Summary
Overview
Work History
Education
Skills
Timeline
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Enid Thomas-Wade, CPC

Hoschton,GA

Summary

Recent Health Information Management graduate highly knowledgeable in electronic health records software. Revenue Cycle Analysts with Senior leadership in billing operations, improving team performance, and onboarding new employees. Communicative Team Lead with a passion for Medicare Advantage operations, working collaboratively with departments to minimize risk and effectively resolve issues. Offers an entrepreneurial attitude with proven abilities in strategic business planning, financial management, marketing, and operational management. Ability to function and excel in a remote environment as a Certified Professional Coder with 8 years of experience, in a fast-paced position handling time-critical appeals, authorizations, and grievance cases. Eager to secure an entry-level Health Information Manager (HIM) position and take on a challenging role with an established organization with room for advancement. A flexible, exceptional leader, focused on conflict resolution, boosting productivity and performance with conscientious and detail-oriented approaches. Hardworking and passionate with strong organizational skills. Excited to apply proficiency and ready to help the team achieve company goals.

Overview

15
15
years of professional experience

Work History

Senior Grievance Coordinator Team Lead

Cigna Medicare
05.2022 - 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 supervise a team of 12, engaged in conflict resolution and productivity development.
  • Establish positive relationships with internal departments, enhancing cooperation when resolving cross-functional grievances.

Senior Authorization Analyst

Cigna Medicare
2020 - 2022
  • Trained new prior authorization associates in proper procedures
  • Explained authorization process and results to providers by phone or letter notification
  • Researched accurate assigned CPT, ICD-10, HCPCS codes and guidelines
  • Followed all Medicare, Medicaid, HIPAA, and private insurance, regulation and requirements
  • Validated results and performed quality assurance to assess the accuracy of data.
  • Collaborated with cross-functional teams to identify opportunities for process improvement and increased efficiency.

Senior Customer Service Analyst

Cigna Medicare
2019 - 2020
  • Received inbound calls from MAPD customers about their healthcare plans and benefits
  • Assisted members with online provider and pharmacy director research and demographic updates
  • Advised all copay information including office visits, dental, hearing, vision, and transportation
  • Verified authorization, referral, and grievance statuses
  • Provided first-call resolution and follow-up calls
  • Selected on the Organizational Determination change and suggestion review panel
  • Participated in the Customer Experience Investigator Project (CEI)
  • Quality 100%, Adherence 98% AHT 11:13 seconds, Hold 64 seconds, and no CTM's.
  • Introduced quality assurance measures that significantly reduced error rates in case management activities.
  • Implemented new strategies to reduce customer wait times, enhancing the overall support experience.
  • Streamlined customer support processes for increased efficiency and faster response times.
  • Mentored junior analysts, fostering professional growth and improving team performance.
  • Consistently exceeded performance targets through diligent work ethic and commitment to excellence in customer service delivery.
  • Managed high-stress situations with tact and professionalism, maintaining positive relationships with customers during difficult interactions.
  • Spearheaded initiatives to automate repetitive tasks, increasing efficiency and reducing errors in the team's workflow.

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 Certified Nursing Assistant (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 the development of individualized care plans, collaborating with medical professionals to ensure optimal patient outcomes.

CNA

Watermark
08.2009 - 12.2012
  • Responsible for caring for clients while multi-tasking
  • Observe and document any changes and status of the client
  • Supported residents with bathing, feeding, personal care, and appointments
  • Collaborated with nursing leadership to implement range of motion protocols resulting in a 25% reduction in patient falls.

Education

Online (RHIA-Candidate) - Health Information Management

University of Arizona Global Campus
Chandler, AZ
12.2023

Bachelor of Science - Public Health Education

Kennesaw State University
Kennesaw, GA
05.2019

Associates of Science - Medical Office Management

Norwalk Community College
Norwalk, CT
01.2016

CPC - Certified Professional Coder Medical Billing & Coding (AAPC)

Housatonic Community College
Bridgeport, CT
01.2016

Skills

  • Certified Nursing Assistant (CNA)
  • Certified Professional Coder (CPC)
  • 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

Timeline

Senior Grievance Coordinator Team Lead

Cigna Medicare
05.2022 - Current

Senior Revenue Cycle Management Specialist

PhyBus, LLC
05.2018 - 12.2019

Referral Coordinator

Piedmont Cancer Institute
10.2016 - 11.2017

Private Duty Certified Nursing Assistant (CNA)

Maxim Healthcare Services
07.2011 - 11.2015

CNA

Watermark
08.2009 - 12.2012

Senior Authorization Analyst

Cigna Medicare
2020 - 2022

Senior Customer Service Analyst

Cigna Medicare
2019 - 2020

Online (RHIA-Candidate) - Health Information Management

University of Arizona Global Campus

Bachelor of Science - Public Health Education

Kennesaw State University

Associates of Science - Medical Office Management

Norwalk Community College

CPC - Certified Professional Coder Medical Billing & Coding (AAPC)

Housatonic Community College

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Enid Thomas-Wade, CPC