Evoni Simmons
Sacramento,CA
Summary
Detail-oriented with well-established knowledge of control process validation. Trained in multiple areas and known for great attention to detail, exemplary auditing skills, and commitment to excellence.
Overview
8
8
years of professional experience
Work History
Billing Auditor
Poplar Medical
Memphis, TN
12.2024 - Current
- Investigated and resolved billing issues to maximize cash flow and minimize liabilities.
- Updated and managed accounts payable databases, employing access controls to protect data.
- Presented audit results to management teams, delivering information in non-technical terms for easy understanding.
- Reached out to attorneys for medical liens and letters of protection in order to bill patients' ledgers.
- Prepared audit reports summarizing findings and recommending corrective action when necessary.
- Generated periodic statistical reports on billing performance metrics such as revenue collection rates, dispute resolution times.
- Posted financial data in Excel spreadsheets and managed inventory.
- Reviewed and audited financial records to identify discrepancies and ensure accuracy of billing information.
Physical Therapist Assistant
Poplar Medical
Memphis, TN
08.2024 - 12.2024
- Assisted with treating acute care patients.
- Ensured compliance with all healthcare regulations and standards during therapy sessions.
- Minor front office duties, such as scanning, uploading, and filing.
- Documented patients' pain levels and modalities to be entered into the company's documentation system, Eclipse.
- Implemented treatment plans designed by the physical therapist, such as heat, cold, muscle stimulation, dry hydrotherapy, and cold laser treatment.
- Assisted patients with therapeutic exercises, manual therapy techniques, and modalities.
Front and Back Office Lead Medical Assistant
ExamWorks
Sacramento, CA
05.2023 - 07.2024
- Kept facility stocked with necessary supplies, equipment and instruments.
- Managed back-office duties such as patient check-in and check-out, rooming patients, taking vital signs, and preparing charts for physician visits.
- Incorporated outside records into charts and EHR.
- Supervised, trained and coached team of medical assistants.
- Set up, cleaned and stocked examination rooms with medical supplies.
- Organized charts, documents and supplies to maintain team productivity.
- Assisted physicians during examinations by taking notes on patient history and symptoms presented.
- Collaborated with Worker's Compensation Attorney's to gather and process medical records requests, including release of information forms.
- Handled general office duties to support administrative staff during peak hours.
- Scheduled appointments for patients via phone and in person.
Dental Claims Processor
Robert Half Staffing Agency
Sacramento, CA
01.2023 - 04.2023
- Conducted quality assurance reviews of submitted claims to ensure they meet all requirements prior to submission.
- Resolved discrepancies between insurance companies and patients regarding payments, fees, and benefits.
- Prepared detailed reports to document claims processing activities.
- Organized information by using spreadsheets, databases or word processing applications.
- Transcribed data to worksheets and entered data into computer to prepare documents and adjust accounts.
- Used insurance rate standards to calculate premiums, refunds, commissions and adjustments.
- Maintained updated knowledge of federal and state laws pertaining to health care reimbursement practices.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Assisted with the development of procedures for processing dental claims in accordance with current standards.
- Processed incoming patient data into system, including demographic information and insurance coverage details.
- Evaluated patient eligibility for services based on plan documents and state regulations.
- Acted as liaison between providers and insurers and payers when necessary.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Ensured compliance with HIPAA guidelines throughout all stages of the claims processing process.
- Examined claims, records and procedures to grant approval of coverage.
Collections Account Manager
American Car Center
Memphis, TN
04.2022 - 12.2022
- Developed relationships with customers to encourage resolution of overdue accounts.
- Encouraged customers to pay due amounts on credit accounts, claims or overdrawn checks.
- Assisted customers in resolving billing disputes or other issues that impacted their ability to pay outstanding balances.
- Contacted customers with delinquent accounts to solicit payment.
- Maintained detailed records of all collection activity including calls, emails, letters and payments received.
- Coordinated legal action against delinquent accounts when necessary.
