EMILY ELY
Eden
Summary
Experienced in medical insurance representation, with comprehensive knowledge of health insurance policies, claims processing, and patient advocacy. Skilled in bridging gaps between healthcare providers and insurance companies, ensuring optimal coverage for patients. Strengths include strong customer service skills, ability to handle high-stress situations, and demonstrated proficiency in medical coding and billing software. Previous roles marked by enhanced efficiency in claims processing and improved patient satisfaction rates.
Overview
23
23
years of professional experience
Work History
Medical Insurance Representative
Eden Internal Medicine
Eden
09.2022 - Current
- Performed regular reviews of medical insurance accounts to identify any potential issues or changes in policy terms.
- Resolved customer inquiries related to medical insurance plans, including eligibility, billing, and claims processing.
- Responded promptly and accurately to requests for information from both internal teams and external customers and providers.
- Identified areas where process improvements could be made in order to streamline operations within the department.
- Provided advice and assistance on medical insurance coverage options to clients.
- Served as a liaison between customers, insurers, healthcare providers, and other stakeholders regarding matters pertaining to medical insurance policies.
- Maintained detailed records of customer interactions and transactions while adhering to data privacy laws.
- Investigated discrepancies in invoices or payment records and coordinated resolution with customers or providers.
- Prepared reports on claims activity or other performance metrics for management review.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Reviewed administrative guidelines whenever questions arose during processing of claims.
Certified Allergy Technician
American Allergies, LLC
01.2021 - Current
- Stocked prepared/disinfected office/testing area each day
- Tested patients for 80 different allergens, evaluated & documented reactions and developed treatment plans including antigen injections
- Calculated and mixed each antigens in order for patient to begin immunotherapy
- Administered immunotherapy injections to patients
- Completed all billing using Availity and other Insurance Providers
- Utilize systems and technology to complete account management tasks
- Listen to customers/patients, understand their needs, and resolve any billing/healthcare issues
- Controlled office expenses through proper ordering
- Maintained in-date inventory
- Scheduled appointments and meetings with corporate offices
- Recorded and reported all patient incidents/complaints in accordance with American Allergies procedural expectations
911 TELECOMMUNICATOR
Rockingham County Emergency Services
Wentworth
06.2018 - 10.2021
- Notified supervisors of unusual problems and problem trends
- Operates a two-way radio or telephone to receive and transmit messages for County Sheriff's Department and Jail, municipal police departments, volunteer and municipal fire departments, Highway Patrol, Department of Transportation, rescue squads, ambulance service, air ambulance service, public utilities, magistrate's office, animal control, wildlife services, various human services agencies, Department of Social Services, etc.
- Receives complaints and requests for service by telephone or radio and in person
EMERGENCY MEDICAL TECHNICIAN
Guilford County Emergency Medical Services
Greensboro
10.2017 - 05.2018
- Communicated with dispatcher to receive and understand call data and customer feedback.
- Demonstrated sense of professionalism and ethical standards.
- Assessed each call situation to determine best course of action and appropriate protocol
- Performed Basic Life Saving skills on a daily basis
CERTIFIED NURSING ASSISTANT/NURSE TECH +3
Morehead Memorial Hospital Nursing Center
Eden
08.2016 - 10.2017
- Identified and recorded signs and symptoms of physical and mental conditions
- Took vital signs including, pulse and blood pressure and CBG
- Bathed, feed, dressed and cared for physical and psychosocial needs of patients
- Anticipated customer's desires and took proactive steps to meet those needs
- Inserted and d/c’d foley caths, primed/dc’d IV’s and performed sterile dressing changes
ARBY’S SHIFT MANAGER
Arby’s
Eden & Reidsville
06.2002 - 10.2008
- Maintained an atmosphere of enthusiastic customer awareness while exercising friendly customer service
- Offered solutions that met or exceeded customers’ expectations on a daily basis
- Supervised the performance of all duties and responsibilities of employees
- Utilized and completed financial reports, scheduling, productivity and end of shift reports
Education
EMT/Practical Nursing -
ROCKINGHAM COMMUNITY COLLEGE
Wentworth, NCSkills
- Claims processing
- Policy review
- Customer service
- Data entry
- Billing inquiries
- Regulatory compliance
- Record keeping
- Process improvement
- Report preparation
- Problem resolution
- Communication skills
- Attention to detail
- Time management
- Team collaboration
- Customer advocacy
- Medical coding
- Microsoft office
- Policy interpretation
- Insurance regulations
- HIPAA compliance
- Healthcare billing
- Claim denial resolution
- Professionalism and ethics
- Lapsed case follow up
- Thorough claims reviews
- ICD codes
- Medical terminology
- Insurance claims
- Critical Decision-making
Education Certifications
- Certified Allergy Technician
- CPR current
- Emergency Medical Technician (expired but can renew)
- Emergency Telecommunicator
- Emergency Medical Dispatcher with Honors
- Emergency Police Dispatcher with Honors
- Emergency Fire Dispatcher
- Emergency Vehicle Operations
- EMT/Practical Nursing, ROCKINGHAM COMMUNITY COLLEGE, Wentworth, NC
Timeline
Medical Insurance Representative
Eden Internal Medicine
09.2022 - Current
Certified Allergy Technician
American Allergies, LLC
01.2021 - Current
911 TELECOMMUNICATOR
Rockingham County Emergency Services
06.2018 - 10.2021
EMERGENCY MEDICAL TECHNICIAN
Guilford County Emergency Medical Services
10.2017 - 05.2018
CERTIFIED NURSING ASSISTANT/NURSE TECH +3
Morehead Memorial Hospital Nursing Center
08.2016 - 10.2017
ARBY’S SHIFT MANAGER
Arby’s
06.2002 - 10.2008
EMT/Practical Nursing -
ROCKINGHAM COMMUNITY COLLEGE