Summary
Overview
Work History
Education
Skills
Timeline
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Ciera Simmons

Stafford,VA

Summary

To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.

Overview

9
9
years of professional experience

Work History

Provider Payer Enrollment Specialist

Hughston Clinic, PC
08.2022 - Current
  • Streamlined the enrollment process for increased efficiency and enhanced user experience.
  • Collaborated with cross-functional teams to develop targeted marketing campaigns for prospective students.
  • Enhanced customer service by promptly addressing inquiries and resolving issues in a timely manner.
  • Enroll over 200 Group provider specialist to accurate in network insurance companies.
  • Monitored credentials and contacted practitioners when expiration dates were nearing.
  • Contacted insurance carriers to obtain information regarding denials.
  • Used Athena Health, Monday, and Verity Stream to enter provider effective dates into enrollment database.
  • Created and implemented provider acquisition initiative with focus on high-margin services.
  • Updated, entered and reviewed customer data.
  • Communicated effectively via telephone, email and in person with prospective customers.
  • Understood and thoroughly explained services provided to customers and potential customers.
  • Creating providers NNPPES surrogacy's
  • Reduced errors in provider applications with meticulous attention to detail and thorough review procedures.
  • Collaborated with cross-functional teams for timely resolution of enrollment issues, improving overall customer satisfaction.
  • Maintained up-to-date knowledge on regulatory changes, ensuring compliance in all provider enrollments.
  • Managed high-volume caseloads effectively, prioritizing tasks to meet strict deadlines consistently.
  • Developed comprehensive reports on enrollment trends and performance metrics, facilitating data-driven decision-making for management.
  • Established strong relationships with providers through clear communication and prompt assistance during the enrollment process.
  • Audited provider information regularly to ensure accuracy and completeness of documentation, reducing potential risks associated with noncompliance.
  • Implemented quality control measures to identify areas for improvement in the enrollment process, resulting in reduced processing time.
  • Assisted providers with navigating online portal systems, enhancing user experience and expediting application submissions.
  • Reviewed contracts thoroughly to ensure adherence to organizational policies and guidelines before finalizing provider agreements.
  • Coordinated closely with credentialing teams to verify provider qualifications, maintaining high standards of care within the organization.
  • Troubleshot technical issues related to the online enrollment system, providing prompt resolutions for providers and internal stakeholders alike.
  • Facilitated seamless transitions between different stages of the enrollment process by maintaining open lines of communication among various departments involved in provider services operations.
  • Handled escalated enrollment cases with professionalism and tact, ensuring positive outcomes for both providers and the organization.
  • Consistently met or exceeded departmental performance targets through diligent management of individual workload and effective collaboration with team members.
  • Prepared and processed provider enrollments with Medicare and Medicaid in multiple states.
  • Assisted in the development of enrollment strategies, resulting in higher conversion rates and overall growth.
  • Participated in professional development opportunities, continuously refining skills and staying current on emerging trends within higher education administration spaces.

Medical Records Manager

Rivertown Psychiatry
08.2020 - 08.2022
  • Scheduled and conducted educational programs to explain and discuss documentation policies and practices.
  • Developed and implemented record storage and retrieval system for 5 clinics to comply with record retention laws and maintain accessibility.
  • Oversaw secure transfer of patient records to other health care providers to support requests and authorizations.
  • Analyzed quality control assessment findings and developed and implemented methods to improve performance.
  • Abstracted information from records as authorized or requested by insurance companies and other third-party payers.
  • Evaluated requests for information and maintained and tracked releases to comply with federal and state laws.
  • Communicated with patients, ensuring that medical information was kept private.
  • Produced monthly financial reports like income statements, balance sheets and cash flow statements for presentation to clinical management.
  • Gathering and processing of Medical Records for a multitude of insurance audits/claims.
  • Processing and submitting court ordered subpoena's.
  • Improved patient care by efficiently managing and organizing medical records for easy access and retrieval.
  • Ensured compliance with healthcare regulations by conducting regular audits of medical records and implementing corrective actions when necessary.
  • Collaborated with healthcare professionals to develop and implement best practices for the maintenance of accurate and up-to-date medical records.
  • Assisted in the transition from paper-based records to digital formats, resulting in improved efficiency within the department.
  • Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
  • Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
  • Implemented electronic health record systems to enhance data management, leading to improved patient outcomes.
  • Optimized workflow by implementing efficient filing systems that allowed for quicker retrieval of pertinent medical information.
  • Managed a team of medical records clerks, providing guidance on their daily tasks and ensuring timely completion of projects.
  • Managed, Ran, and kept documentation of CPT Testing (Conners Continuous Performance Test).

Veterinarian Assistant

Affordable Veterinary Services
06.2015 - 08.2020
  • Assisted veterinarians with restraining animals during examinations to assess injuries.
  • Scheduled appointments, answered phones, billed customers for services and maintained inventory to maximize office productivity.
  • Provided care for animals before surgeries, administering anesthetics as necessary for overall comfort and health.
  • Managed medical intervention and therapy for animals in collaboration with Veterinarian.
  • Performed catheterizations, ear flushes, enemas, intravenous feedings, vaccinations and other procedures.

Education

Master of Science - Clinical Child Psychology

Troy University
Phenix City, AL
05.2027

Skills

  • Data entry skills
  • Policy Interpretation
  • Customer service background
  • Documentation Management
  • Marketing knowledge
  • Workflow Optimization
  • Cross-Functional Teamwork
  • Application verification
  • Customer service expertise
  • Exceptional communication
  • Deadline Management
  • Clinical Documentation Improvement
  • Account Management
  • Policyholder Communication
  • Health insurance
  • Insurance Practices
  • Billing Procedures
  • Records Maintenance
  • Form Completion and Submission
  • Medical terminology expertise

Timeline

Provider Payer Enrollment Specialist

Hughston Clinic, PC
08.2022 - Current

Medical Records Manager

Rivertown Psychiatry
08.2020 - 08.2022

Veterinarian Assistant

Affordable Veterinary Services
06.2015 - 08.2020

Master of Science - Clinical Child Psychology

Troy University

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Ciera Simmons