond to emails timely and effectively. Adhere to HIPPA /PHI information.

•Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.

•Comprehend research and resolution of the appeals, dispute, grievances, and/or complaints from company members, providers and related outside agencies to ensure that internal and/or regulatory timelines are met.

County of San Diego, CA 04/2021- 06/2021

Ancillary (Administrative)

•Ensure all forms and materials (immunization cards) are completed. Determine if clients have an appointment and are in the appropriate Tier to receive vaccines for that day. Verifying documentation in the computer system is accurate, complete, and legible.

•Review updated CDC, FDA, State or Local guidelines for COVID-19 vaccine related topics.

•Ensure adequate supply of all forms, office supplies, and site-specific equipment.

•Check in guests with appointments. Non appointment guests dropped into the appointment system.

•Ensure clients are receiving appropriate temperature screening. Troubleshoot or elevate IT issues to Lead Ancillary. Clean disinfect workstations and equipment between guests.

•Provide guests with Facts Sheet (Observation Area) in the appropriate language available or direct clients to use Fact Sheet or QR Code.

Dexcom (Contract), San Diego, CA 10/2018 - 8/2019

Patient Billing Analyst

•Review insurance and cash orders for accuracy, completeness, and compliance with payor medical policy requirements.

•Review patient medical documentation to ensure medical necessity according to payor guidelines. Strong communication skills & organization.

•Responsible for calculating patient deductibles, co-pay, and co-insurances.

•Review patient orders. Write and submit complaint investigation reports into the data system.

•Understanding and interpreting payor medical policies.

•Review customer accounts through the process of quality control to identify delinquent accounts and placement of subsequent AR hold as necessary.

•Process claims worked from Excel spreadsheet.

•Create follow-up requests via Outlook for additional account research.

•Maintain a high level of integrity and confidentiality / patient privacy (HIPAA).

•Support Reimbursement Team with payor and customer related questions and issues. Work closely with Finance/Accounts Receivables and remain current on third party coverage, reimbursement information IC9, ICD-10D9 and HCPCS.

•Maintain complaints through a tracking system in accordance with regulations.

Solara Medical Supplies, Chula Vista, CA 3/2017 - 9/2018

Account Document Management

•Ensures all medical documents, patient accounts and files are updated, consistent and complete in the Brightree & Conduit system.

•Validates all orders including quantity, products, items, insurance, and physician information Auditing internal paperwork for accuracy. Faxing, documents electronically & scanning.

•Logs orders into the billing system in a timely manner to allow for order shipment and reimbursement. Research and prepare correspondences as needed.

•Verifies that appropriate supporting documentation has been obtained prior to shipment.

•Obtains, reviews and maintains documents for new and existing patients.

•Collects documents to hold accounts to allow shipment of future orders.

•Reviews accounts and contacts referrals sources and sales team for accurate documentation.

•Reviews insurance records for accuracy and completeness.

•Escalates recurring problem accounts or physician groups or other trends to the management and in a timely manner to reduce reimbursement issues.

•Maintains a high degree of confidentiality at all times due to access to sensitive information.

•Follows all Medicare, Medicaid, HIPPA, PHI, and Private Insurance regulations and requirements.

•Abides by all regulations, policies, procedures and standards.

•Monitor and track patient authorizations, informing supervisors of any expired dates. Work appeals

•Ensure payment for services by verifying benefits with the insurance provider.

•Obtain, review and input insurance authorization and referrals prior to patient services.

•Make outbound calls to numerous insurance companies regarding denials.

Covance (Contract), San Diego, CA

10/2015 – 6/2016

Program Specialist Appeals Authorizations

•Conduct insurance verification, facilitate the prior authorization process on behalf of patients, and perform reimbursement case management to identify insurance and alternative funding sources.

•Prepared all cases in accordance to regulations, compliance standards, policies and procedures.

•Provide case management including coordination, authorization, and tracking of patient care via the plan of care.

•Assist with appeal support after insurance denials. Explain appeal process to patients.

•Input accurate data entry of appeal and grievance request to the Appeals and Grievances Department.

•Register patients for co-pay coupons for a discount on their medication.

•Knowledge of Medicare and Medi-Cal benefits coverage.

•Knowledge of the Affordable Care Act Program.

•Help patients apply for the Support Path free medication program.

•Identified opportunities for business process improvement through various meetings with business users and developers.

•Assigned to investigate, document, and analyze client requirements in areas of new/existing business operating models.

•Utilized project planning tools by coordinating with cross-functional teams for quality data and analysis.

•Relay results to doctor and patients regarding insurance benefits and pharmacy coverage.

•Countless of outbound and inbound calls to insurance companies and patients.

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