Summary
Overview
Work History
Education
Skills
Timeline
Generic

Deidra Bailey

Louisville,KY

Summary

Results-driven professional with expertise in leadership strategies that enhance employee performance and satisfaction. Proficient in problem-solving with a focus on identifying root causes and implementing effective solutions. Strong knowledge of organizational and regulatory standards to optimize performance outcomes.

Overview

19
19
years of professional experience

Work History

Supervisory Medical Support Assistant

Veteran’s Health Administration
Louisville, Kentucky
10.2022 - Current
  • Works collaboratively in an interdisciplinary coordinated care delivery model (i.e. Integrated Community Care Teams, Call Center), providing a high level of care coordination including administrative and clerical support for Veterans receiving medical care in the community.
  • Responsible for the daily oversight of Community Care, providing direct supervision, guidance and leadership to the staff.
  • Defining overall objectives, priorities, and deadlines, assisting with unusual situations that do not have clear precedents, resolving complex problems to ensure Veterans' services are met, mentoring and oversight regarding the setting of priorities for assigned staff, management of the staff schedules, knowledge of computerized data entry and information processing systems, ensures the database integrity by monitoring for accuracy and completeness, extracting and analyzing data to provide reports in support of performance measures to senior management, quality assurance, oversees staff training and orientation, knowledge of the standard procedures, medical records, medical terminology, security of sensitive electronic files, process improvement, gives guidance and initiates action as appropriate, and customer service.
  • Ensures that Lead AMSAs and AMSAs work well within integrated Community Care teams to achieve Office of Community Care, VISN, and local goals with respect to the authorization and scheduling of Active Consults and the completion of Scheduled Consults.
  • Ensuring the timely and accurate indexing and scanning of Community Care records and completion of consults.
  • Supervise and manage electronic fax system to ensure that files are indexed on a timely basis and no backlog is created.
  • Responsible for supervising and managing the Community Care customer service telephone line to ensure that calls are answered by staff in a timely basis with attention to excellent customer service skills.
  • Address Veteran and community provider complex questions and concerns, whether in person, by telephone, by secure message, email, regular correspondence, or fax, including the completion of PATS-Rs, EVs, and Congressional Inquiries.
  • Evaluates new products, equipment and systems to make recommendations for improved operations, identifying educational or training needs, evaluating performance, and taking disciplinary action when necessary.
  • Full administrative and professional responsibility for planning and directing the activities of Lead AMSAs and AMSAs, including making sure that staff meet the performance requirements to be eligible for telework and managing the telework program in a transparent, fair way.
  • Participate in and present as needed in meetings of various constituencies, including team meetings, staff meetings, multi-disciplinary meetings, VISN meetings, meetings with third-party administrator, DOD, and community providers.
  • Responsible for the oversite of all assigned staff, review of staff work product and performance, and ensures that all staff are adhering to VHA directives, laws, and regulations that apply.
  • Responsible for extracting and analyzing data to provide reports in support of performance measures to senior management.
  • Provides AMSAs and Lead AMSAs with data-driven performance feedback on a timely basis and receive standards, one mid-year review and an end of year review.
  • Provide a high level of care coordination including administrative and clerical support for Veterans receiving medical care in the community.
  • Plan and direct day-to-day operations managing 23 civilian and veteran employees.
  • Compile and analyze information from a variety of sources to assist in the preparation of reports and compare performance data to VISN goals on a weekly basis.
  • Distribute daily work assignments, evaluations, monthly, quarterly and annual performance counseling to employees; Provide local training aids, links to programs impromptu refresher training for all staff.
  • Work closely with the Specialty Clinics, Mental Health, and Ambulatory Care staff to provide the best experience possible for patients, through clear and concise communication.
  • Act as a first line Patient advocate at the administrative level, resolving simple to complex problems and ensuring patient services and expectations are met.
  • Evaluate new products, equipment, staff training, and education.
  • Deliver disciplinary actions as needed.
  • Create the recruiting aspects of Human Resources: processing staffing changes, transfers, and administrative paperwork to include ‘usastaffing’ job announcements and desk audits.
  • Prepare hiring evaluations and enter requests for hiring actions through the Light Electronic Action Framework ‘LEAF’ system, enter all MSS requests for staffing through HRSMART web utility, additionally process clinic cancels through the LEAF system and assign appropriate tasks to subordinates.
  • Using Microsoft Office products for data functions, pulling reports, analyzing, reviewing information, sorting, creating training materials, clear and concise instructions, hands on testing and organizing training for further instruction or review as needed.
  • Assist and instruct with pre-registration, keeping my own skills up to date, maintain all continuity functions collaborate with the Patient Aligned Care Team (PACT) Primary Care and Specialty providers, nurses, and advanced medical support assistants to ensure effective and clear communication while scheduling is kept up to date and accurate.
  • Handle staff briefings and on-site technical training to my own staff, the mental health team, the PACT and telehealth teams to ensure compliance of policies, required training, optional training and regulations.
  • Work on clinic level standard operating procedures creating and collaborating with the leadership to maximize our teamwork.
  • Process and deliver midyear and annual ePerformance MSA Standards; Set short term goals for staff and mentor for long term goals and pathways to assist in staff advancement.
  • Continual improvement of self through Talent Management System (TMS), handle all timecard approvals, using Veterans Affairs Time and Attendance System (VATAS) time and handing of all overtime and compensatory time requests for staff, closely using interpersonal skills with staff to maintain and improve overall customer and staff relations.
  • Daily use of Excel, BISL, VSSC, Pyramid Analytics, Microsoft Teams, and work with all of the teams to resolve any customer complaints or issues at the lowest possible level.

