Enid Thomas-Wade, CMT, CNA, CPC
Hoschton,GA
Summary
Experienced healthcare professional with 16 years of patient care and daily living assistance. Expertise in providing compassionate care and supporting medical staff in fast-paced environments. Reliable team player focused on adapting to evolving patient needs and delivering quality outcomes. Proficient with conflict resolution, documentation management, and policy compliance. Utilizes strong communication skills to mediate disputes and foster understanding, with a track record of enhancing grievance procedures and supporting organizational harmony.
Overview
16
16
years of professional experience
Work History
Senior Grievance Coordinator
The Cigna Group
05.2019 - Current
- Investigate grievances or appeals and respond to complaints consistently, adhering to all regulatory, accreditation, and internal processing timelines and guidelines
- Keep cases in compliance with Medicare and prepare a variety of different written communications, reports, and documents
- Document and monitor appropriate tracking systems ensuring the quality and accuracy of work is outstanding
- Aid in the preparation of reports to various collaborators and provide feedback on ways in which cases can be enhanced or improved
- Complete internal and external case audits, and provide feedback and training
- Case Management/Conflict Resolution Assist care, delivery managers and providers develop a plan of action for managing difficult, abusive, or fraudulent cases
- Stay ahead of any changes to health plan policies and procedures and work closely with key partners to ensure files are prepared for external agencies are accurate, well-written, and meet the needs of all parties
- Weekend and Holiday on-call coverage to meet the needs of the members and the organization.
- Train new team members by relaying information on company procedures and safety requirements.
- Promote a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.
- Direct and engaged in conflict resolution and productivity development.
- Establish positive relationships with internal departments, enhancing cooperation when resolving cross-functional grievances.
- Maintained accurate records of all grievance cases, facilitating easier reporting and analysis of trends.
- Reduced case backlog by prioritizing urgent grievances and effectively delegating tasks to team members.
Senior Revenue Cycle Management Specialist
PhyBus, LLC
05.2018 - 12.2019
- Monitored Insurance verification, Appeals processing Patient's phone calls and or inquiries
- Researched denied CPT codes with comparison to the LCD/NCD requirements, audited medical claims and applied appropriate coding/billing procedures
- Maintained knowledge of managed care contracts and fee schedules including Medicare and Medicaid
- Generated weekly billings of third-party payors, charge entry, and monthly patient statements
- Reconciled cash received for billing and entry of reconciled cash or check receipts into the patient's account
- Account follow-up 31 days and greater including self-pay accounts and AR discrepancy log
- Posted daily adjustments, refunds, and write-offs of accounts as needed.
- Decreased Workers compensation claims by one-third from $486k to 396k.
- Reduced outstanding AR in the 180+ day aging bucket from $900k to less than $500k within 4 months.
Referral Coordinator
Piedmont Cancer Institute
10.2016 - 11.2017
- Assigned insurance payers to ensure proper reimbursement, billing, follow-up, or collections steps qualification
- Scheduled appointments with specialists on behalf of clients.
- Demonstrated strong attention to detail and organizational skills in managing a high volume of referrals while maintaining exceptional levels of patient care.
- Proficient with Excel, data entry, cash posting, hospital charges analyzing daily correspondence denials, and underpayments
- Maintained working knowledge of CPT, ICD-10 CM, ICD-9 CM, coding principles government regulations protocols and 3rd party regulations.
Private Duty CNA
Maxim Healthcare Services
07.2011 - 11.2015
- Aided in daily living activities according to the personal care plan
- Monitored clients and charted vital signs, changes in behavior, and other pertinent information.
- Ensured meals and medications were provided at appropriate times
- Delivered exceptional patient care while working closely with interdisciplinary teams of healthcare professionals.
- Contributed to developing individualized care plans, collaborating with medical professionals to ensure optimal patient outcomes.
- Checked patient vitals such as temperature, blood pressure, and blood sugar levels.
- Administered prescribed medications under supervision, ensuring accurate dosages for optimal treatment efficacy.
Certified Nursing Assistant (CNA)
Watermark
08.2009 - 12.2012
- Responsible for caring for clients while multitasking
- Observe and document any changes and the status of the client.
- Supported residents with bathing, feeding, personal care, and appointments
- Supported the needs of 6+ residents under long-term care.
- Collaborated with nursing leadership to implement range of motion protocols, resulting in a 25% reduction in patient falls.
- Assisted patients with daily living activities, promoting independence and dignity.
- Checked patient vitals such as temperature, blood pressure, and blood sugar levels.
Education
Certificate - CMT, CNA
Hillendell Medical Training LLC
03-2025
Bachelor of Science - Health Information Management
University of Arizona Global Campus
12.2023
Associates of Science - Medical Office Management
Norwalk Community College
01.2016
CPC - Certified Professional Coder Medical Billing & Coding (AAPC)
Housatonic Community College
01.2016
Skills
- Certified Nursing Assistant (CNA)
- Certified Medication Technician (CMT)
- Basic Life Support (CPR & AED)
- Certified Professional Coder (CPC)
- Member Development Officer (2020-2022) Current
- A Beacon of Hope, Every Mother's Advocate (EMA)
- Registered Health Information Administrator (RHIA)-Candidate
- MS Word/MS Excel
- PowerPoint/Outlook
- SQL Quantitative Research and Databases
- Evidence-Based Decision Making
- Budget Forecasting
- Data Integrity Assurance
- Audit Reporting and Support
- Centricity
- Epic/EncoderPro
- EClinicalWorks
- HSTpathways/QNXT
- Harris CareTracker/Spinfusion
- Team Collaboration and Leadership
- Analytical Thinking
- Dispute resolution
- Cross-functional coordination
Timeline
Senior Grievance Coordinator
The Cigna Group
05.2019 - Current
Senior Revenue Cycle Management Specialist
PhyBus, LLC
05.2018 - 12.2019
Referral Coordinator
Piedmont Cancer Institute
10.2016 - 11.2017
Private Duty CNA
Maxim Healthcare Services
07.2011 - 11.2015
Certified Nursing Assistant (CNA)
Watermark
08.2009 - 12.2012
Bachelor of Science - Health Information Management
University of Arizona Global Campus
Associates of Science - Medical Office Management
Norwalk Community College
CPC - Certified Professional Coder Medical Billing & Coding (AAPC)
Housatonic Community College
Certificate - CMT, CNA
Hillendell Medical Training LLC
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