ANDREA JAMES
Fort Mill,SC
Summary
Pragmatic Insurance Verification Specialist touting five years of expertise in benefits explanation and coverage tracking. A team player with a vast knowledge of medical terms and working with all types of personalities effectively. Offering dynamic organizational skills and attention to detail. Responsible, punctual and productive professional when working with little to no supervision.
Overview
15
15
years of professional experience
Work History
Insurance Verification Specialist
SCA Charlotte Surgery Center
10.2022 - Current
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Posted payments to accounts and maintained records.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Communicated verification and authorization status updates with the business department to facilitate decision-making for patient admissions and insurance coverage.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Reduced errors in billing by accurately maintaining patient records with updated insurance information.
- Collaborated with team members to resolve discrepancies in insurance verification, ensuring proper billing practices.
- Increased patient satisfaction by promptly addressing concerns regarding insurance coverage or billing issues.
- Negotiated payment plans on behalf of clients facing financial hardship, helping them access necessary healthcare services without undue burden.
- Assisted patients with understanding personalized insurance coverage and benefits.
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Obtained payments from patients and scanned identification and insurance cards.
- Performed various administrative tasks by filing, copying and faxing documents.
- Demonstrated a high level of professionalism and attention to detail in all aspects of insurance verification specialist role, consistently exceeding performance expectations.
- Developed strong relationships with insurance representatives, facilitating smooth communication channels for resolving inquiries or disputes.
Insurance Verification Specialist
Amerisourcebergen
11.2021 - 10.2022
- Verified Lupus patients insurance benefits and eligibility for the medication Benlysta.
- Carefully obtained information from insurance companies on behalf of the Physicians.
- On a daily basis, worked with ICD-10 codes, diagnosis codes, and prepared benefit letters to be faxed over to the Physicians.
- Accurately obtained and logged all information into the program Fusion.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Posted payments to accounts and maintained records.
- Optimized productivity within the department by prioritizing tasks according to urgency and importance levels.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Contributed to company''s bottom line by reducing write-offs due to incorrect or outdated insurance information through diligent verification efforts.
- Developed strong relationships with insurance representatives, facilitating smooth communication channels for resolving inquiries or disputes.
- Streamlined workflow for medical providers by obtaining necessary referrals and authorizations for services.
- Minimized delays in treatment scheduling by promptly identifying potential coverage issues and working proactively towards their resolution.
- Collaborated with team members to resolve discrepancies in insurance verification, ensuring proper billing practices.
- Implemented improvements to existing verification processes, increasing accuracy rates while reducing time spent on manual tasks.
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Demonstrated a high level of professionalism and attention to detail in all aspects of insurance verification specialist role, consistently exceeding performance expectations.
Associate Representative
Prism Medical Products LLC.
12.2019 - 04.2021
- Provided the highest level of client care to the patients while accurately and efficiently processing patient orders and navigating insurance policies
- Increased customer loyalty by offering personalized support throughout the entire sales process.
- Implemented effective time-management techniques for prioritizing tasks and meeting deadlines consistently.
- Maintained detailed records of all client interactions, facilitating accurate reporting and informed decision making.
- Contributed valuable insights during strategy meetings, helping shape company initiatives based on current market conditions.
- Cultivated a positive work environment through open communication channels among team members.
- Demonstrated exceptional problem-solving skills when addressing complex client concerns or issues.
- Managed multiple accounts simultaneously while maintaining exceptional organization and attention to detail.
- Developed customized solutions that addressed unique challenges faced by each client, resulting in high client retention rates.
- Engaged with customers to effectively build rapport and lasting relationships.
- Helped customers locate products and checked store system for merchandise at other sites.
- Maintained calm demeanor and professionally managed issues in busy, high-stress situations.
- Managed conflict resolution with dissatisfied customers professionally, resulting in improved customer retention rates.
Certified Nurse Assistant
CareOne Team
06.2019 - 12.2019
- Interviewed the patient based off of nurse notes then escalated over to the patients primary care physician according to urgency.
- Collaborated with interdisciplinary team members to develop personalized care plans tailored to individual patient needs.
- Performed accurate documentation of patient information according to established protocols for record-keeping purposes.
- Boosted overall patient satisfaction through genuine empathy, active listening skills, and consistent professionalism in all interactions.
- Supported patients'' emotional well-being by actively listening to their concerns and offering compassionate companionship.
- Streamlined communication between patients and healthcare providers by serving as an attentive liaison during shift handovers and interdisciplinary meetings.
- Maintained accurate records of vital signs, fluid intake, and output for effective patient monitoring.
- Strengthened continuity of care by meticulously updating electronic health records in accordance with HIPAA regulations.
Certified Nurse Assistant
Bayada Home Health Care
11.2015 - 05.2019
- Provided skilled post-operative care to patients, closely monitoring their recovery progress and reporting any changes to nursing staff promptly.
- Improved patient comfort by repositioning and transferring them on a regular basis.
- Promoted physical therapy goals through guided exercise routines with patients experiencing mobility challenges or recovering from surgery.
