Customer Service Quality Control

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HOME 910-***-**** • E-MAIL ***********@*****.***

REGINA B. GLOVER

EMPLOYMENT HISTORY

*/****-**/**** ****** Institute Clarksville, TN

Adjunct Instructor – Medical Billing and Coding Program

Creates a classroom environment that is conducive to student learning

Uses adult learning and latest instructional methods

Develops and/or updates course syllabi

Recommends teaching materials, including textbooks, training aids, etc.

Recognizes and responds effectively to different learning abilities of individual students

Develops and administers classroom assignments that are relevant, fair and professional

Develops and administers tests that are relevant, fair and professional

Records and reports student grades to the Registrar within 24 hours of completion

6/2008-9/2010 MedAssurant Bowie, MD

Remote Coding Review Consultant (RCRC)

Conduct chart reviews for purposes of identifying, confirming, and/or documenting appropriate medical coding

Perform quality control over-read reviews of previously completed record reviews to ensure accuracy, completeness, and overall high quality of MedAssurant’s record review processes, including

Electronically downloading completed, pre-filled record reviews to assigned computer system and Data Collection Tool (DCT)

Comparing pre-filled record review results contained in DCT application to the scanned support documentation resident within MedAssurant’s Site Review Support Application (SRSA)

Uploading completed quality control over-read reviews to centralized server system via the Internet, intranet, and associated web portal

Maintain ongoing communication (verbal, e-mail, updates and Stats) with supervising coordinator regarding issues/nuances that arise during review processes

Record all time worked performing record reviews and over-read reviews

Maintain compliance with policies, procedures and mission statement

Adhere to all confidentiality and HIPAA requirements as outlined within Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position

4/2006-5/2008 Health Net Federal Services- TRICARE Ft. Campbell, KY

TRICARE Service Advocate- security clearance obtained

Primary face-to-face point of contact for TRICARE beneficiaries in the field

Provides general program information, on-site benefit counseling, referral for care support, Clearly Legible Report (CLR) program support, and claims and enrollment support services to walk-in customers in the TRICARE Service Center (TSC)

Provides appropriate program education as part of each beneficiary interaction

Offers on-site assistance and support services to TSC walk-in customers providing beneficiaries and Military Treatment Facility (MTF) employees with general program information on the TRICARE program and tailors benefit counseling to individual beneficiary concerns or situations

Assists with the referral and authorization for care process, clearly legible report (CLR) process support, claims issues and the TRICARE enrollment process

Advises beneficiaries of primary care manager choices and enforces MTF, Regional Director and program enrollment guidelines MTF Commander Customer Service Support Requirements and Beneficiary Education

Maintains schedules, completes workload reports, attends meetings, orders supplies and marketing materials, and performs general administrative functions to keep TSC fully operational

Displays thorough understanding of the TRICARE Program and benefit structure, understanding of TRICARE enrollment, DEERS and claims processing requirements and procedures

1/2001-10/2005 Jennie Stuart Medical Center Hopkinsville, KY

Precertification/scheduling coordinator department of radiology

Determine when additional information is needed from physicians

Responsible for answering multiple phone lines and redirecting calls

Cancel/reschedule appointments as needed

Notify appropriate clinic personnel of emergency add-on procedures scheduled

Obtain and enter all authorization and correspondence relating to referrals in patients charts and computer

Obtain necessary pre-certification as required

Arranges for patients to have financial counseling as needed

Demonstrates an understanding of patient confidentiality to protect the patient and clinic/corporation- HIPPA compliant

Cover other front office functions as requested

Schedule and obtain authorization for outpatient diagnostic exams; by working closely with doctors’ offices and insurance companies daily

Maintain all physician orders received through the radiology department

Order departmental supplies

Make staff schedule in the absence of immediate supervisor

Ensure exams for patients with Medicare meet LMRP guidelines, and diagnostic images have accurate ICD-9 codes on physician orders

Receive weekly diagnostic denial report and phone providers for updated information as appropriate

Issue staffing schedule; cover for training, vacations, sickness, etc.

Decreased radiology denials by 10% by reviewing orders prior to patient appointments

File diagnostic reports in radiology file room and forward to ordering providers

Apply appropriate ICD-9 and CPT code to diagnostic procedures performed

Register patients for exams as needed

EDUCATION

2010- 2011 Murray State University Murray, KY

Master of Science Human Development and Leadership

2004-2005 Trevecca Nazarene University Nashville, TN

Bachelor of Arts in Management and Human Relations

MEMBERSHIPS/ CERTIFICATIONS

American Academy of Professional Coders (AAPC) 2004-present Certified Professional Coder (CPC)

Girl Scouts of America- 2008-2011 Leader for middle school and co-leader for 4th grade

Breckenridge Type Indicator (BTI) Certified 2011

Non-profit Leadership Alliance National Certification (NLA) Student member since 2010

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