Summary
Overview
Work History
Education
Skills
Job Related Training
References
Timeline
Generic

Dorothy Stuckey

Memphis,TN

Summary

Efficient Authorization Specialist with comprehensive knowledge of medical insurance policies, coding and procedures. Demonstrated ability to liaise effectively between patients, healthcare providers, and insurance companies for smooth transactions. Strengths include strong problem-solving skills, thoroughness in documentation and a keen eye for identifying inconsistencies. Proven impact in previous roles includes streamlined authorization processes, improved patient satisfaction rates, and reduced claim denials.

Overview

28
28
years of professional experience

Work History

Certified Nursing Assistant

Trezevant Manor
Memphis, TN
10.2024 - Current
  • I assist all residents and clients with a high quality of personal care, including, but not limited to, bathing, dressing, grooming, shaving, incontinent care, foot care, vital signs, height, and weight checks per policy.
  • I make all beds as needed in the A.M., and turn them down as needed in the P.M. Change bed linens once each week, or as needed.
  • I assist residents with mealtime by cutting food. And it is encouraging to eat.
  • I promoted a calm atmosphere. I complete my shift assignments; if I am unable to complete them, I report to the nursing supervisor.
  • I turn and reposition residents using proper body mechanics to prevent pressure ulcers.
  • I report daily to the nurse on duty and the Director of Health Services all unusual behavior of residents (changing of status).
  • I respond quickly to emergency situations involving sudden illness or injury.
  • I provide assistance with activities as planned and/or directed.
  • I documented resident status as per policy.
  • I responded to call lights and emergencies in a timely manner.
  • I exhibit compassionate care and communication regarding issues surrounding death and dying.
  • I provide emotional support to family members regarding end-of-life decisions.
  • I provide emergency care within the scope of practice.
  • I'm very familiar with, and I follow community policies.

Customer Service Representative

CoSolutions, Inc.
Millington, TN
04.2024 - 10.2024
  • I provided support and information to Sailors about various benefits, retirement, etc.
  • I answered incoming calls and emails, providing frontline customer support, or assistance with product and service transactions.
  • I resolved customer complaints promptly and efficiently.
  • I ensured that customer problems and concerns are resolved appropriately, preferably in a timely manner.
  • I maintained sailors' accounts, and records of customer interactions were secured.
  • I proactively took steps to enhance the customer experience.
  • I escalated complex issues to the appropriate team.
  • I interacted with customers via phone, email, or online chat.
  • I collaborated with other departments to ensure that the Sailors' request is resolved.
  • I participated in training and development programs.
  • I promoted high customer satisfaction by resolving problems with knowledgeable, friendly service.
  • I conducted regular follow-up calls with customers after resolving their issues.
  • I identified areas of improvement in customer service processes and suggested changes accordingly.

Program Support Assistant

Department of Veterans Affairs - Memphis VAMC
Memphis, TN
01.2023 - 07.2024
  • I organized data into Access databases or spreadsheet formats, and received and processed documents and reports in accordance with established procedures.
  • I collected, compiled, and/or tracked data and statistical information in support of the Nutrition and Food Service (NFS) program operation; this may include RDN-required training, leave requests, and regular/on-call weekend schedules.
  • I organized and coordinated meetings, conferences, presentations, and other events.
  • I coordinated with team members to ensure the timely completion of tasks.
  • I reviewed documents and reports for completeness, and I entered pertinent information into an automated tracking system or created spreadsheets/databases to track them.
  • I prepared a wide variety of recurring and nonrecurring correspondence, reports, and other documents; established, updated, and maintained office files and records. Keep/type meeting minutes, agendas, and reports.
  • I performed office duties using software applications such as word processing, spreadsheets, electronic mail, calendars, databases, and/or graphics.
  • I served as an official timekeeper for NFS using VATAS; I assure that information is kept up to date, and I notify my supervisor when leave limits are exceeded.
  • I serve as a Budget Technician for the Nutrition and Food Service Department.
  • I develop and monitor resources, and make recommendations to the service regarding the needs, distribution, or redistribution of the resources.
  • I administer the budget for several fund control points.
  • I adhere to all administrative rules, regulations, and procedures associated with recording, reporting, processing, and keeping track of budgetary transactions, such as credit, receipt, transfer, allotment, withdrawal, obligation, or outlay of funds.
  • I prepare the required documents to resolve discrepancies with cost reports, budget analysis, or other service-related needs.
  • I assisted the Chief of Nutrition and Food Service and other managers in handling all union and human resources correspondence and personnel management documentation, generating appropriate documents to address suspense file issues, and creating/managing suspense files to address disciplinary and union actions within strict time limits while reminding staff of time-sensitive issues and deadlines.
  • I used the patient electronic health care record to access and retrieve confidential patient information to facilitate contact, schedule patient appointments, and manage consultations. Schedule nutrition clinic appointments, prepare appointment confirmation letters, and enter appointment data.
  • I performed data entry into software systems used by the program team members.
  • I provided administrative support to program staff and management teams.
  • I served as the primary ADPAC and TMS Administrator for NFS, assuring NFS employees are up-to-date and have met all mandatory training, and orienting and training all NFS employees on computer use.
  • I maintained filing systems for records related to the programs being supported.
  • I placed and tracked work orders from submission to completion.
  • I maintained office supplies, tracking, ordering, and delivering as needed.
  • I completed administrative errands and retrieved administrative items; received, sorted, and distributed mail to the appropriate staff.
  • I maintained a positive working relationship with fellow staff and management.
  • I maintained office equipment, assisted staff with troubleshooting office equipment and computer hardware problems, resolved software problems, and worked with OI&T to upgrade computer functions.

