Angel Jones
Milwaukee,WI
Summary
Polished professional manages multiple tasks, utilizes electronic medical record systems, and provides excellent customer service to patients and staff. Adheres to medical records policies and procedures to comply with HIPAA regulations. Track record of effectively troubleshooting issues and maintaining patient confidentiality.
Overview
14
14
years of professional experience
Work History
Release of Information Specialist Lead
ScanSTAT Technologies
04.2022 - 08.2024
- Reproduced protected health information by using data extraction and file management techniques.
- Coordinated patient information flow through caregivers, insurance companies, billing departments and patients.
- Navigated within patient records to locate requested documentation, successfully completing over 160 requests per day.
- Maintained historical reference by abstracting and coding clinical data such as diseases, operations procedures and therapies.
- Handled phone calls from attorneys, insurance companies and patients.
- Assisted in training new staff on medical record processing and filing procedures.
- Scanned and uploaded medical records into electronic medical records system.
Patient Access Representative
Froedtert Health
09.2021 - 03.2022
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Educated patients on importance of preventive health care and insurance coverage.
- Coordinated patient's care by facilitating caregiver access to medical home providers and resources to meet patient needs.
- Contacted patients on annual renewal dates to offer assistance.
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Verified patient insurance eligibility and entered patient information into system.
- Compiled and maintained patient medical records to keep information complete and up-to-date.
- Greeted and assisted patients with check-in procedures.
- Trained new staff on filing, phone etiquette and other office duties.
Quality Assurance Analyst
Cardinal Health
08.2020 - 09.2021
- Supported company in maintaining work environment focused on quality, communication, collaboration, integration, and teamwork.
- Created and achieved product quality objectives and met product specifications.
- Adhered to standardized software quality assurance best practices, policies and processes.
- Examined events in application log management and monitoring tool to identify root causes for failures.
- Designed, documented and executed test scenarios to identify software bugs.
- Created successful test scripts to manage automated feature testing,
- Mentored and coached team members on QA topics and strategies.
- Used SQL, Test Director and TestBench to assist with completing projects.
- Built automated test scripts to handle repetitive software testing work.
Lead Patient Access Specialist
R1 Rcm
08.2017 - 01.2020
- Resolved patient billing issues in line with established guidelines.
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Helped address client complaints through timely corrective actions and appropriate referrals.
- Facilitated communication between patients and various departments and staff.
- Followed document protocols to safeguard confidentiality of patient records.
- Provided excellent customer service to patients and medical staff.
- Trained new staff on filing, phone etiquette and other office duties.
- Delivered support to medical staff in completion of patient paperwork.
- Recommended service improvements to minimize recurring patient issues and complaints.
Claims Processor
CGS
04.2015 - 07.2017
- Followed up with customers on unresolved issues.
- Evaluated accuracy and quality of data entered into agency management system.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
- Managed workload and priorities to meet claims processing meet deadlines.
- Established positive and trusting relationships with injured clients, administering efficient customer service and processing claims quickly.
- Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes.
- Posted payments to accounts and maintained records.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
Prior Authorization Specialist
TriWest Healthcare Alliance
01.2013 - 03.2015
- Researched denied claims and contacted insurance companies to resolve these issues.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Tracked referral submission during facilitation of prior authorization issuance.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Processed patients lacking coverage for planned procedures.
- Developed and maintained productive working relationships with healthcare providers.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
Data Management Officer
HCA
01.2011 - 01.2015
- Reviewed source documents and listings to compile resources for identifying and correcting data allocation issues.
- Identified and resolved data-handling errors and hardware conflicts to maintain organizational IMS infrastructure.
- Deployed optimal reporting software and developed dashboards and reporting systems for data summaries.
- Partnered with subject matter experts in continuous improvement process, upgraded data quality and recommended innovative information management strategies.
- Oversaw security and information retention policies and practices according to internal and government-ordered standards.
- Analyzed content access, retention and evaluation projects to maintain nonstop information repository.
- Lent qualitative analytical support to lead data analysis testing policy.
- Liaised between data management and IT support personnel to communicate ongoing system maintenance and new software development.
- Gathered, defined and refined requirements, led project design and oversaw implementation.
- Established and secured enterprise-wide data analytics structures.
- Planned and installed upgrades of database management system software to enhance database performance.
- Designed data models for complex analysis needs.
Education
Associate of Applied Science - Respiratory Therapy
Milwaukee Area Technical College
Milwaukee, WI05.2033
Skills
- HIPAA Compliance
- Document Scanning
- Information Management
- Information Sourcing
- Attention to Detail
- Epic Systems
- Health Record Index Maintenance
- Testing plans
- Hardware and software installation
- Bug tracking
- Deductive Reasoning
- Technical Analysis
- Transactions reconciliation
- Claims review
- Claims
- Policy Interpretation
- Medical terminology knowledge
- Quality Assurance
- Pre-Admission Requests
- Work Quality Evaluation
- Appointment Scheduling
- NoSQL Databases
- Data Security
- Data Mapping
- Data monitoring
- Training Coordination
- Customer Service
- EMR
- EMR Updating
- Regulatory Compliance
- Money Handling
Timeline
Release of Information Specialist Lead
ScanSTAT Technologies
04.2022 - 08.2024
Patient Access Representative
Froedtert Health
09.2021 - 03.2022
Quality Assurance Analyst
Cardinal Health
08.2020 - 09.2021
Lead Patient Access Specialist
R1 Rcm
08.2017 - 01.2020
Claims Processor
CGS
04.2015 - 07.2017
Prior Authorization Specialist
TriWest Healthcare Alliance
01.2013 - 03.2015
Data Management Officer
HCA
01.2011 - 01.2015
Associate of Applied Science - Respiratory Therapy
Milwaukee Area Technical College
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