Carmella Harris
Saint Louis,MO
Summary
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
12
12
years of professional experience
Work History
Navigator
United Healthcare
12.2022 - Current
- Serve as the patient’s liaison throughout the life cycle of the program by addressing program specific quality measures and adhering to company guidelines/standard operating procedures
- Outreach to patients’ providers and input appointments, place regular/consistent outreaches to the patient
- Provide support to patients either prior to admission for an elective procedure, post-discharge from the hospital, or post-procedure
- Identify and connect patient to resources for addressing Social Determinants of Health (SDOH)
- Prepare information for patient case status summaries, success stories, etc
- And participate in daily huddles, weekly meetings, and other scheduled events
- Resolve and or support tough patient cases via communication to management.
CSA Virtual Proctor
Truepill
01.2021 - 01.2022
- Support various programs within business unit
- Perform other duties as assigned
- Become an expert with our software solutions, including but not limited to; Talkdesk, Zendesk and other internal tools
- Primary work will come from internal systems to complete outbound calls throughout the day and questions and support requests from internal and external customers and team members
- Help with training new hires when needed
- Partner and take direction from Pharmacy Ops teams as needed
- Make inbound/outbound & virtual video calls to patients, pharmacies, and doctor's offices to obtain/verify information for business purposes.
Clinical Admin Coordinator
UHC/Briova Rx Infusion
01.2018 - 01.2021
- Managing authorizations/notifications and other service requests received via incoming phone calls, faxes and portal submission
- Providing excellent customer service, including the ability to handle escalated callers
- Determining authorization or notification requirements
- Providing administrative approvals (depends on line of business)
- Handling expedited authorizations, authorization updates and status checks
- Conducting provider searches and verifying if a provider is in network
- Confirming member eligibility.
Correspondence Specialist
Ciox Health
01.2016 - 01.2018
- Receives incoming requests for information and responds to requests by opening mail, assisting walk-ins and telephone inquiries, and retrieving facsimile inquiries in a timely manner
- Validates requests and authorizations for release of medical information according to established procedures and HIPAA guidelines
- Completes release of information requests including retrieving patients medical charts and returning charts, copying/scanning medical records accurately and correctly, according to requests, established procedures, and established standards of quality and productivity
- Maintains working knowledge of the current state laws regarding fee structure, and HIPAA regulations as well as facility policies and procedures in regards to release of information.
Office Coordinator
SSM Health Care
01.2016 - 01.2017
- Registrar, schedule and cancel patient appointments in Epic
- Collect co-payments and close batch end day
- Manage the physician schedules per specialty
- Responsible for assuring that the daily office activities are coordinated
- Responsible for planning and coordination all clerical and administrative office activities
- Order supplies when needed for the office
- Answering any inquiries with patients, doctor offices, and insurance
- Data entry.
Registrar/Scheduler
Barnes Jewish Hospital
01.2015 - 01.2016
- Answer multiple telephone lines, taking messages and directing calls
- Schedule, confirm and cancel patients appointments in Syngo
- Verify insurance and precertification with multiple insurance companies
- Prepare patients record/orders for the next business day per schedule
- Collect co-payments
- Responsible for assuring the readiness of the reception area, closing the building at the designated time.
Prior Authorization Representative
Express Scripts
01.2014 - 01.2015
- Handle inbound telephone and written inquiries from pharmacists and doctors regarding prior authorization by screening and reviewing requests based on benefit plan design, client specifics and clinical criteria
- Provide information to clients, participants, pharmacists and doctors regarding participants pharmacy benefit, drug coverage and provide accurate procedures for medication exceptions
- Facilitate resolution of drug coverage issues and pro-actively address, research and resolve issues while maintaining accurate and complete documentation of all inquires for continuous improvement.
Clerk I
St. Louis City Courts
01.2013 - 01.2014
- Prepare dockets or calendars of cases to be called
- Answer inquiries from the general public regarding judicial procedures, court appearances, trial dates, adjournments, outstanding warrants, summonses, subpoenas, witness fees, and payment of fines
- Instruct parties about timing of court appearances
- Search files in order to obtain information for the court
- Coordinates with other related departments and staff in other legal matters
- Trained and mentored new staff members on critical subjects including HIPPA guidelines, privacy, and training of employees.