- Collaborated with interdisciplinary team members to develop personalized care plans tailored to individual patient needs.
- Boosted overall patient satisfaction through genuine empathy, active listening skills, and consistent professionalism in all interactions.
- Supported patients'' emotional well-being by actively listening to their concerns and offering compassionate companionship.
- Facilitated safe transportation within the facility using wheelchairs or gurneys when necessary for appointments or treatments.
- Ensured timely medication administration by accurately recording dosage and time in medical charts.
- Maintained accurate records of vital signs, fluid intake, and output for effective patient monitoring.
- Contributed to a sanitary environment by adhering to strict infection control protocols when cleaning rooms and equipment.
- Strengthened continuity of care by meticulously updating electronic health records in accordance with HIPAA regulations.
- Demonstrated proficient use of medical equipment such as blood pressure monitors and oxygen concentrators for efficient patient care delivery.
- Assisted patients during meal times, ensuring they received proper nutrition according to specific dietary requirements.
- Helped patients with self-feeding and assisted feeding, based on individual needs.
- Checked patient vitals such as temperature, blood pressure, and blood sugar levels.
- Cared for clients with diagnoses such as respiratory failure, diabetes, Parkinson's disease and muscular dystrophy.
- Participated in fun group activities with patients to boost mood, improve overall memory, and provide light entertainment.
- Maintained a clean, safe environment by sanitizing surfaces, changing linens, and disposing of waste properly.
- Provided high-quality personal care services such as bathing, grooming, dressing, and feeding to ensure patient dignity.
- Helped patients complete range of motion exercises to prevent loss of function during care.
Host
Texas Land & Cattle
12.2014 - 12.2015
- Took reservations and to-go orders by phone, answered customer questions, and informed of accurate wait times.
- Worked with front of house staff to move tables and adjust seating to accommodate groups with special requests.
- Assisted managers with quickly resolving service- and food-related issues.
- Resolved guest and employee complaints to maintain complete customer satisfaction and workforce effectiveness.
- Answered customer questions about hours, seating, and menu information.
- Facilitated positive first impressions for guests through friendly greetings, professional attire, and genuine enthusiasm for their visit.
- Consistently upheld company standards and policies, contributing to a positive reputation for the establishment among guests and peers.
- Maintained a clean and welcoming environment, ensuring the comfort of guests throughout their visit.
- Supported servers, food runners, and bussers with keeping dining area ready for every guest.
- Greeted customers warmly upon arrival and provided friendly and warm presence throughout dining experience.
- Developed and maintained up-to-date knowledge of menu items and daily specials to accurately respond to customer queries.
- Demonstrated strong multitasking skills, balancing responsibilities such as answering phone calls, greeting guests, and updating reservation logs simultaneously.
- Boosted customer loyalty through consistent delivery of exceptional service, friendly interactions, and prompt attention to guest inquiries or concerns.
- Assisted in training new host staff, sharing best practices for maintaining a professional demeanor and efficient work habits.
- Increased overall dining satisfaction by promptly addressing and resolving guest concerns or issues.
- Handled high-pressure situations with composure, effectively managing large parties or unexpected events during busy shifts.
- Coordinated closely with event planners for successful execution of private functions held at the restaurant.
- Managed reservations efficiently to accommodate walk-in guests and reduce wait times.
Sales Associate
Once Upon A Child
08.2012 - 11.2012
- Organized racks and shelves to maintain store visual appeal, engage customers, and promote specific merchandise.
- Engaged with customers to effectively build rapport and lasting relationships.
- Maintained calm demeanor and professionally managed issues in busy, high-stress situations.
- Accurately processed POS transactions, returning coin, currency, payment cards, and receipts to customers.
- Answered customer questions about sizing, accessories, and merchandise care.
- Provided positive first impressions to welcome existing, new, and potential customers.
- Prepared merchandise for sales floor by pricing or tagging.
- Organized in-store promotions and events to increase foot traffic and drive additional sales opportunities.
- Contributed to visual merchandising efforts by creating eye-catching displays that showcased products effectively and enticed shoppers to make purchases.
- Assisted in training new staff members on company policies, product information, and sales techniques for a seamless onboarding experience.
- Managed returns, exchanges and refunds in accordance with store policy.
- Achieved monthly sales targets consistently by implementing effective sales strategies and maintaining a high level of product knowledge.
- Rotated stock and restocked shelves to maintain product availability and store appearance.
- Handled cash transactions efficiently while adhering to company cash handling policies, ensuring accuracy in all financial exchanges.
- Managed efficient cash register operations.
Loss Mitigation Representative
Wells Fargo Home Mortgage & Talent Tree Staffing
08.2009 - 02.2010
- Maintained thorough documentation of all borrower interactions, ensuring compliance with company policies and regulatory guidelines.
- Streamlined processes for loss mitigation activities, increasing efficiency within the department.
- Analyzed property valuations to assess risk levels, informing decision-making on foreclosure alternatives.
- Evaluated borrower''s financial situation to determine appropriate loss mitigation solutions.
- Provided exceptional customer service while addressing sensitive financial matters with empathy and professionalism.
