Quality Assurance Medical Records

CAREER OBJECTIVE

Productive and accountable professional with diverse work history, hands-on skill set and highly developed customer-

service skills poised to parlay comprehensive medical education into career-advancement opportunities.

§Skill Highlights: Benefit Verification Specialist, Quality Auditor, Quality Compliance Surveyor, Claims Tracking/Appeals Assistance, Self-awareness, Diverse Billing & Coding, Written and verbal communications (letters, emails, presentations, face-to-face communications), Decision-making skills, Problem solving skills, Critical thinking skills, Quality Assurance, Time management skills, Reimbursement Associate, Healthcare Call-center Manager. Skills in developing and executing marketing strategies.

QUALIFICATIONS

Accounting, Payroll, Banking Systems, Salesforce, and Oracle Fusion Systems Healthcare Law

Basic Coding skills for ICD/CPT Claims Appeal Process CMS1450 UB04 CMS1500

Electronic Medical Records EMR / EHR Practice Management Software Greenway Prime SUITE

Healthcare Computer Information Systems Medical Practice Management Systems

HIPAA Compliance Anatomy & Physiology Basic Pharmacology

Human Resource Management Organizational Improvements

Insurance Billing Procedures Healthcare Claim Cycle Insurance Verification

Interpersonal Professional Communications Business Office Operations Medical Office Procedures

Maintaining Prescription Line Appointment Scheduling Charting Filing Processing Co-Payments

Practice Structure Leadership & Management Medical Terminology

PROFESSIONAL EXPERIENCE

St. Christopher’s Private Homecare Agency LLC – Hybrid/Remote

Healthcare Manager/ Full-time/ Hybrid-Remote 06/2015 – 03/2025

Plan,direct and coordinate all agency direct services

Manage & supervise 30 + healthcare professionals.

Oversee payroll, work schedules, and accounting issues.

Schedule all client assessments, client on-boarding processes.

Oversee employee orientations & safety training.

Developing and managing budgets.

Monitoring and improving financial performance.

Order and receive all agency supplies.

To determine health care needs and how medical decisions affect the procedures and the finances of the agency.

Ensure sensitive medical data is safeguarded from casual and unauthorized access.

Ensure all patient medications, Labs, and medical records are delivered in a timely manner, by our couriers.

Process patient health Insurance Claims.

Verify Patients Healthcare Benefits.

Arise Virtual Solutions Inc.

Cruise Line Customer Support Specialist/ Remote 10/2010 – 02/2025

Royal Caribbean Cruise Line

Duties and Responsibilities

Serve as the first point of contact for customers via phone, email, chat, and social media.

Provide exceptional customer service by addressing inquiries regarding bookings, itineraries, pricing, promotions, and onboard experiences.

Resolve customer concerns, complaints, and disputes in a professional and empathetic manner.

Assist guests with pre- and post-cruise questions related to policies, excursions, travel documentation, and onboard services.

Handle VIP and loyalty guests’ inquiries with specialized attention

Assist customers in booking cruise vacations, stateroom upgrades, and add-on packages (e.g., shore excursions, beverage/dining packages, spa services).

Modify and update reservations, including changes to dates, itineraries, and personal details.

Inform customers of special promotions, discounts, and loyalty rewards programs.

Ensure customers meet all travel requirements, including visa, passport, and COVID-19-related regulations.

Process cancellations, rebookings, and refunds as per company policy

Guide customers through the online booking process and assist with troubleshooting website or mobile app issues.

Provide support for online check-in, digital boarding passes, and reservation modifications.

Help customers set up and manage their cruise account, preferences, and loyalty program details.

Advise on flight arrangements, transfers, and hotel accommodations for cruise guests.

Assist in coordinating special requests such as accessibility needs, dietary restrictions, or medical assistance.

Provide guests with travel insurance options and policy details.

Offer recommendations on ship amenities, activities, entertainment, dining options, and excursions.