Advanced Medical Support Assistant (AMSA), Decedent Affairs/Eligibility

Department of Veterans Affairs - Memphis VAMC
Memphis, TN
04.2021 - 01.2023
  • I served as a Health Benefit Advisor for Eligibility and Enrollment, advising applicants on national VA Enrollment, the Uniform Benefits package, and non-medical benefits.
  • I supported the management information components of all health eligibility related programs.
  • I interviewed applicants applying for medical benefits while using various methods to verify eligibility and entitlement for benefits; providing information and answering questions about services provided by the VA Medical Center.
  • I processed VA ID cards for newly enrolled patients and assist with replacement cards for established patients using VHIC.
  • I entered and verified demographic, insurance, military service, service-connected ratings, and income information provided by applicants using the following systems: VIC, HINQ, VIS, VISTA, and ESR.
  • I performed technical activities involved with screening, processing, and assisting veterans, non-veterans, and beneficiaries seeking multiple medical treatment benefits.
  • I ensured all veterans are in the database eligible for enrollment are properly enrolled through the Health Eligibility Center and all registrations are complete with no missing data.
  • I interpreted and fully understood all eligibilities requirement, to make initial determinations whether veterans/non-veterans meet legal/contractual requirements for medical care.
  • I provided each patient information on patient rights and responsibilities for both inpatient and outpatient care.
  • I monitored enrolled patient database for information on a regular basis to perform any necessary updates to health insurance data, income assessments for the Means Test and Pharmacy Co-pay Exemption programs as mandated by law.
  • I served as relief and support to Beneficiary Travel clerk and all Patient Service Assistant clerks assigned to the Enrollment and Admissions Office.
  • I was the Subject Matter Expert and advisor to Veterans on the National Enrollment Program, the established priority levels, the Uniform Benefits Package, and benefits not affected by this legislation.
  • I performed Decedent Affairs functions, entering death entry into VISTA and recording all deceased Veterans’ information on LEAF and SharePoint spreadsheets.
  • I was responsible for initial determination on whether the deceased Veteran meets legal requirements for burial benefits and provide all necessary paperwork needed.
  • I served as primary contact for deceased Veterans’ families who are applying for the Veterans’ death benefits, providing advisory and technical assistance in a compassionate manner.
  • I used to excel spreadsheet to manage and maintain the Memphis VAMC daily report for the Morgues contacted.
  • I served as liaison between burial facilities and Memphis VAMC to coordinate the release of deceased Veterans’ while maintaining all required documents for proper release.
  • I utilized CPRS, VISTA GUI, and VISTA to cancel all future appointments and consults and ensure any open encounters are cleared for deceased Veterans for Test and Deceased Report.
  • I answered a multi-line telephone in a timely and courteous manner, determine the nature and/or urgency of the request and either resolve the request or refer it to the appropriate individual.
  • I adhered to the VA Privacy and HIPAA policies in all interactions regarding patients or their personal health information.

