Office & Clerical Operations Specialist

CONNIE REDMOND *** Brook Valley Drive, LaVergne, TN 37086 (C) 615-***-**** ******.**********@*****.***

Professional Summary

I hold a bachelor’s degree and have extensive experience performing general office duties, including filing records, preparing correspondence and reports, and scheduling appointments in Microsoft Outlook. Experience in producing monthly reports using Excel spreadsheet functions and PowerPoint, assisting in preparing outstanding accounts reports, gathering credit, and performing outstanding collection and purchasing orders, from vendor to vendor. Expertise in reviewing and updating correspondence files, scheduling databases, and preparing monthly reports. Experience in notifying merchandisers of shortages and overages of payment invoices. Completed DSM Deals and Purchasing Orders daily, using a script that utilizes AS400 and SAP software. Excellent experience with tools such as Word, Excel, PowerPoint, Outlook, OneNote, SAP, AS400 Core, JPMorgan, CRM, JD Edwards’ Web-based applications, Epic, and Health Source.

I possess excellent interpersonal communication skills, which enable me to quickly establish a rapport with clients and maintain strong relationships with colleagues and clients. I am accustomed to working in a high-paced environment where deadlines are a priority. I am a detail-oriented self-starter capable of handling multiple projects simultaneously, resourceful and focused on delivering results from start to finish. I am also a quick learner, quickly grasping new ideas, concepts, methods, and technologies.

Skills__

•Excellent verbal and written communication skills

•Experienced with SAP, AS400, CORE, CRM, and JD Edwards’ Web-based applications, Epic, and OnBase

•Experienced with the following: Word, Excel, PowerPoint, and Outlook

•Ability to access and retrieve information using a PC and a basic understanding of Microsoft Office products.

•Prior office or clerical experience and Data Entry experience

•Self-motivated, independent worker with strong time management skills.

•Collections/Payment Processing and Accounts Receivable experience

•Experience in Healthcare Reimbursement

•Knowledge of UB04 Claim forms and HCFA 1500s.

•Knowledge of the Claims Life Cycle

•Insurance verification (Medicare/Medicaid)

•Strong Customer Service skills

•Experienced in validating insurance patient coverage and communicating any issues with benefits or coverage

• Basic ICD9/ten and CPT code familiarity

•Basic knowledge of the payer payment process with a detailed understanding of the payer's prior authorization processes

•Utilizes systems such as Epic, Facets, Care Communication Management Systems (CCMS), and Care Advance (CA)

Work History

Accounts Receivable Specialist II/Customer Service

Community Health System

03/29/2023 to 7/8/2026

•Responsible for credit balances, undistributed payments, and requests for refunds

•Conducts timely and accurate review of undistributed payments, overpayments, credits, and requests for refunds in the patient accounting system

•Responsible for taking all steps necessary to facilitate prompt and accurate resolution of payments, including follow-up with third-party payers to determine coordination of benefits, insurance primacy rules, and filing orders.

•Effectively communicate insurance billing and follow-up process information to patients and internal customers.

•Initiate refunds to patients/guarantors, insurance companies, and other third parties by following established refund procedures, contractual obligations, and payer and regulatory requirements.

•Conduct a timely and accurate review of refund requests for payers with contracted recoupment language to reduce future recoupment reconciliations.

•Analyze data, identify issues, reach conclusions, and propose strategies for resolving complex reimbursement issues.

•Determine the most effective repayment method based on payor processes, e.g., Manual Refund via Check, Resubmission of corrected claim, or Payor Offset.

•Responsible for reviewing, validating, and correcting account adjustments based on insurance reimbursement, coverage, contracted payers, and services provided.

•Redistribute or transfer payments between multiple accounts of the same patient within the patient accounting system.

•Validate and update patient demographic and insurance information to ensure the accuracy of future claims.

Healthcare Self-Pay Receivable Specialist I A/R

Navient Xtend Healthcare (Contract through Rem X)

10/17/2022- 01/2023

Used Salesforce and SAP

•Prepared and sent invoices

•Contacting clients for payment resolution

•Negotiating payment arrangements

•Recording and reconciling payments

•Resolving payment discrepancies

•Maintaining billing accounts and records

•Producing reports as required by management

•Performing duties for the revenue cycle department related to medical insurance collections, credits, or setting patient insurance coverage.

•Extending credit to clients

•Reviewing and updating the current credit policy

•Ensuring complete review of claims and forwarding them to the correct insurance companies.

•Contacting insurance carriers or other responsible parties to confirm payment dates and details.

•Manage all claims related to denials, rejections, and no-response work queues, following up, reviewing, and documenting accordingly.

•Contact patients to obtain updated insurance information as needed.

•Planned, coordinated, and reported on health promotion and wellness education outreach activities for the health plan

•Worked with the health plan, population health, and LTSS teams to meet goals and solve problems related to social needs and health equity

•Ensured timely and accurate reporting to TennCare

•Prioritized and organized own work to meet deadlines

•Supported reporting, auditing, and process performance validation activities

•Developed relationships with community organizations and providers to close gaps and allow for warm handoffs of members requiring community resources

•Monitored social determinants of health and strategically planned how to remove barriers (food insecurity, housing insecurity, etc.) with community partners and providers.

•Cross-trained in other positions

Health Specialist Representative, Senior Level

Ciox Health Services

11/29/2019 to 9/21/2022

•Perform duties for the revenue cycle department related to medical insurance collections, credits, or setting patient insurance coverage.

•Create and maintain medical records, general files, logs, and other related records and documents, organized, including sorting, labeling, filing, and retrieving, by corporate and facility file retention and storage procedures; and maintain confidentiality and security of records.

•Read and comprehend medical instructions and procedures, correspondence, policies, regulations, reports, directions for form completion, and other simple or moderately complex documents.

•Knowledgeable in HEDIS measures, claims billing guidelines, and health plan standards

•Insurance verification (Medicare/Medicaid.

•Perform various medical records administration tasks to resolve problems, questions, or situations.

AR Collection Billing Specialist

03/2016 to 10/2019

Florida Orthopedic Institute – Tampa, FL

• I performed General office clerical and administrative duties.

•Analyzed and verified insurance benefits for patients receiving treatment at the clinic.

•I utilized multiple sources to verify patient demographics for accurate billing.

•Maintained electronic and manual data entry billing systems.

•Customer Service and phone skills. I effectively addressed patient complaints and concerns.

Rebate Clerk – Administrative Assistant/Finance Department

01/2010 to 11/2015

Sysco Foods – Nashville, TN

•Interpreted and coded all earned income & purchase agreements for the AR Department

•Administered all aspects of setting up earned agreements for local corporate vendors.

•Analyzed and researched corporate earnings reports (SMR050) and critical adjustments.

•Notified merchandisers of shortages or overages when paying invoices.

•Completed DSM Deals and Purchasing Orders daily using a script that utilizes AS400 and SAP software

Patient Representative/Data Entry Clerk

06/1998 to 01/2010

Vanderbilt Medical Center – Nashville, TN

•We utilized multiple sources to verify patient demographic data for accurate billing.

•Served as a point of contact for clinics to coordinate treatment authorizations, ensuring patients receive treatment promptly.

•I led an in-service training program regarding a new insurance verification program.

•I posted and tracked suspense accounts to identify the beginning and end of forwarding balances.

Education: Bachelor of Science - Brescia University–Owensboro, KY -Graduated May 8, 1977

References: Available upon request. Certificates: HIPAA Compliance and Code of Business and Ethics

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