Advanced Medical Support Assistant

Veteran’s Health Administration
Louisville, Kentucky
08.2022 - 10.2022
  • Schedule appointments: notifies his/her supervisor when clinic area access is less than desirable or if an individual patient cannot be scheduled within mandated timeframes; Collect, scans, and updates health insurance information, promote Veteran registration and utilization of MyHealthyVet (MHV); Daily review of active/pending Consults, Encounters, Electronic Wait List, Recall list and MHV secure messaging communications for accuracy and disposition.

Legal Assistant/Hearing Customer Service Representative

Social Security Administration-Office of Hearings Operations
Louisville, Kentucky
01.2022 - 07.2022
  • Responsible for developing and processing requests for hearing cases from their receipt in the office to completion, independently performing a wide range of case development actions, and processes more complex hearing cases where analysis of pertinent issues and interpretation of the provisions of the laws, regulations, rulings, precedents, policies, procedures, and guidelines relative to the cases is necessary.
  • Handle appeals that have been filed by Claimants who have been denied Social Security, Supplemental Security Insurance (SSI), or Medicare benefits; Conduct interviews or hearings in person or by telephone with Veterans and public eligible individuals, representatives, and advocates to obtain or clarify information for their appeal process; develop and process requests for hearing cases from their receipt in the office to completion independently, performing a wide range of case development actions; provide support to Administrative Law Judges and other professional employees in processing cases filed under the Social Security Act by ordering Medical Records from Providers and Veteran’s Health Administration to be included as supporting evidence, schedule in-person and virtual hearings for Claimants and Representatives, and verify contact information for all parties involved in the hearing.

Lead Medical Support Assistant

Veteran’s Health Administration
Louisville, Kentucky
02.2021 - 12.2021
  • Assuring coverage of all areas of A-MSA responsibility; conducting ongoing reviews to ensure quality of work; providing guidance to staff members to include changes in policies and procedures; organizing the work structure of assigned areas and distributing and balancing the workload; creating and maintaining employee work schedules; orientating and providing on-the-job training for new and current employees; certifying that all training requirements are met for A-MSA’s; acting as liaison between MSA and staff (Mental Health, Primary Care/PCMHI) in order to resolve day to day matters; assist with clinic access contingency plans by adjusting appointment times, location, or dates as well as shift patients to other healthcare providers as conflict with staffing and/or coverage occurs; ensure that all necessary health/administrative information are integrated into Computerized Patient Record System (CPRS); daily review of active/pending consults, Return to Clinic orders, Recall list, and Audio-care communications for accuracy and disposition; participate in the daily huddles and weekly team meetings; accurately input LEAF Requests for with the Clinic Management Profile department for clinic set up and utilization; primary time keeper for A-MSA’s; order office supplies for the clinic and ensure the budget is maintained.

Advanced Medical Support Assistant

Veteran’s Health Administration
Louisville, Kentucky
11.2019 - 01.2021
  • Ensuring accurate and timely scheduling of appointments for both Mental Health and PCMHI; single-handedly schedule Mental Health Consults for all CBOCS within the region; trained staff across all CBOCS on Mental Health Consults; trained new hires on CPRS, VSE, VCM, and daily operations of MSA duties; created MSA Handbook for new-hires as well as Standard Operating Procedures for Mental Health Consults; managed inbound and outbound calls accurately and professionally; Identify customers’ needs, clarify information, research every issue and provide solutions and/or alternatives; Verify and update patient’s insurance information.

Team Lead-Member Services

Aetna Better Health of Kentucky
Louisville, Kentucky
12.2015 - 11.2019
  • Cross trained to serve as back up to supervisor and director; Responsible for resolving escalated Supervisor calls, dispersed daily work to Member Service Representatives; Performed monthly Quality Audits, providing feedback based on those results; Coach and mentored less experienced team members; Initiates and maintains partnerships with others departments such as Claims, Prior Authorization, and Case Management and communicating workflow results, ideas, and solutions throughout the organization; Track and trend metrics for Representatives; Create Standard Operating Procedures (SOP's) for process improvement and contribute to work flow review/distribution; Serve as a training resource as needed; Reviewed and processed Medical and Pharmacy claims; Complete Out-of-State billing issues and Pharmacy Reimbursement Requests; Manage secured Member Portal requests and department email account; Meet personal/team qualitative and quantitative targets; Manage the State Website for emergency enrollment/disenrollment situations; Arrange Translator appointment requests for providers and members.