Advanced Medical Support Assistant (AMSA), Mental Health

Department of Veterans Affairs - Memphis VAMC
Memphis, TN
02.2019 - 04.2021
  • I worked collaboratively and coordinate with the patient care team to review the clinic utilization by using various reports such as Clinic Utilization Statistical Summary.
  • I ensured that the clinic setup was closely monitored to effectively support the needs of the clinic and make any necessary adjustments.
  • I develop and maintain effective and efficient communication with the patient, interdisciplinary team, management team, VA medical centers, and other agencies.
  • I collect, scan, and update health insurance information in ICB, promote Veteran registration and utilization of My HealtheVet (MHV).
  • I provided doctors for return to work.
  • I mailed appointment reminders for upcoming appointments.
  • I cross-trained other MSAs on correct clinic operations and serve as a preceptor to developmental level MSAs.
  • I scheduled appointments using VISTA and VISTA GUI; notifying provider and supervisor when clinic area access is less than desirable or if an individual patient cannot be scheduled within mandated timeframes.
  • I reviewed daily the active and pending consults, encounters, Electronic Wait List, Recall list and MHV secure messaging communications for accuracy and disposition.
  • I ensured that patient appointments are appropriately dispositioned and that current procedures are followed thoroughly for processing no show appointments in a timely manner.
  • I reported backlogs, difficulties in meeting deadlines, uncooperative physicians, or difficulty in securing information from clinicians to supervisor.
  • I organized work independently and handle scheduling problems and deviations based on knowledge of clinic operations and policy, schedules, and provider's preferences.
  • I identified customer's concerns, perform the tasks required to resolve the issue accurately and timely, and follow-up as necessary to ensure a satisfactory resolution.
  • I answered multi-line telephone in a timely and courteous manner within 2 rings, determine the nature and/or urgency of the request and either resolve the request or refer it to the appropriate individual.
  • I adhered to the VA Privacy and HIPAA policies in all interactions regarding patients or their personal health information.

Nursing Assistant, Spinal Cord Injury Unit

Department of Veterans Affairs - Memphis VAMC
Memphis, TN
09.2015 - 02.2019
  • I assisted 3-8 patients with activities of daily living such as bathing, dressing, toileting, feeding and mobility.
  • I took vital signs, weights, and chart patient’s nutritional intake and output using CPRS during an eight-hour shift.
  • I have experience observing/preventing skin breakdown, foley catheter care and irrigation, colostomy care, bowel training, administering EKG's, tracheostomy care, changing tracheal dressings and changing wet/dry dressings and report changes to the primary nurse.
  • I transferred patients to and from bed or wheelchair using proper lifting equipment; escorting patients to x-ray and CT appointments in the main hospital.
  • I performed passive/active range of motion and restorative care, documenting any behavioral or physical changes and report changes to the primary nurse.
  • I assisted with set-up for new admissions to the unit, transfers, discharges, and nursing procedures.
  • I adhered to close observation/suicide precaution policy and procedures when caring for patients who are deemed high risk.
  • I assisted in SCI Clinic with clerical duties as needed; answering phones, routing calls to appropriate parties, confirming patient information in CPRS.
  • I effectively communicate with patients, their families, interdisciplinary team and other personnel via phone or face-to-face interactions; providing emotional support when needed.

Financial Counselor

Semmes Murphy Clinic
Memphis, TN
09.2015 - 12.2016
  • I managed the internal and external referral process, and daily referral reconciliation, gathering all required documents and patient information for authorization and pre-certification.
  • I processed a variety of billing and accounting documents, such as invoices, forms, and records.
  • Analyzes source documents, such as obligations, disbursements, adjustments, and transfers.
  • I ensured that thorough and accurate patient registration was completed, confirming patient demographics and current insurance information.
  • I reviewed records and source documents when the reconciliation is out of balance to identify the cause of the discrepancy.
  • I followed up on missing authorizations, contacting patients to advise them of financial responsibility if authorization is not obtained within 48 hours prior to service.
  • I handled requests from third-party referral sources, providing relevant data and information as needed.
  • I answered a multi-line telephone in a timely and courteous manner, determined the nature and/or urgency of the request, resolved the request, or referred it to the appropriate individual.
  • I obtained and updated prior authorizations, and referral authorizations for both internal and external specialty offices.
  • I verified insurance eligibility and benefits on all assigned accounts using electronic verification systems, or by contacting payers directly to determine the level of insurance coverage.
  • I accurately documented insurance verification and authorization information in the system; identified outstanding deductibles, copayments, coinsurance, and policy limitations; and informed the patient of the amount due at or before the time of service.
  • I negotiated payment arrangements with creditors when necessary, on behalf of clients.
  • I answered clients' questions regarding the details of financial plans and strategies, and explained data in easy-to-understand terms.
  • I maintained knowledge and ensured procedures are followed, including referral guidelines and policies, privacy, and confidentiality, and utilized knowledge of insurance policies and procedures.
  • I reviewed clients' accounts and plans regularly to determine the need for plan reassessment.
  • Participate in department and market education, training, and meetings.