Office Service Representative
St. Louis County Department of Health
01.2012 - 01.2013
- Registered patients to collect current information, verify insurance coverage if any, if not then put them on a sliding scale fee based on their income
- Handled payments, created a batch with the entering and posting of payments, entering encounter forms for the day, and also taking payments on patient accounts
- Operated phone screening calls to see where calls should be directed or if I can answer their questions, scheduling appointments, and call to confirm, reschedule, or cancel appointments
- Front desk clerk duties were to check patients in for appointments or seeing nurse on call, if they have questions, want to get registered with clinic, and also greeting all visitors such a drug reps
- Trained new employees on policies, procedures, HIPPA, confidentiality, and internal policies.
Education
B.A. in Business and Healthcare Management -
Missouri College
A.A.S. in Medical Billing and Coding -
Allied College
Diploma in Medical Administrative Assistant -
Everest College
Skills
- Decision-making capabilities
- Team Coordination Experience
- Prior Authorization Process
- ICD-10 Coding Familiarity
- Medical Terminology
- Authorizations
- Insurance Verification
- Medicare and Medicaid knowledge
- Patient Referrals
- Data Entry
- HIPAA Compliance Knowledge
- CPT coding knowledge
- Electronic Health Records Proficiency
- Physician order verification
- Medical terminology knowledge
- Benefit Coverage
- Understanding of medical terms
- Medical Office Procedures
- Process improvement strategies
- Understanding of insurance details
- Insurance procedures
- Patient Confidentiality Compliance
- Records Maintenance
- Patient Scheduling
- Provider Relations
- Claim research
- Utilization Review Experience
- Critical thinking abilities
- Medical Coding
- Issue Research
- Healthcare Regulations Understanding
- Eligibility Determination
- Referral Coordination
- Telephone Etiquette
- Appointment Scheduling
- Documentation and paperwork
- Program knowledge
- Application support
- Resource information
- Fraud investigation
- Applicant engagement
- Payment Collection
- Customer Service
- Computer Skills
- Remote Office Availability
- Administrative and Office Support
- Multitasking and Organization
- HIPAA Regulations
- Attention to Detail
- Understanding of medical terminology
- Office Administration
- Managing patient records
- HIPAA Compliance
- Patient Registration
- Medical Records Maintenance
- Insurance Billing
- Documentation and Recordkeeping
- Administrative Support
- Patient Referral
- Medical Records Verification
Skilledhighlights
- Immense ability to type accurately at a rate of 45 w.p.m.; use 10-key calculator by touch; interact tactfully and effectively with members of the public, co-workers and managers
- Uncommon ability to understand and carry out written and oral instructions; perform detailed clerical work and maintain attention to detail despite frequent interruptions
- Sound knowledge of basic business arithmetic; techniques and methods of using standard word processing, spreadsheet, database and other office software and equipment
- Familiar with Physicians Current Procedural Terminology (CPT) Common Procedure Coding Systems (HCPCS) International Classification of Diseases (ICD-9-CM) HIPAA Compliance
Timeline
Navigator
United Healthcare
12.2022 - Current
CSA Virtual Proctor
Truepill
01.2021 - 01.2022
Clinical Admin Coordinator
UHC/Briova Rx Infusion
01.2018 - 01.2021
Correspondence Specialist
Ciox Health
01.2016 - 01.2018
Office Coordinator
SSM Health Care
01.2016 - 01.2017
Registrar/Scheduler
Barnes Jewish Hospital
01.2015 - 01.2016
Prior Authorization Representative
Express Scripts
01.2014 - 01.2015
Clerk I
St. Louis City Courts
01.2013 - 01.2014
Office Service Representative
St. Louis County Department of Health
01.2012 - 01.2013
B.A. in Business and Healthcare Management -
Missouri College
A.A.S. in Medical Billing and Coding -
Allied College
Diploma in Medical Administrative Assistant -
Everest College