Charlsie Ward
Overton,TX
Summary
Fifteen plus years in the emergency and medical field ranging from level one trauma hospitals, call centers, health insurance, and Quality Analyst. Seeking employment that allows for growth professionally while utilizing all skills for the betterment of the organization. Team player with excellent communication skills, high quality of work, driven and highly self-motivated. The ability to work independently, flexible, detailed, and able to successfully adapt to change. Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
13
13
years of professional experience
Work History
Quality Management/Analyst/Group Pension Administrator
TPA/Imagine360
05.2017 - Current
- Responsible for interviewing, training, and developing new and existing Member Service Professionals and Member Experience Professionals
- Assisted with development of current quality program used in hiring and training processes to select new member service representatives
- Monitoring and documenting Member Service Professional call quality in support of Member Service departmental quality goals and initiatives
- Evaluates both verbal and written customer contact by MSPs
- Will fairly and consistently review calls and emails of MSPs for accuracy and coaches each professional for success in executing superior service and quality to customers
- Documents call quality results and provides feedback and trend data to their leadership as required
- I am recognized for soft skills and my relationship with Member Service Department.
- Collected and analyzed data to measure effectiveness of quality control processes.
- Performed tests and inspections to conform to established standards.
- Developed and implemented procedures to meet product quality standards.
- Conducted data review and followed standard practices to find solutions.
Service Professional/Insurance Verification Representative/Group Pension Administrator/Imagine
360
05.2017 - Current
- Soft Skills training, which assures the ability to assist member and providers with the best quality of service
- Reviewed claims and medical records which included CPT and diagnosis codes to make sure they have been processed based on the medical benefit listed within the specific medial insurance policy selected
- Required to quote medical, vision, and dental benefits
- Communicated and assisted members and provider by explaining how the benefits affect the services they are wanting preformed
- Initiated contact with several internal and external departments, organizations, facilities, and providers to quickly resolve any issue that may have been presented
- This position is very fast paced and requires focus and attention to details
- Required that each step and communication be thoroughly documented.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Customer Service/Insurance Verification Representative
Healthfirst TPA
01.2015 - 05.2017
- Required to quote medical, vision, and dental benefits for members and providers by using GBAS and Javelina systems
- Answered questions pertaining to claims submitted by the members and providers
- This position requires extensive amounts of time on the phone supplying and verifying accuracy of information
- Fasted paced position that requires specific attention to detail to assure quality service.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Achieved insurance pre-authorizations to enable timely patient procedures.
- Assisted patients with understanding personalized insurance coverage and benefits.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Performed various administrative tasks by filing, copying and faxing documents.
Precert/Insurance Verification Representative
Texas Spine and Joint Hospital
03.2013 - 01.2015
- Verifying patient insurance coverage and to ensure necessary procedures are covered by the individual's policy
- Responsible for updating patient benefit information, verify its accuracy, and enter data in a timely manner
- Must spend extensive amounts of time on the phone with different insurance companies
- I have been recognized for being detailed oriented, organized and my ability to focus and work quickly to ensure the patients satisfaction.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Achieved insurance pre-authorizations to enable timely patient procedures.
- Trained new staff on current, correct insurance verification procedures.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Assisted patients with understanding personalized insurance coverage and benefits.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Established and maintained relationships with insurance providers for productive communications.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Assisted with medical coding and billing tasks.
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
- Prepared and processed patient referrals and transfer requests.
Administrative/Registration Clerk
East Texas Medical Center Level 1 Trauma Center
08.2010 - 03.2013
- Primary responsibility was patient registration, in high flowing emergency department
- Required to remain calm and alert in a high stress level position
- Responsible for verifying any incoming patient's information including emergency contact, personal contact information and insurance
- Provide information to EMS, Doctors, nurses, dispatch, police departments, and additional hospitals
- Documented all steps taken with detail related to each patient.
- Verified insurance benefits and obtained pre-authorizations before any medical procedures were performed.
- Answered patient questions and inquiries regarding registration process and documentation.
- Assisted in processing patient payments via cash, checks and credit cards.
- Scheduled patient appointments, collected copays and verified insurance coverage to complete check-ins.
- Assisted other clerks with front desk duties, answering questions and accurately using reservation system.
- Entered patient information into payment system accurately for billing purposes.
- Confirmed patient demographics and updated practice management software for accuracy.
- Explained form wording to patients to help each understand information required.
- Upheld HIPAA regulations and standards for protecting patient information.
- Retrieved medical data for physicians and patients.
- Performed regular quality and validation assessments on patient data to verify accuracy.
- Safeguarded patient privacy with strict adherence to data security protocols related to electronic health records.
Education
Associates degree - Healthcare Administration
Tyler Junior College
Tyler TX 12.2022
Some College (No Degree) - Healthcare Administration
Tyler Junior College
Tyler TX Skills
- Adhere to HIPAA guidelines with HIPAA compliance
- Monitor Member Service and Member Experience Professional call and review emails for accuracy of information and call handling standards
- Deliver coaching feedback on performance
- Conduct interviews to hire new service professionals
- Train all new Member Service and Member Experience Professionals
- Facilitated changes to current quality guide used to train and hire new employees
- Received and answered client's inquiries regarding timing and service available
- Scheduled appointments as per doctors need and informed patients accordingly
- Documented and organized patient records for reference in case of emergencies
- Registered patients per hospital policy and educated them about medical policies to be followed
- Assisted patients in filling out medical forms and collected any fees due at time of service
- Verified patient insurance eligibility and benefits for CPT and diagnosis codes sent from doctor's office
- Corresponded with scheduling on urgent orders
- Fluent with GBAS, Javelina, Macess , DocuShare, Smartsheet, One Chart, SharePoint and CPSI programs
- Proficient with Workday, Excellent time management skills
- Conflict Management
- Ability to collaborate with different agencies
- Able to educate individuals on their options
- Up to date with medical terminology
- Soft Skills Training
- Strong knowledge in Word, Excel and PowerPoint
- Flexible, detailed and able to adapt to change
- Experienced first responder
- Insurance Terminology
- Benefits Verifications
- Customer Experience
Timeline
Service Professional/Insurance Verification Representative/Group Pension Administrator/Imagine
360
05.2017 - Current
Quality Management/Analyst/Group Pension Administrator
TPA/Imagine360
05.2017 - Current
Customer Service/Insurance Verification Representative
Healthfirst TPA
01.2015 - 05.2017
Precert/Insurance Verification Representative
Texas Spine and Joint Hospital
03.2013 - 01.2015
Administrative/Registration Clerk
East Texas Medical Center Level 1 Trauma Center
08.2010 - 03.2013
Associates degree - Healthcare Administration
Tyler Junior College
Some College (No Degree) - Healthcare Administration
Tyler Junior College
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