Certified Nurse Aide

Graceland Nursing Home
Memphis, TN
02.2006 - 09.2016
  • I assisted residents with activities of daily living such as bathing, dressing, toileting, feeding and mobility.
  • I took glucose readings, vital signs, weights, and chart resident’s nutritional intake and output during shift.
  • I experienced observing/preventing skin breakdown, foley catheter care, colostomy care, and changing wet/dry dressings and report changes to the primary nurse.
  • I transferred residents to and from bed, wheelchair or recliner using proper lifting equipment.
  • I performed passive/active range of motion and restorative care, documenting any behavioral or physical changes and report changes to the primary nurse.
  • I assisted with set-up for new admissions to the unit, transfers, discharges, postmortem care, and nursing procedures.
  • I adhered to close observation/suicide precaution policy and procedures when caring for patients who are deemed high risk.
  • I effectively communicated with residents, their families, interdisciplinary team and other personnel via phone or face-to-face interactions; providing emotional support when needed.
  • I answered the phone and transferring calls to appropriate parties when unit clerk or other staff are unavailable.
  • I provided patient reminders to take medication and nutritional supplements.

Authorization Specialist

People Mark (Bioventus)
Memphis, TN
04.2014 - 08.2015
  • I pre-screened all orders for medical necessity and referred completed documents for accuracy.
  • I completed thorough and accurate patient registration, confirming that patient demographics and current insurance information are collected and entered in the system.
  • I worked directly with the primary patient care provider and insurance carriers to maintain and update benefits for primary and secondary insurance coverage required for billing.
  • I verified calculations on financial reports, and computations of total cost on purchase orders and invoices.
  • I ensured that correct pricing and ICD codes are entered for durable medical equipment.
  • I reviewed applications to verify client information and resolve discrepancies.
  • I researched patient eligibility, coverage information, and benefit levels.
  • I applied reviewed analytical techniques so that I would uncover discrepancies, errors, and internal control issues.
  • I corresponded with insurance carriers to obtain prior authorization and pre-certification for medical procedures, to collect reimbursement per Bioventus guidelines, and reviewed financial responsibility with the payer and patient.
  • I entered data into the electronic medical record system accurately and efficiently.
  • I created spreadsheets utilizing Microsoft Excel for tracking authorization status updates from payers.
  • I investigated denials to ensure guidelines were followed, and proper coding was entered in the system before resubmitting claim forms.
  • I provided customer service to internal and external customers related to authorization requests.
  • I prepared appeal letters on behalf of clients when necessary, to resolve disputes with insurers.
  • I prepared and submitted claims appeals with the carrier and verified the credentials of providers to ensure that carrier protocols were met.
  • I explained the reasons behind application denials and recommended further action.
  • I maintained current knowledge of applicable regulations, laws, and standards.

Lead Financial Counselor

Regional One Hospital
Memphis, TN
09.2008 - 09.2012
  • I am responsible for the accurate and timely processing of patient accounts related to billing, collections, and reimbursements service in accordance with PFS standards, policies, and procedures.
  • I process billing discrepancies from Ledger for correction of claims/Invoices, within allotted time for payment.
  • I reviewed erroneous claims and researched commercial guidelines to ensure corrections, adjustments, and proper modifications to claims in accordance with documented billing procedures.
  • I served as an integral member of the Revenue Cycle team, ensuring that all financial obligations for medical services are collected and properly communicated with patient.
  • I Supervised the Admitting Clerks; provide daily work assignments, assist in orientation and continuous job training, ensure daily productivity standards are met, and assist with managing workflow.
  • I ensured pre-certification is obtained via software and/or phone for all inpatient stays or emergency procedures and provide patient with their estimated financial responsibility.
  • I used a computer or word processor to create, edit, print, retrieve, or manipulate files.
  • I protected the privacy of health information of patients when using or disclosing protected health information while complying with HIPAA regulations.
  • I answered a multi-line telephone in a timely and courteous manner, determines the nature and/or urgency of the request; resolve the request or refer it to the appropriate individual.
  • I promoted a positive work environment, ensuring the first line of contact with patients, families and staff appropriately display the quality of healthcare services at facility.
  • I attended and participated in daily team briefings, metrics tracking and prompt resolution of issues.