Assist with pre-booking dining reservations, spa appointments, and specialty experiences.

Provide information on the Royal Caribbean Crown & Anchor Society (loyalty program) and assist with points redemption.

Handle emergency situations, including lost documents, medical concerns, and itinerary changes due to weather or operational disruptions.

Assist guests impacted by canceled or rescheduled cruises by providing alternative options or refunds.

Work with internal teams (operations, guest services, travel partners) to resolve escalated issues efficiently.

Ensure compliance with company policies, maritime regulations, and international travel laws.

Maintain accurate records of customer interactions, inquiries, and resolutions in the CRM system.

Stay updated on Royal Caribbean products, services, policies, and procedures through ongoing training.

Attend customer service workshops and meetings to improve skills and knowledge.

Contribute to team discussions on improving customer service strategies.

Blessing Keepers Adult Living LLC - Snellville, GA

Regional Director 01/2010 – 07/2015

§Managed all roles & responsibilities of 15 Supervisors / 36 Hourly Employees

§Overseen the New hire employee orientations & Assuring Benefit packages are intact.

§Overseen company quarterly and yearly audits for all 6 Adult Foster Care Homes

§Negotiating all new Federal government contracts, and assuring all new rules & regulations are being carried out throughout the organization.

§Ensuring all CMS Policies & Procedures are being implemented.

§Responsible for processing of the Patient and Clinical Information provided on each patient enrollment referral form.

§Verify insurance benefits, assist with prior authorizations, appeals, and provide claims assistance.

§Main point of contact and liaison for healthcare providers, social workers, caregivers, sales representatives, regional business managers, patients, and other client contacts regarding program needs.

§Worked closely with contracted Specialty Pharmacies providing dispensing authorizations according to FDA regulatory guidelines.

Executive Administrator 02/2008 – 01/2013

§Answered telephones and gave information to callers, took messages, and transferred calls to appropriate individuals.

§Coordinated calendars, prioritized corporate meetings, and made travel arrangements, Domestically & Internationally.

§Created documents, charts, spreadsheets, and presentations and edited documents and prepared them for approval.

§Greeted visitors or callers and handled inquiries or directed them to the appropriate person according to their needs.

§Operated office equipment, such as fax machines, copiers, or phone systems

§Recorded information, updated files, or paperwork, and maintained documents such as correspondence or other material.

§Scheduled and confirmed appointments for clients, customers, and supervisors.

§Set up and manage paper or electronic filing system, using multiple computer screens.

§Used computer for various applications, such as database management or word processing.

§Overseen all new hire employee orientations & payroll.

§Confirming Health Insurance & Benefits are active.

§Processed incoming enrollment forms while scheduling the appropriate follow up to-do for reimbursement support.

General Motors Corporation- Doraville, GA

EDUCATION

Respite Care Certification, CPR Certification, CMS Certification, HIPPA Certification, Coronavirus COVID -19 Certification Training.

Ultimate Medical Academy, Tampa, FL

Associate of Science Degree – Healthcare Management, 01/2015 - 03/2017

Fully accredited, accelerated program providing instruction in healthcare management, leadership skills, business office operations, computer applications, healthcare delivery and accounting systems. Program content includes personnel management, customer service, employee benefits and adherence to healthcare laws, regulations, and ethics. Research, professional writing, critical thinking and communications skills are emphasized throughout the program.

Ultimate Medical Academy, Tampa, FL

Associate of Science Degree – Medical Coding & Billing 02/2019 – 06/2020

Review patient records and assign the right medical codes for treatment, diagnoses, and services. Familiar with healthcare services like surgery, radiology, anesthesia, pathology and more.

Knowledge of medical coding rules, procedures, compliance, and reimbursement.

Managing issues like claims denials, medically necessary procedures, and bundling.

Fully Understand key medical terminology, anatomy, and physiology.

Contact this candidate