Lead Referral Coordinator

Jencare Neighborhood Medical Center
Louisville, Kentucky
09.2013 - 12.2015
  • Served as an Assistant to the Referral Coordinator Supervisor and Clinic Office Manager. Assigned work and evaluated daily tasks to Referral Coordinators and Front-desk staff; Review and analyze complex medical information (i.e., diagnostic tests, office notes, operative reports, etc.) for referral to Specialty clinics; monitored office workflow; evaluated and completed performance evaluations; resolved complex patient issues; trained Front-desk and Check-out staff to demonstrate effective communication with patients in order to provide complete and accurate information; supported Front-desk and Check-out Staff with answering incoming telephone calls and scheduling follow-up appointments; created Standard Operating Procedures for all clinic departments; facilitated timely and efficient referrals to Specialty Medical Offices; verified insurance eligibility for all new patients; captured patient level demographics, insurance eligibility, and registration details and authorizations prior to service completion; backed up and served as the central access point for referring providers and assists in meeting key service and financial goals.

Medicare Supplement Project Analyst

Humana, Inc
Louisville, Kentucky
01.2011 - 01.2013
  • Provided support to Humana product managers during the initial product development process for Individual Medicare Supplement plans; Maintained and validated product design information for ongoing renewals and state specific requirements for 17 states; Conducted market research on Medicare product pricing and plans; Strategically reevaluated competitive concepts and strategies to identify potential risk and barriers; Served as the Medicare Supplement single point of contact; Created and maintained audits for various benefits sources. Documents included benefit grids, master product reference grids for Humana and competitors; Participated in the developing and review of approved Humana plans and insurance products as requested by the Department of Insurance for each state; Supplied market research to internal and external partners for new product expansion and product renewal; Acted as a liaison between product managers, Actuary Implementation, Sales Markets and Strategic Alliances; Maintained departmental process flows, training materials and documentation to ensure that information was distributed to proper channels in a timely and efficient manner.

Grievance & Appeals Specialist

Humana, Inc
Louisville, Kentucky
01.2007 - 01.2011
  • Analyzed and evaluated appeals from stakeholders and members across all lines of Humana Medicare businesses; Consistently managed a cue of 100+ cases to resolve issues for members and providers while exceeding compliance deadlines; Implemented departmental processes to improve business results by decreasing claim response time; Determined the validity of claims by reviewing supported documents resulting in $75K savings for claims paid in error; Consultatively recommended claim resolution to management and members resulting in positive results.

Education

Some College (No Degree) - Organizational Leadership and Learning/Training/Development

University of Louisville
Louisville, KY

Skills

  • VISTA and CPRS
  • VSE and VCM
  • VeTEXT and VAR
  • RAMP search
  • Power BI reporting
  • VATAS and VSSC lCB
  • Leaf requests
  • Microsoft Word and Excel
  • CPMS and HACPS
  • PCOM and DART
  • Avaya softphone
  • ICD-9 coding
  • CPT coding
  • HCPCS coding
  • Leadership development
  • Staff training
  • Research methodologies
  • Technical proficiency
  • Negotiation skills
  • Problem-solving strategies
  • HIPAA compliance expertise
  • Medical terminology knowledge
  • Anatomy and physiology understanding
  • Behavioral health expertise
  • Medicare knowledge
  • Medicaid knowledge
  • Commercial insurance familiarity
  • Third-party payer relations

Timeline

Supervisory Medical Support Assistant

Veteran’s Health Administration
10.2022 - Current

Advanced Medical Support Assistant

Veteran’s Health Administration
08.2022 - 10.2022

Legal Assistant/Hearing Customer Service Representative

Social Security Administration-Office of Hearings Operations
01.2022 - 07.2022

Lead Medical Support Assistant

Veteran’s Health Administration
02.2021 - 12.2021

Advanced Medical Support Assistant

Veteran’s Health Administration
11.2019 - 01.2021

Team Lead-Member Services

Aetna Better Health of Kentucky
12.2015 - 11.2019

Lead Referral Coordinator

Jencare Neighborhood Medical Center
09.2013 - 12.2015

Medicare Supplement Project Analyst

Humana, Inc
01.2011 - 01.2013

Grievance & Appeals Specialist

Humana, Inc
01.2007 - 01.2011

Some College (No Degree) - Organizational Leadership and Learning/Training/Development

University of Louisville

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Deidra Bailey