Admitting Clerk

Regional One Hospital
Memphis, TN
07.2006 - 09.2008
  • I interviewed and registered patients for medical treatment, services, and/or admission while using various methods to verify eligibility and entitlement for benefits; providing information and answering questions about services being provided.
  • I entered and verify patient demographic, income information and insurance, collecting any required co-pays.
  • I performed technical activities involved with screening, processing, and assisting patients seeking multiple medical treatment benefits.
  • I verified insurance eligibility and benefits on all assigned accounts using electronic verification systems or by contacting payers directly to determine level of insurance coverage.
  • I accurately document insurance verification and authorization information in system; identify outstanding deductibles, copayments, coinsurance, and policy limitations and inform patient of the amount due at or before the time of service.
  • I assisted in cording bed control activities to ensure patients are assigned appropriate level of care and accurate bed assignment in accordance with established policies and procedures.
  • I collaborated with medical staff and nursing to expedite admissions and transfers.
  • I answer a multi-line telephone in a timely and courteous manner, determines the nature and/or urgency of the request; resolve the request or refer it to the appropriate individual.
  • I maintained knowledge and ensure procedures are followed including referral guidelines and policies, privacy, and confidentiality, and utilize knowledge of insurance policies and procedures.
  • I participated in department and market education, training, and meetings.

Certified Nurse Assistant

Regional One Hospital
Memphis, TN
09.1997 - 07.2006
  • I assisted patients with activities of daily living such as bathing, dressing, toileting, feeding and mobility.
  • I took glucose readings, vital signs, weights, and chart resident’s nutritional intake and output during shift.
  • I observed/prevented skin breakdown, foley catheter care, colostomy care, administer EKG's, tracheostomy care, change tracheal dressings and wet/dry dressings and report changes to the primary nurse.
  • I transferred residents to and from bed, wheelchair or recliner using proper lifting equipment; escorting residents to dental and doctor appointments in the main hospital.
  • I performed passive/active range of motion and restorative care, documenting any behavioral or physical changes and report changes to the primary nurse.
  • I obtained and label specimens to include clean catch urine specimens or sterile specimens; transporting to the laboratory as needed.
  • I assisted with set-up for new admissions to the unit, transfers, discharges, postmortem care, and nursing procedures.
  • I adhered to close observation/suicide precaution policy and procedures when caring for patients who are deemed high risk.
  • Effectively communicate with residents, their families, interdisciplinary team and other personnel via phone or face-to-face interactions; providing emotional support when needed.
  • I answered the phone and transferred calls to appropriate parties when unit clerk or other staff were unavailable.

Education

High School Diploma -

Coahoma Agricultural High School
Clarksdale, MS
05.1986

Skills

  • Benefit verification
  • Claims processing
  • Effective communication
  • Attention to detail
  • Problem solving
  • Data entry
  • Medical terminology
  • Customer service
  • Vista GUI
  • CPRS
  • Enrollment System (ESR)
  • Veteran Information System (VIS)
  • VIC
  • Hospital Inquiry (HINQ)
  • Veterans Health Identification Card (VHIC)
  • PCCM (Primary Care Management Module)
  • Health Eligibility Center (HEC)
  • SAP
  • HMS
  • Meditech
  • Cerner
  • Soarian
  • NexGen
  • AR Accelerator
  • Centricity
  • SharePoint
  • Microsoft Office
  • Appraisal review
  • Outlook
  • Excellent customer service
  • Conflict resolution
  • Prior authorization
  • Insurance verification
  • Medical billing
  • Benefit Enrollment
  • Time management
  • Patient registration
  • Confidentiality compliance
  • Data analytics
  • Recordkeeping and data input
  • Documentation and paperwork

Job Related Training

  • Certified Nurse Aide, Tennessee, 07/2024, 64779
  • CPR/AED, BLS for Healthcare Providers, American Heart Association

References

References available upon request.

Timeline

Certified Nursing Assistant

Trezevant Manor
10.2024 - Current

Customer Service Representative

CoSolutions, Inc.
04.2024 - 10.2024

Program Support Assistant

Department of Veterans Affairs - Memphis VAMC
01.2023 - 07.2024

Advanced Medical Support Assistant (AMSA), Decedent Affairs/Eligibility

Department of Veterans Affairs - Memphis VAMC
04.2021 - 01.2023

Advanced Medical Support Assistant (AMSA), Mental Health

Department of Veterans Affairs - Memphis VAMC
02.2019 - 04.2021

Nursing Assistant, Spinal Cord Injury Unit

Department of Veterans Affairs - Memphis VAMC
09.2015 - 02.2019

Financial Counselor

Semmes Murphy Clinic
09.2015 - 12.2016

Authorization Specialist

People Mark (Bioventus)
04.2014 - 08.2015

Lead Financial Counselor

Regional One Hospital
09.2008 - 09.2012

Admitting Clerk

Regional One Hospital
07.2006 - 09.2008

Certified Nurse Aide

Graceland Nursing Home
02.2006 - 09.2016

Certified Nurse Assistant

Regional One Hospital
09.1997 - 07.2006

High School Diploma -

Coahoma Agricultural High School

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Dorothy Stuckey