Debra Caldwell
Millsboro,DE
Summary
Accomplished professional offering great communication and customer service skills. Reliable and dedicated when working alone or as part of team. Motivated individual with business acumen and willingness to take on challenging roles. Tech-savvy and quick learning with technical know-how, social media expertise and sales abilities to support and drive substantial growth. Hardworking employee with customer service, multitasking, and time management abilities. Devoted to giving every customer a positive and memorable experience. Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
After years of being a homemaker, I am now an empty nester and excited to return to the workforce. I took time off from work due to marriage and relocation from 2012 to 2022, as well as after the birth of my son from 2003 to 2008. However, I am now eager to pursue new career opportunities and challenges.
Overview
35
35
years of professional experience
Work History
Independent Contractor – Member Services
AmeriHealth Caritas Pennsylvania - Medicaid & Keystone First – AmeriHealth Caritas Pennsylvania Community Health Choices – Keystone First Community Health Choices
09.2023 - Current
- Answer and respond to a high volume of calls and assist members and providers with any inquiries in relation to eligibility, benefits and claims status
- (HIPAA verify standards) Create accurate and timely member documentation concerning all inquiries taken
- Communicate complex healthcare information in a way that is understandable and relatable to members and providers
- Utilize customized scripting based on the type of insurance and the reason for caller to contact member services
- Provide positive solutions and be willing to educate members on all of their other benefits
- Add/Change/Terminate Primary Care Providers, as well as update TPL (third party liability-insurance) Address care gaps if necessary for preventative screening as well as REL (race, ethnicity, language) Access and utilization of OLH - Online Health topics for various call types for the various Medicaid Insurance types
- Systems and Programs used to perform duties include but are not limited to: Citrix, IAD, Exp Masess, eltss, ecis (PA State system), Avaya, Company Website Navigations, One Note, Microsoft Excel Spreadsheets, Microsoft Teams, Zoom, Outlook, Okta Verify, Duo, Shiftboard, OpenForce, Litmos, LON (liveops nation)
Independent Contractor
LiveOps
10.2022 - 09.2023
- I also have experience working from home as an Independent Contractor on the LiveOps platform
- I have received extensive training for multiple clients, including Exact Sciences (Cologuard), Piedmont Natural Gas (PNG), and Nike (voice)
- Despite being praised as a model student by my trainers, I eventually opted out due to limited hours and inconsistent income
- Additionally, some clients had left the LiveOps platform, making it no longer viable for me to provide services.
Front-End Patient Representative (Patient Financial Services – Business Center)
New Hanover Regional Medical Center (NHRMC)
Wilmington, NC
12.2011 - 08.2012
- Assist patient with all insurance and billing inquiries Review daily encounter forms looking for Managed Care Authorizations, Medicaid Eligibility, Bad Debt, Dismissed Patient Accounts, Delinquent Patient Account Balances Update and revise patient demographic information Mail Insurance Information Request letters to No Insurance and Medicaid Pending hospital patients and monitor as indicated in policy Verify Worker’s Compensation eligibility Complete Disability and Cancer Policy insurance forms Make appropriate adjustments to patients accounts ie: insurance only, professional courtesy, managed care contractual adjustments, etc Set-up monthly payment plans and monitor monthly Research credit balances on patient accounts and refund as appropriate Communicate with doctors making recommendations regarding patient delinquent accounts, credit risks, patient hardships, etc Assist department supervisor as requested Assist fellow patient reps as needed and other departments as requested Cover for other patient reps when they are absent from work, ie: sick/vacation
Billing Representative
Wilmington Orthopaedic Group
Wilmington, NC
08.2009 - 08.2011
- Commercial Insurance Billing and Follow-up for unprocessed or unpaid claims
- Print aging reports for claim status and correct claims for resubmission or resubmit with requested missing documentation
- Work with RealMed online inquiry reports for claim status and submit electronically
