CONSTANCE SEXTON
Plainfield,NJ
Summary
I am a dedicated and focused individual who excels at prioritizing responsibilities. I strive to complete tasks correctly the first time and understand the impact of time management on department planning. I am detail oriented, conscientious, and reliable. I would be grateful for an opportunity to be an asset to your department and to assist in achieving department goals and objectives.
Overview
25
25
years of professional experience
Work History
MEDICAL ADMINISTRATION ASSISTANT GS-7
LYONS VA MEDICAL CENTER
LYONS, NJ
09.2021 - Current
- Serves as the Administrative Officer of the Day during irregular hours of duty on all issues involving enrollment and eligibility determination process, and provides administrative guidance, counsel, and support to clinical and administrative staff to ensure that procedural, legal, and administrative requirements, about all facet of irregular hour patient care are met to the maximum degree possible within existing medical center capabilities.
- Responsible for maintaining a daily log and reporting pertinent information to ensure that the Chief of the department and other staff have a clear and concise synopsis of the off-hour events.
- Responsible for verifying eligibility for VHA health benefits using primary sources such as Veteran Information System (VIS), JVL, Vista, and military discharge papers (DD214) or applied Compact Act Eligibility for emergency patients.
- Ensures admission office procedures are properly conducted by VA and Medical Center Directives, in such areas as outpatient treatments, hospitalization, discharges, and patients’ disposition, special patient transportation.
- Perform bed control movements such as Registration, Admissions, Discharges, and Transfers using Vista and CPRS systems.
- Responsible for the accuracy of all admissions and discharges and bed movements. Running statistical report for Lyons and East Orange VA Healthcare
- Responsible for the Management of wandering, absent, and missing patient events at VANJ Health Care System to prevent accidental injury or death.
- Initiate notification procedures for disasters or emergencies in accordance with Medical Center Disaster plan, notifying management as necessary.
- Responsible for completing Death Certificates in the Electronic Death Registration System (EDRS), VA Liaison for the State of New Jersey Medical Examiner’s Office, releasing remains, processing death paperwork and informing the deceased veteran families on burial and memorial benefits.
- Coordinate with clinical staff, and Lyons VA Police when Medical Emergencies are called, and patients are transported to other VA Healthcare facilities or non-VA hospitals.
- During off- tour, communicate and assist with investigations involving unusual incidents, such as suicide, injuries, visitors, and criminal action, with the VA Police, local Police, VA Fire Department and Upper Management.
Insurance Verification Technician
LYONS VA MEDICAL CENTER
LYONS, NJ
07.2019 - 09.2021
- Verify patient’s insurance coverage both military and commercial.
- Coordinate benefits with multiple insurance plans to verify who will pay the VA in sequence order.
- Inform patients of any inconsistencies in their insurance file
- Terminate health care policies that are no longer effective.
- Receive pre-certification for procedures to verify if the procedure is covered by insurance.
- Assure accuracy for effective dates of coverage are correct for scheduled appointments.
- Review and evaluate insurance data and procedures.
OPERATION SUPERVISOR (PT)
UNITED PARCEL SERVICE (UPS)
Bound Brook, NJ
08.2001 - 05.2020
- Responsible for supervising the account receivable department ensuring staff receive proper guidance regarding billing. Responsible for ensuring all invoices are correct for customer mailing.
- Educates customer(s) on shipping and receiving compliance guidelines for domestic and international packages along with special pricing and discounts.
- Consolidates productivity and payroll for 55 drivers throughout Middlesex, Somerset, and Union counties.
- Assist customers and shipping clerks with problem resolutions to ensure correct daily transmitting.
MEDICAL BILLING TECHNICIAN GS-6
LYONS VA MEDICAL CENTER
LYONS, NJ
04.2018 - 07.2019
- Preparing written correspondence to submit to outside agencies for bill payments before deadlines.
- Assign diagnostic codes, billing transcription and provide responses to patient medical care billing inquiries.
- Contact veterans to inform them of health care services outside the VA that they may qualify for.
- Process specialty billing for Tricare and CHAMPVA claims for both inpatient and outpatient care.
- Verify claims are correct matching medical service dates with billing date to ensure proper billing.
- Increased customer satisfaction by promptly addressing inquiries and resolving disputes related to billing issues.
- Managed and coordinated purchase of office supplies.
- Reviewed billing statements for accuracy, identifying and correcting errors to enhance payment cycles.
MEDICAL SUPPORT ASSISTANT GS-5
LYONS VA MEDICAL CENTER
LYONS, NJ
10.2017 - 04.2018
- Assist in gathering income information from a variety of sources to use in reporting income for the completion of new enrollment and financial updates.
- Responsible for verifying Veteran’s health insurance directly with their Health Insurance Company.
- Serves as the point of contact for Veterans questioning their Ineligible Status for VA benefits. Exceptional communication skills are utilized to ensure the Veteran understands the rules and regulations of the VA and where his eligibility falls within the many directives issued regarding eligibility and enrollment.
- Utilize outstanding communications skills regarding complaints/disputes/inquiries when speaking to Veterans, their families, and employees. Assist the individual tactfully, professionally and in a courteous manner in resolving the complaint/dispute/inquiry. Prepare and release correspondence for other departments to obtain medical information from outside physicians.
- Responsible for determining the eligibility and enrollment for VA health care benefits by analyzing eligibility and enrollment completed packet. Analyzing the character of discharge from the military as well as the length of active military duty service.
- Volunteering with organizations at different location to increase the knowledge of veteran concerning their benefits within the VA.
Customer Service Representative
AT&T
Bridgewater, NJ
07.2005 - 11.2006
- Analyze and resolve customer billing issues and determine corrective action to be taken.
- Responsible for researching current exchange rates when issuing credits to overseas accounts and providing all credit promptly.
- Responsible for setting up automatic debits from customer’s bank account for bill payment.
- International Dispute
- Resolved customer inquiries and issues through multiple communication channels, enhancing overall satisfaction.
Education
Some College (No Degree) - Business Administration
Middlesex County College
Edison, NJSkills
- Results-oriented
- Strong interpersonal skills
- Knowledgeable of VA directives, and policies
- 11 years administrative and supervisory skills
- Problem solving prowess
- HIPAA compliance
- Conflict resolution
- Medical records management
- Healthcare billing
- Multitasking and organization
- Patient registration
- Insurance authorizations
- Insurance verification
- Problem-solving abilities
Timeline
MEDICAL ADMINISTRATION ASSISTANT GS-7
LYONS VA MEDICAL CENTER
09.2021 - Current
Insurance Verification Technician
LYONS VA MEDICAL CENTER
07.2019 - 09.2021
MEDICAL BILLING TECHNICIAN GS-6
LYONS VA MEDICAL CENTER
04.2018 - 07.2019
MEDICAL SUPPORT ASSISTANT GS-5
LYONS VA MEDICAL CENTER
10.2017 - 04.2018
Customer Service Representative
AT&T
07.2005 - 11.2006
OPERATION SUPERVISOR (PT)
UNITED PARCEL SERVICE (UPS)
08.2001 - 05.2020
Some College (No Degree) - Business Administration
Middlesex County College