- Located new addresses of delinquent customers through research, contacting credit bureaus or by questioning neighbors.
- Used excellent verbal skills to engage customers in conversation and effectively determine needs and requirements.
- Negotiated repayment arrangements with customers to ensure timely payments were made.
- Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
- Accepted and processed customer payments and applied toward account balances.
Answering Service Operator
MAP Communications
Memphis, TN
01.2022 - 03.2022
- Shared or forwarded messages and information to designated personnel.
- Handled incoming and outgoing calls according to standard operating procedures.
- Routed calls to appropriate personnel or departments.
- Followed up with customers on outstanding requests or orders placed over the phone.
- Responded to customer inquiries in a timely manner.
- Answered customer inquiries via telephone and email in a timely manner.
Outreach Coordinator
Managed Staffing
Sacramento, CA
09.2021 - 01.2022
- Provided direct service and support by handling referrals for advocacy issues or resolving complaints.
- Performed ongoing monitoring of care plans to evaluate effectiveness, documenting interventions and goal achievements and suggesting changes accordingly.
- Handled administrative procedures to meet objectives set by boards of directors or senior management.
- Communicated regularly with staff members to ensure that all outreach materials were up-to-date and accurate.
- Acted as consultant to community programs by interpreting regulations and policies.
Member Relations Specialist
California Dental Association
Sacramento, CA
02.2020 - 06.2021
- Presented and explained services and products to meet member needs.
- Educated non-members of the Association's products and services.
- Served as liaison between CDA and its 32 local components, including the American Dental Association.
- Processed membership payments, and worked closely with the finance department to resolve any payment discrepancies.
- Assisted with activities related to member benefits, such as conferences (CDA Presents), oral health clinics (CDA Cares), or onsite meetings.
- RDA, DMD, DDS, and licensing verifications.
Appeals and Grievances Coordinator
Centene
Rancho Cordova, CA
11.2016 - 01.2020
- Collaborated with other departments within the organization to identify potential solutions for resolving customer disputes.
- Researched case files to ensure accuracy of information prior to making decisions on appeals or grievances.
- Triaged expedited medical and RX appeals within 72 hours.
- Triaged Medicare Part D appeals within 24 hours.
- Compiled data on an ongoing basis concerning trends in appeals or grievances filed.
- Monitored progress made towards resolving appealed or grieved matters.
- Prepared written responses to customers regarding the status of their appeal or grievance filings.
- Drafted reports summarizing findings from investigations into appealed or grieved matters.
- Interpreted external regulations governing the handling of appeals and grievances.
- Assessed customer complaints to determine eligibility for appeal or grievance filing.
- Attended hearings as a representative of the organization when necessary.
Education
High School Diploma -
Monterey Trail High School
Elk Grove, CA05-2014
Some College (No Degree) -
University of Phoenix
Tempe, AZSkills
- Billing reconciliation
- Audit reporting
- Financial analysis
- Claims processing
- Data entry
- Revenue collection
- Dispute resolution
- Medical billing
- Compliance auditing
- Time management
- Problem solving
- Data interpretation
- Regulatory compliance
- Record examination
- Insurance confirmation
- Decision-making
- Compliance standards
Languages
Spanish
Limited
Timeline
Billing Auditor
Poplar Medical
12.2024 - Current
Physical Therapist Assistant
Poplar Medical
08.2024 - 12.2024
Front and Back Office Lead Medical Assistant
ExamWorks
05.2023 - 07.2024
Dental Claims Processor
Robert Half Staffing Agency
01.2023 - 04.2023
Collections Account Manager
American Car Center
04.2022 - 12.2022
Answering Service Operator
MAP Communications
01.2022 - 03.2022
Outreach Coordinator
Managed Staffing
09.2021 - 01.2022
Member Relations Specialist
California Dental Association
02.2020 - 06.2021
Appeals and Grievances Coordinator
Centene
11.2016 - 01.2020
High School Diploma -
Monterey Trail High School
Some College (No Degree) -
University of Phoenix
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