Summary
Overview
Work History
Education
Skills
Education and Training
Timeline
BusinessAnalyst
ALICIA GRAHAM

ALICIA GRAHAM

Jacksonville,NC

Summary

Highly skilled administrative and customer service professional with over 25 years in the healthcare industry. Proficient in medical billing and coding, including ICD, HCPCS, and CPT, with a strong focus on HIPAA compliance and EHR management. Known for exceptional critical thinking and a patient-centered approach to service. Aiming to apply extensive experience to drive operational improvements in healthcare settings

Overview

30
30
years of professional experience

Work History

BCBS Healthcare Advisor II - Remote

Concentrix
02.2025 - Current
  • Increased customer satisfaction ratings by effectively answering questions, suggesting effective solutions, and resolving issues quickly by maintaining ACW, AHT and FCR
  • Applied HIPAA privacy and security regulations while handling patient information.
  • Handled high volume of incoming calls, providing exceptional customer service to patients and families.
  • Worked collaboratively with other departments such as billing, coding, clinical documentation improvement specialists and providers when necessary.
  • Processed patient responsibility estimate determined by insurance at pre-registration.
  • Processed insurance verifications and authorizations to ensure coverage of services.
  • Kept records of customer interactions or transactions through programs like Smart Desktop, Facets, Amisys, and Salesforce, thoroughly recording details of inquiries.
  • Processed patient co-pays, deductibles, and other payments, ensuring accurate financial records.
  • Collaborated with insurance companies to resolve billing discrepancies and pre-certification issues.

Healthcare Customer Service Representative - Remot

SupportNinja
12.2024 - 02.2025
  • Processed customer enrollment, benefits, and claims accurately using HealthRules and other key programs.
  • Handle customer inquiries via phone, email, or chat using platforms such as Outlook, Teams, and Skype, providing timely and precise information while maintaining a strong attention to detail.
  • Input and update customer data into systems, ensuring that HealthRules, Miramar, and InComm data are accurately recorded and cross-referenced, following strict data entry protocols and HIPAA guidelines.
  • Resolved customer issues accurately, utilizing data analysis from AVD and Find Care for effective solutions.
  • Ensure data integrity by reviewing and cross-referencing customer information in systems like HealthRules and Medica, identifying discrepancies, and making corrections as necessary.
  • Follow up on pending claims and inquiries, ensuring that all related customer data is accurately recorded, and all issues are fully resolved.
  • Meet or exceed data-related KPIs, such as accuracy rates, entry speed, and customer satisfaction.

Co-Owner/Operations Manager

9-Ten Renovations, LLC
07.2016 - 11.2024
  • Maintained a digital filing system, enhancing document retrieval and accuracy.
  • Reviewed and approved contracts and agreements to protect company interests and ensure compliance with regulations.
  • Managed day-to-day business operations including staffing, inventory management, budgeting, accounting, and payroll processing.
  • Managed budgeting, cost controls, and account reconciliation, enhancing efficiency through meticulous record-keeping and financial data entry.
  • Conducted regular customer follow-ups and addressed inquiries, building long-term client relationships, and increasing repeat business by 30%.
  • Coordinated vendor communications, processed supplier invoices, and tracked expenses to improve budgeting accuracy and cost control.

Store Manager

The Hemp Farmacy
09.2017 - 01.2019
  • Oversaw inventory control, maintaining accuracy in stock levels and data entry for inventory tracking, resulting in a 15% reduction in shrinkage.
  • Trained and supervised employees in POS and customer service, resulting in a 25% improvement in transaction speed and customer satisfaction ratings.
  • Processed end-of-day sales, reconciled cash and card payments, and resolved discrepancies to ensure accurate financial records.
  • Implemented customer loyalty initiatives, gathering and managing customer data to enhance service personalization and retention.

Front Desk Medical Receptionist

Carolina Psychological Health Services
02.2007 - 12.2008
  • Managed front office customer service, appointment management, billing and administration tasks to streamline workflow.
  • Verified patient demographics, entered data into electronic health record system and provided support to physicians.
  • Transmitted, filed, updated, and processed medical records, and other correspondence by mail, e-mail, or fax.
  • Coordinated with healthcare providers to create detailed reports, organize schedules, oversee billing operations, and manage patient admittance.
  • Ensured compliance with HIPAA regulations by maintaining confidentiality of all patient information.
  • Utilized advanced technical skills and expertise to troubleshoot complex problems and implement solutions.
  • Contributed innovative ideas and solutions to enhance team performance and outcomes.

Education

Associate of Science - Medical Billing And Coding

Ultimate Medical Academy
Clearwater, FL
09-2024

Skills

  • Medical Billing & Coding: ICD, HCPCS, and CPT coding proficiency; adept at insurance verification, HIPAA compliance, and medical documentation
  • Data Entry & Management: Fast and accurate data entry with extensive experience in managing electronic health records, databases, and patient documentation
  • Customer Service Excellence: Expert in de-escalation, active listening, and fostering client satisfaction with a patient-centered approach
  • Administrative Proficiency: Skilled in call-center phone systems, insurance verification, patient scheduling, clerical support, and office management
  • Technical Skills: Proficient in Microsoft Office Suite (Word, Excel, PowerPoint), Electronic Medical Records (EMR) out systems, Adobe Connedt, Outlook, Teams, HealthRules, AVD and other POS systems

Education and Training

other

Timeline

BCBS Healthcare Advisor II - Remote

Concentrix
02.2025 - Current

Healthcare Customer Service Representative - Remot

SupportNinja
12.2024 - 02.2025

Store Manager

The Hemp Farmacy
09.2017 - 01.2019

Co-Owner/Operations Manager

9-Ten Renovations, LLC
07.2016 - 11.2024

Front Desk Medical Receptionist

Carolina Psychological Health Services
02.2007 - 12.2008

Associate of Science - Medical Billing And Coding

Ultimate Medical Academy

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