Gamika Jones
Casa Grande,AZ
Summary
Detail-oriented professional with excellent communication, interpersonal and creative thinking skills. Aiming to leverage my abilities to successfully fill the vacancy for the company. Frequently praised as hardworking by my peers, I can be relied upon to help your company achieve its goals.
Overview
12
12
years of professional experience
Work History
Contracting/Credentialing Specialist
RCBilling
Cedar Park, TX
01.2023 - Current
- Review, draft, and negotiate contractual agreements, including but not limited to, non-disclosure agreements, service agreements,purchase agreements,and licensing agreements.
- Ensure contract compliance with legal requirements and company policies
- Manage contract change requests, amendments and extensions.
- Direct contracting with health insurance payers, and in some cases, conduct SCA's.
- Maintain contract records and documentation.
- Create and maintain licensing, credentials and insurance records.
- Conduct research on updated state and federal regulations and policies.
- Monitor licensee and credential expirations dates and advise staff members of required "renew by" dates.
- Ensure the facility and staff members are maintaining compliance with regulatory and accrediting institutions.
Senior Contracting Specialist
Lisa Tyson Private Consulting
Tolleson , AZ
01.2016 - Current
- Coordinate several contracting and credentialing work for insurance companies and doctor's offices
- Review and redline provider contracts with CMS guidelines
- Fill network gaps
- Update CAQH applications
- Negotiate provider's contracts
- Initiate single case agreements
- Design and execute member programs for clients.
Pre-service Contracting Representative
Oscar Health West Region
Tempe, AZ
01.2022 - 01.2023
- Develop and implement purchasing and contract management instructions, policies and procedures
- Develop a comprehensive understanding of the contract drafting and execution processes
- Became an in-house expert on SCA contracting processes
- Ensure that all SCA contracts are turned around within required timelines
- Contribute to team-wide goals to improve the SCA Contracting team outcomes.
Financial Counselor
Springstone/Copper Springs East
Gilbert, AZ
10.2021 - 01.2022
- Assessed patient's financial ability
- Determined patient's ability to pay
- Advised patients of insurance benefits and explains financial liability
- Collected patient's payment, negotiates payment arrangement, secures financing, and identifies funding sources
- Verified patient's insurance benefits
- Obtained proper authorization and identification prior to release of confidential medical records.
Patient Service Representative, III
Ortho Arizona
Scottsdale , AZ
02.2021 - 10.2021
- Team Lead for the front desk staff
- Communicated delays in appointments and offered rescheduling
- Answered, investigated and directed patient inquiries or complaints to manager
- Obtained proper authorization and identification prior to release of confidential medical records
- Provided clerical support to assist in delivery of quality health care services
- Verified and updated changes in patient, physician, or insurance to maintain proper billing
- Obtained and validated photo identifications and insurance cards, scanning documents into patients' charts
- Coordinated with back office staff for timely and effective care of patients.
Scheduler/Register
HonorHealth
Phoenix, AZ
02.2018 - 02.2021
- Team Lead for the scheduling staff for the Gastroenterology office
- Team Lead for the front desk staff for Cardiac Rehab, Physical Therapy, and Wound Care
- Utilized computerized appointment scheduling system and supported updates
- Communicated additions, cancellations and special requests for appointment schedules to appropriate parties
- Generated and communicated new ideas and suggestions to improve quality of service
- Answered phones, returning messages to schedule appointments
- Collected demographic data at time of appointment scheduling
- Achieved appointment-setting goals by meeting objectives and metrics
- Coordinated appointments according to established scheduling guidelines.
Reimbursement Specialist
McKesson
Scottsdale, AZ
11.2016 - 02.2018
- Contacted health insurance companies on behalf of doctors to gain patients eligibility and benefits.
- Collaborated closely with team members to achieve project objectives and meet deadlines.
- Maintained updated knowledge through continuing education and advanced training.
- Managed time effectively to ensure tasks were completed on schedule and deadlines were met.
Customer Service Representative
Luxottica
Mason, OH
06.2015 - 08.2016
- Addressed customers courteously using suitable methods and problem-solving skills
- Remained open to feedback from supervisor and peers to build and improve skills set
- Followed up with customers regarding product functionality and overall satisfaction
- Greeted customers by name and displayed respectful attitude, helping develop rapport with customer base and build lasting relationships
- Complied with corporate and regulatory policies regarding information confidentiality and privacy
- Provided account information to customers and explained bill service policies and customer rights
- Maintained logs and documentation to detail key information regarding incoming and outgoing calls
- Updated and maintained database with accurate customer information and timely data entry
- Utilized automated systems to log and retrieve call information
- Maintained knowledge of company products to provide helpful suggestions and recommendations to customers
- Responded to telephone inquiries and complaints following standard operating procedures.
Customer Service Representative
Medicare/Medicaid
Coralville, IA
01.2013 - 05.2014
- Addressed customers courteously using suitable methods and problem-solving skills
- Updated and maintained database with accurate customer information and timely data entry
- Responded to telephone inquiries and complaints following standard operating procedures
- Provided account information to customers and explained bill service policies and customer rights
- Delivered personalized customer service relating to questions and promptly resolved basic problems on customer accounts.
Education
Bachelor Of Science (B.S.) In Health Administration -
University of Phoenix
07.2021
Skills
- Provider contracting
- Contract negotiation
- Project management
- People Management
- Patient care
- Leadership
- Healthcare management
- Financial analysis
- Customer service
- Clerical experience
- Benefits administration
- ACA marketplace
- Medical customer service
- Microsoft Excel
- Microsoft Powerpoint
- Microsoft Word
- Credentialing
- Performance Mangement
- Process Improvement
- Workflow Design
- Management Consulting
- Improvement Plans
- Pricing Updates
- Financial and Operational Reporting
- Project Requirements
- Compliance Requirements
- Authorization
- Claims
Contact - Summary
Detail-oriented professional with excellent communication, interpersonal and creative thinking skills. Aiming to leverage my abilities to successfully fill the vacancy for the company. Frequently praised as hardworking by my peers, I can be relied upon to help your company achieve its goals.
Timeline
Contracting/Credentialing Specialist
RCBilling
01.2023 - Current
Pre-service Contracting Representative
Oscar Health West Region
01.2022 - 01.2023
Financial Counselor
Springstone/Copper Springs East
10.2021 - 01.2022
Patient Service Representative, III
Ortho Arizona
02.2021 - 10.2021
Scheduler/Register
HonorHealth
02.2018 - 02.2021
Reimbursement Specialist
McKesson
11.2016 - 02.2018
Senior Contracting Specialist
Lisa Tyson Private Consulting
01.2016 - Current
Customer Service Representative
Luxottica
06.2015 - 08.2016
Customer Service Representative
Medicare/Medicaid
01.2013 - 05.2014
Bachelor Of Science (B.S.) In Health Administration -
University of Phoenix
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