- Stayed current on industry trends and regulatory changes, adapting strategies as needed to maintain effectiveness in loss mitigation efforts.
- Maintained high levels of confidentiality, adhering to privacy regulations and protecting sensitive borrower information.
- Managed a high volume of cases, maintaining strong attention to detail and organization for timely resolutions.
- Mitigated potential losses by proactively identifying early warning signs of borrower distress and initiating appropriate interventions.
- Contributed to departmental performance metrics by consistently meeting or exceeding established goals for successful loan modifications, short sales, and other loss mitigation solutions.
- Prevented unnecessary foreclosures by effectively communicating available options to borrowers and guiding them through the loss mitigation process.
- Maintained strong relationships with external partners such as attorneys, real estate agents, and mortgage servicers to facilitate seamless cooperation during the loss mitigation process.
Cashier
Zaxby's
08.2008 - 05.2009
- Worked flexible schedule and extra shifts to meet business needs.
- Operated cash register for cash, check, and credit card transactions with excellent accuracy levels.
- Made change and issued receipts or tickets to customers for each transaction.
- Provided customers with information on specials and discount deals.
- Operated and sanitized kitchen and food preparation equipment.
- Cleaned and organized condiment and beverage stations to maintain tidiness.
- Replaced CO2 tanks and soda syrups when depleted.
- Provided exemplary customer service through active listening, understanding individual preferences, and making knowledgeable recommendations based on customers'' needs or dietary restrictions.
- Collaborated with team members to provide exceptional customer service during peak hours.
- Utilized proper PPE and followed food-preparation safety and sanitation guidelines to reduce risks.
- Managed cash drawer responsibly, ensuring accurate daily accounting of funds received and disbursed.
- Supported positive work atmosphere by actively participating in team meetings and offering constructive feedback when necessary.
- Collected trash and empty trays from empty tables to maintain clean and tidy dining area.
- Trained new employees on proper cash handling procedures and point-of-sale technology use, improving staff productivity levels.
- Upsold menu items effectively, increasing overall sales and contributing to the restaurant''s revenue growth.
- Ensured compliance with local health regulations through diligent adherence to sanitation guidelines in both front-and back-of-house areas.
- Served as a reliable employee with consistent punctuality and attendance record, setting an example for colleagues to follow suit.
- Provided clear communication with kitchen staff regarding special requests or dietary restrictions, ensuring customer satisfaction with their meals.
- Strengthened customer loyalty by remembering regular patrons'' preferences and engaging in friendly conversation during transactions.
- Trained new employees on company policies, procedures, and best practices in foodservice operations for seamless integration into the team.
Education
Associates Degree Nursing - Registered Nurse
Stanly Community College
Locust, NC08.2018
Certified Nursing Assistant (North Carolina) - CNA
Stanly Community College
Locust, NC05.2014
BLS Healthcare Providers - BLS CPR
American Heart Association
03.2014
Telemetry Training - Telemetry
Central Piedmont Community College
Charlotte, NC10.2013
GED -
Stanly Community College
Locust, NC03.2013
Skills
- Communication and Interpersonal Skills
- Attention to Detail
- Multitasking Abilities
- Interpersonal Skills
- Critical Thinking
- Problem Solving
- Conflict Resolution
- Computer Literacy
- Telephone Etiquette
- Time Management
- Organizational Skills
- Data Entry Proficiency
- Documentation and Correspondence
- Healthcare Industry Knowledge
- HIPAA Compliance
- Patient Confidentiality
- Insurance Billing
- Insurance Coverage Verification
- Prior Authorization Processing
- Claims Processing
- Coverage and Authorizations
- ICD-10 Coding
- CPT Coding
- Medical Terminology
- Medical Billing
- Electronic Medical Records
- Patient Rapport
- Proficient in Microsoft Word
- Proficient in Microsoft Excel
- Proficient in Microsoft Powerpoint
- Proficient in Microsoft Outlook
- Proficient in Office 365
- Proficient in Athena Health
- Proficient in Fusion
- Proficient in Epic
- Proficient in Nexgen
Timeline
Insurance Verification Specialist
SCA Charlotte Surgery Center
10.2022 - Current
Insurance Verification Specialist
Amerisourcebergen
11.2021 - 10.2022
Associate Representative
Prism Medical Products LLC.
12.2019 - 04.2021
Certified Nurse Assistant
CareOne Team
06.2019 - 12.2019
Certified Nurse Assistant
Bayada Home Health Care
11.2015 - 05.2019
Host
Texas Land & Cattle
12.2014 - 12.2015
Sales Associate
Once Upon A Child
08.2012 - 11.2012
Loss Mitigation Representative
Wells Fargo Home Mortgage & Talent Tree Staffing
08.2009 - 02.2010
Cashier
Zaxby's
08.2008 - 05.2009
Associates Degree Nursing - Registered Nurse
Stanly Community College
Certified Nursing Assistant (North Carolina) - CNA
Stanly Community College
BLS Healthcare Providers - BLS CPR
American Heart Association
Telemetry Training - Telemetry
Central Piedmont Community College
GED -
Stanly Community College