Dynamic Account Management Specialist with Compliance Expertise
Resume:
Medical Assistant:
Health Care Management
*****************@*****.***
Rowlett, TX 75088
Skills
• HIPAA compliance
• Problem solving
• Relationship building
• Networking
• Team leadership
• Analytical thinking
• Organization skills
• Staff training and motivation
• Customer satisfaction
• CRM software proficiency
• Client onboarding
Verbal and written
communication
•
• Check-in coordination
• Electronic health records
• Flexible schedule
• Phone and email etiquette
• Medical insurance
• Clinical data entry
• Deductible & co-pay calculation
• Data security and confidentiality
• Collaborative relationships
• Coverage and authorizations
• Private insurance
• Eligibility determination
• Electronic medical records (EMR)
• Prior authorization processing
• Medicaid and Medicare
• Account maintenance
• Fraud prevention
• Appointment scheduling
• Regulatory compliance
• Payment processing
• Registration management
• Complaint processing
• Conflict resolution
• Admitting coordination
• Patient check-in
Education And Training
Dynamic Account Management Research Specialist with extensive experience at Prime Therapeutics LLC, excelling in HIPAA compliance, and relationship building. Proven track record in enhancing client satisfaction and retention through effective written and verbal communication, and problem-solving. Skilled in managing multiple accounts and training staff, ensuring seamless operations and compliance in fast-paced environments.
Prime Therapeutics LLC - Research Specialist
Minneapolis, Minnesota
12/2014 - Current
SHAKOA DAVIS
Summary
Experience
• Proactively communicate with clients to address needs, and align objectives. Ensure compliance with HIPAA regulations regarding Protected Health Information.
•
• Manage client accounts to ensure satisfaction and retention.
• Coordinate communication between clients and internal teams.
• Facilitate training sessions for new Account Management staff. Manage multiple accounts simultaneously, ensuring all deadlines and turnaround times are met.
•
Research and analyze facts to determine the root cause of customer complaints and concerns, providing effective written and verbal resolutions.
•
Serve as an expert on prescription insurance benefits, medication prior authorization processes, and denial resolutions, advising members and internal teams.
•
Collaborate with internal and legal teams to develop initiatives that enhance member experience and satisfaction.
•
Facilitate training sessions for new agents across internal departments for advancement in the Account Management and Member Satisfaction teams, fostering professional growth and team cohesion.
•
Streamline Member Satisfaction standard operating processes (SOP), improving efficiency and accuracy in account handling, and maintaining high member retention through strong relationship building.
•
Manage outreach to healthcare providers for critical information and ensure compliance with HIPAA standards.
•
Prepare comprehensive account management documentation, including member files, and meeting reports.
•
Document discussions during client meetings and conference calls to ensure accurate records.
•
Organize member documents, reports, and correspondence for efficient access and retrieval.
•
• Provide feedback on project estimates and timelines to enhance overall accuracy.
• Process internal and external information requests promptly to support PCI Health Training
Dallas, TX
05/2002
High School Diploma:
Skyline Magnet High School
Dallas, TX
Certifications
• CMA
• PBT
Prime Therapeutics LLC - Quality Assurance Specialist Minneapolis, Minnesota
07/2014 - 12/2014
Prime Therapeutics LLC - Member Service Specialist Minneapolis, Minnesota
03/2012 - 06/2014
United Healthcare - Insurance Verification Supervisor Dallas, Texas
11/2008 - 03/2012
stakeholders.
• Maintain accurate records of ongoing projects and archive past documentation. Conducted detailed quality assurance reviews, ensuring team accuracy, and delivering constructive feedback to enhance performance and identify trends for continuous improvement.
•
Facilitated the onboarding and professional development of new hires through targeted side-by-side training, and weekly performance evaluations to bolster agent success and adherence to quality standards.
•
Conducted quality reviews on contact center agents to ensure compliance with client and company standards.
•
• Collaborated with cross-functional teams to identify and resolve quality issues. Developed and updated quality assurance documentation for operational procedures.
•
Implemented corrective action plans to address non-conformance findings effectively.
•
• Trained agents on call control and other best practices after evaluation.
• Utilized data analysis tools to track quality metrics and trends over time. Coordinated activities with other departments related to new process release decisions.
•
Monitored QA procedures for adherence by employees, notifying personnel of non-compliance issues.
•
Verified insurance coverage for upcoming patient appointments to ensure eligibility.
•
• Provided price quotes for medications.
Determined patient financial responsibility, utilizing electronic methods, and phone communication.
•
Entered insurance details accurately into the billing system for efficient processing.
•
• Processed prescription refill requests.
• Assisted new patients with enrollment in the mail-order pharmacy. Communicated updates regarding insurance status effectively with patients and internal departments.
•
• Conducted thorough reviews of insurance claims for accuracy and completeness. Documented all interactions and updates in the patient management system accurately.
•
Provided customer service support to answer inquiries from health care providers, pharmacies and third parties regarding pharmacy benefit insurance verification issues.
•
Medical Edge Healthcare Group - Medical Claims Billing Specialist Dallas, Texas
08/2004 - 04/2008
• Supervised daily operations to ensure efficient workflow and productivity. Coordinated team logistics, including assignment allocation and resource provisioning, ensuring efficient onboarding and operational readiness for new hires.
•
Provided on-floor leadership in the absence of senior management, managed escalated calls, and upheld compliance with HIPAA and Medicare regulations while maintaining effective communication with payers and healthcare providers.
•
• Coordinated schedules and tasks to optimize resource allocation across the team.
• Resolved conflicts among staff to promote a positive work environment.
• Collaborated with management on strategic initiatives for operational efficiency. Provided guidance and direction to subordinates regarding job duties and responsibilities.
•
• Directed and supervised team of 19 employees in daily operations. Maintained accurate records of employee performance, attendance, leave requests, and disciplinary actions.
•
Recruited, hired, trained, mentored, coached, evaluated, and terminated staff as necessary.
•
Collaborated with other departments to coordinate workflow processes between teams.
•
Ensured compliance with workplace safety regulations by providing training sessions for all staff members.
•
Conducted weekly meetings with team members to discuss upcoming tasks and project deadlines.
•
• Tracked progress on projects and provided timely feedback to staff members.
• Trained new employees on company policies and procedures. Fostered a positive and motivating work environment, leading to an increase in team morale.
•
Reviewed and submitted accurate insurance claims for clinic and hospital services, including office visits and immunizations.
•
Ensured compliance with ICD-10, CPT, and HCPCS coding standards specific to pediatric care.
•
Followed up on unpaid claims, resolved billing discrepancies, and resubmitted as necessary.
•
• Verified patient insurance eligibility and benefits prior to services rendered. Posted payments and reconciled Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs).
•
• Maintained precise billing records and updated patient account information. Responded to patient inquiries regarding billing and insurance coverage with clarity.
•
• Collaborated with clinical and administrative staff to ensure billing accuracy. Coordinated resolution of billing inquiries with healthcare providers to enhance efficiency.
•
• Maintained thorough documentation of billing transactions and patient accounts.
• Utilized billing software for accurate data entry and claim status tracking. Analyzed payment trends to identify discrepancies and recommend corrective actions.
•
Collaborated with team members to optimize billing processes and improve overall efficiency.
•
Educated patients on billing procedures and available insurance coverage options.
•
Monitored accounts receivable to ensure timely payments from clients and insurers.
•
Processed credit card transactions through Point-of-Sale systems and online platforms.
•
Contact this candidate