- Process Worker’s Comp claims
- Print out Dr’s dictation notes, nerve study reports, DME invoices and other necessary documentations required for claim processing and mail with claims
- Assist with incoming calls from patients and various insurance companies as well as lawyer offices
- Process Itemized Billing Statement requests from law firms and/or patients via fax or mail Process billing office explanation of benefits and payments received from the mail daily
- Then tally and do a remote bank deposit of checks received
- Process and also keep a Fast Remittance Log daily form online, through RealMed, of money received electronically Scan Explanation of Benefits that have already been posted into Document Management field area of Centricity, as well as scan legal documents or ABN (advanced beneficiary notice) Proficient in Centricity, Mysis, Outlook, Excel, Microsoft Word, scan devices, fax and copier machines, RealMed, RBC bank Remote Deposit program
Visiting Nurses’ Biller (2002-2003) and Physician Orders Processor (Medical Records Dept 2001-2002)
INOVA VNA
Fairfax, Virginia
01.2001 - 01.2003
- Billed insurance companies for home visits made by nursing, physical therapy, and occupational therapy teams
- Insurance companies billed Tricare, Aetna, Hospice, Blue Cross/Blue Shield, Cigna, Alliance, Healthkeepers, Champus, and some third-party insurance companies as well as patient-private pay
- Contacted insurance companies concerning billed therapies and follow-ups
- Corresponded with patients in regard to their responsibility on the billings Filed claims electronically as well as manually I was the Super-User for the new data system called “HBOC” and had trained staff on the new billing application of this custom system and also was the technical support representative Received signed physician orders from visiting nurses and processed the data in the network Prepared physician orders to be signed by doctors and delivered them to the different nurses’ teams to be signed or delivered them to various hospitals for physician signatures Processed medical records for legal requests
Pharmaceutical Therapy Biller and Coder from 1998-2001
Home Health Clinical Services
Alexandria, Virginia
01.1996 - 01.2001
- Pharmaceutical drug biller for Blue Cross/Blue Shield, Aetna, Hospice, Champus, Healthkeepers, Cigna, Tricare and third-party insurance Billed for drug treatments, hydration and nutritional therapies supplied to INOVA VNA - nursing teams and therapists for home visits Made follow-up calls to insurance companies Reviewed patient charts for doctors’ orders and therapies prescribed for billing accuracy Reviewed prescribed therapies with the pharmacists for billing accuracy
Certified Custom Jobst Compression Garments and Devices, Customer Service Rep, Durable Medical Specialist from 1996-1998
Home Health Clinical Services
Alexandria, Virginia
01.1995 - 01.1996
- Custom and over the counter Jobst Compression Garment Fitter as well as compression equipment instructor for patients and co-workers as prescribed by physicians Customer Service duties to include processing and receiving orders for durable medical equipment/respiratory therapies, etc
- Order tracking, set up new patient accounts, front showroom service which included durable medical equipment and supplies as well as respiratory equipment/supplies, ostomy and colostomy supplies etc
- Multi-task with answering calls from patients, facilities, doctor’s offices while processing orders and retail show room responsibilities and custom fittings for the compression garments/devices Re-order show room supplies and kept area organized and clean
Front Office Manager (Homeopathic Medicine)
Sandra Chase, MD
Fairfax, Virginia
01.1995 - 01.1996
- New patient work-up (admissions, appointments, labs, EKGs, and vitals) International correspondences for Homeopathic Conferences and Colleagues Transcription of medical notes to patient’s charts Billing, supply reorders, payment collections, medical records, lab prep, front office organization/cleaning of medical equipment, etc
Pharmaceutical Sales Rep (In-House)
Charise Charles
Altamonte Springs, Florida
01.1989 - 01.1995
- Customer Service Trainer and In-Service Product Trainer Assistant to supervisor (Customer Service Support) – supervised employees and trained new employees Verified State and DEA licenses
