De'Qundra Stevens
Savannah,United States
Summary
Reliable Manager demonstrating high level of ownership and initiative. Possessing exceptional work ethic and desire to go above and beyond to exceed company expectations. Offering knack for building productive working relationships. Successful in fast-paced, deadline-driven environments to manage goals and team development. History of thriving in team-oriented environments.
Overview
4
4
years of professional experience
Work History
Referral Manager
Dedicated Senior Medical Center
Savannah, Georgia
08.2022 - Current
- Develops, documents and/or improves process maps/flows, Standard Operating Procedures (SOPs), best practices, Key Performance Indicators (KPI) scorecards and tool kits.
- Established referrals department in a new region by building the company CPL and serving as Serve as primary contact for providers
- Manages Network performance for assigned region through a consultative management approach
- Develops, manages and reports progress of initiatives using current and future state Value Stream Maps, project management tools and industry vs. business standard, policies and best practices.
- Educates providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
- Leveraged leadership skills to identify deficiencies and opportunities to improve policies, procedures and controls.
- Serve as primary contact for providers and act as a liaison between the providers and the health plan
- Facilitates provider trainings, orientations, and coaches for performance improvement within the network and assists with claim resolution.
- Communicates with Network Director regards to CPL- Report any errors, concerns or feedback in regards to CPL providers.
- Generates Weekly Analysis Report and send to Referral Coordinators
Medical Office Administrator
Memorial University Medical Center
Savannah, GA
04.2021 - 06.2022
- Managed staff scheduling and set patient scheduling policy.
Oversaw digital patient charting, data entry and administrative duties. - Served as an liaison between providers, admin staff, and outside vendors including insurance companies.
- Supported four providers in outpatient medical office through
coordinating all administrative operations. - Maintained current working knowledge of CPT and ICD-10 coding
principles, government regulation, protocols and third-party billing
requirements. - Gathered information to file appeals for insurance denials and minimized inaccuracies by maintaining accurate records of approvals.
- Assisted in managing the incoming claims pool, ensuring that vendors and providers are correctly loaded into the Epic claims platform.
- Performed insurance verification, pre-certification and pre-authorization.
Provider Specialist
Healthcare Staffing Inc.
Brunswick, GA
05.2019 - 01.2021
- Responded quickly to customer complaints and used diplomatic
communication to initiate problem resolution. - Created and maintained accurate and confidential patient files according to regulatory mandates.
- Analyzed and submitted reports regarding special incidents, events and complaints to ethics department.
- Managed front office customer service, appointment management, billing and administration tasks to streamline workflow.
- Maintained office supplies inventory by checking stock and ordering new supplies.
- Completed claims forms for different types of appointments and worked on resolutions for denials or other insurance issues.
Medical Records Specialist-Intern
Saint Simon's By The Sea
Saint Simon's Island, GA
01.2020 - 06.2020
- Reviewed and implemented standards and procedures for processing
medical records requests. - Safeguarded patient records, managing data transfers in compliance with HIPAA standards and organizational regulations.
- Purged outdated files.
- Assessed billing statements for correct diagnostic codes and identified problems with coding.
- Reviewed legal claims for accuracy and issues.
- Scanned incoming documentation.
- Maintained complete confidentiality in accordance with organization and legal requirements.
- Tracked and processed release of information requests.
Education
Master of Science - Healthcare Informatics
Mercer University
Macon, GA05.2024
Bachelor of Arts - Health Administration
The College of Coastal Georgia
Brunswick, GA12.2020
Skills
- Market Trends Analysis
- Resource Evaluation
- Work Planning and Prioritization
- Reports and Documentation
- Customer Relationship Management
- Project Leadership
- Quality Improvement
- Conflict Resolution
- Team Management
Timeline
Referral Manager
Dedicated Senior Medical Center
08.2022 - Current
Medical Office Administrator
Memorial University Medical Center
04.2021 - 06.2022
Medical Records Specialist-Intern
Saint Simon's By The Sea
01.2020 - 06.2020
Provider Specialist
Healthcare Staffing Inc.
05.2019 - 01.2021
Master of Science - Healthcare Informatics
Mercer University
Bachelor of Arts - Health Administration
The College of Coastal Georgia
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