- Performed credit checks on customers In-house cold calling and follow-up of new and existing accounts to pharmacies, doctors’ offices, oncologists’ and nephrologists’, dialysis and nephrology units and facilities Processed Standing Orders (autoship orders) Trade show host and company representative New product demonstrator and trainer to fellow employees for in-services with manufacturer reps Support to Customer Service Dept (trouble shooting and customer inquiries) Extensive knowledge of dialysis, oncology, nephrology, hemodialysis, peritoneal products, and TPN
Education
High School Diploma -
Madison Central High School
Old Bridge06-1986
Skills
- Centricity
- Mysis
- Outlook
- Excel
- Microsoft Word
- Scan devices
- Fax and copier machines
- RealMed
- RBC bank Remote Deposit program
- Micro-Fische
- Use of multi-line phone systems
- Detailed oriented
- Organizational skills
- Able to multi-task in a fast-paced environment
- Possess great initiative
- Able to problem solve when necessary
- Team leader
- Trained new employees
- Key operator for office equipment
- Attended training seminars for Communication Skills and Sales, Quality Customer Service, Financial Planning, as well as Billing/Coding In-service training, etc
- Inventory re-orders and purchase orders
- Pharmaceutical representative
- Customer service representative
- Front-office manager
- Custom fitter for compression garments and devices
- Durable medical specialist
- Financial planner
- Patient billing rep
- Insurance biller
- Administrative assistant
- Quoting and Estimating
- Workload Management
- Scope Definition
- Deadline Adherence
- Service Marketing
- Requirements Gathering
- Safety Compliance
- Schedule Management
- Records Coordination
- Scheduling
- Error Correction
- Project Management
- Production Planning
- Operations Oversight
- Resources Allocation
- Proficient in Epic
- Proficient in Zendesk
- Proficient in Epiphany
- Proficient in Microsoft Teams
- Proficient in Slack
- Proficient in VMware
- Proficient in Five9
- Proficient in Zoom
- Proficient in HBOC
- Proficient in DeScript
- Proficient in Jasper
- Proficient in DFY Studio
- Proficient in YouTube
- Proficient in Facebook
- Proficient in Call Center
- Proficient in Communications (verbal & written)
- Proficient in DME
- Idea Development and Brainstorming
- Process Analysis
- Analytical Thinking
- Issue Research
- Process Improvement
- Logistics Coordination
- Experience in Leadership
- Content Management Expertise
- Data Analysis
- Quantitative Skills
- Commission Structures
- Program Evaluation
Training
Custom Jobst Certification for Compression Garments and Devices Oxygen equipment such as BIPAP, C-PAP, O2 tanks and gauges, compression devices, wheelchairs and scooters, as well as other durable medical devices HBOC Billing System – Super-User and Tech Support Therapy coding for various insurance companies and electronic billing as needed UPS and FEDEX Tracking Training for patient vitals such as EKGs and mounting tapes, temperature, pulse blood pressure, eye tests and lab preps Trained extensively on all areas of dialysis, hemodialysis, peritoneal dialysis, TPN, Nephrology, oncology, drug therapies and supplies needed International correspondence, transcriptions, telex’s, etc. In-house and trade show demonstrator of pharmaceutical supplies and uses along with the drug(s) needed
Affiliations
- YouTube Digital Creator - FrontPage Holistic Natural Remedies
- E-Commerce Website Owner - FrontPage Health & Fitness
References
References available upon request.
Timeline
Independent Contractor – Member Services
AmeriHealth Caritas Pennsylvania - Medicaid & Keystone First – AmeriHealth Caritas Pennsylvania Community Health Choices – Keystone First Community Health Choices
09.2023 - Current
Independent Contractor
LiveOps
10.2022 - 09.2023
Front-End Patient Representative (Patient Financial Services – Business Center)
New Hanover Regional Medical Center (NHRMC)
12.2011 - 08.2012
Billing Representative
Wilmington Orthopaedic Group
08.2009 - 08.2011
Visiting Nurses’ Biller (2002-2003) and Physician Orders Processor (Medical Records Dept 2001-2002)
INOVA VNA
01.2001 - 01.2003
Pharmaceutical Therapy Biller and Coder from 1998-2001
Home Health Clinical Services
01.1996 - 01.2001
Certified Custom Jobst Compression Garments and Devices, Customer Service Rep, Durable Medical Specialist from 1996-1998
Home Health Clinical Services
01.1995 - 01.1996
Front Office Manager (Homeopathic Medicine)
Sandra Chase, MD
01.1995 - 01.1996
Pharmaceutical Sales Rep (In-House)
Charise Charles
01.1989 - 01.1995
High School Diploma -
Madison Central High School
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