With a robust background at UnitedHealth Group, I excel in leveraging technical aptitude and exceptional communication to enhance client experiences and operations. My expertise in cybersecurity and leadership has driven significant improvements in service delivery and risk management, embodying a proactive approach to solving complex challenges and mentoring teams for peak performance.
Overview
5
5
years of professional experience
1
1
Certification
Work History
ESM Client Experience & Operations
UnitedHealth Group
Fort Walton Beach, FL
10.2022 - Current
Resolved conflicts between customers and other departments within the organization.
Provided customers with product information, pricing and availability details.
Identified customer needs and provided appropriate solutions.
Analyzed data from previous emails to predict potential customer service issues.
Maintained records of data communication transactions, problems, and remedial actions or installation activities.
Monitored emails queues and responded quickly to customer requests.
Reviewed applications for eligibility requirements prior to submission for processing.
Stayed current with benefits trends and legislation through continuous education and professional development.
Researched employee benefit and health and safety practices, recommending changes or modifications to existing policies.
Reviewed employee enrollments to verify accuracy, inputting information into company database.
Assisted with audits by preparing accounts and providing information.
Participated in benefits renewal process, analyzing proposals and making recommendations.
Mastered state and federal benefit laws, including FMLA, COBRA, and HIPAA.
Provided assistance to plan participants by explaining benefits information to ensure educated selections.
Coordinated benefits processing, including enrollments, terminations and claims.
Ensured compliance with federal, state, and local regulations affecting benefits programs, including ACA.
Compiled and maintained employee benefit records, ensuring accuracy of information.
Assisted claimants, providers and clients with problems or questions regarding claims.
Educated customers on their rights under state and federal regulations governing insurance policies.
Coordinated and planned investigations of claims to confirm compensability and coverage.
Conducted thorough investigations of claims by reviewing documents, interviewing involved parties, and consulting with experts.
Handled billing related activities focused on medical specialties.
Assisted in the development and updating of claims policies and procedures to improve efficiency.
Transcribed data to worksheets and entered data into computer to prepare documents and adjust accounts.
Processed a high volume of claims efficiently while maintaining quality standards.
Provided clear explanations of benefits, eligibility requirements, and applicable laws when communicating with customers.
Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers.
Supported product change requests to communicate impact on capacity plans.
Educated clients about relevant industry trends and developments impacting their policies.
Advised customers on premium payment plans that fit their budget requirements.
Maintained strict compliance with industry regulations and ethical standards to protect clients and ensure transparency.
Worked closely with patients to discuss payment arrangements when needed.
Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.
Expedited payments by verifying accuracy and currency of vendor information.
Investigated incorrect billings and processed refunds as necessary.
Monitored past due accounts and pursued collections on outstanding invoices.
Executed account updates and noted account information in company data systems.
Processed invoice payments and recorded information in account database.
Reviewed legal claims for accuracy and issues.
Input statement information, reconciled accounts and resolved discrepancies.
Analyzed data trends related to customer renewals, identifying areas of improvement and making recommendations accordingly.
Monitored customer accounts for expired contracts and took appropriate action to resolve them quickly.
Managed customer renewals and account updates, including contact information, payment methods, product quantity.
Patient Access Associate
White-Wilson Medical Center
Fort Walton Beach, FL
04.2022 - 10.2022
Created reports on patient demographics, billing activities, and other related topics as requested by management.
Documented patient counters in hospital system and initiated follow-up actions.
Utilized hospital systems to update patient records, ensuring accuracy and completeness.
Verified patients' insurance and payment methods during admissions or check-in processes.
Resolved any issues that arose during registration process in a timely manner.
Reviewed eligibility responses to assess patient benefit level and prepare estimates.
Organized timely and accurate referrals to help patients obtain health care services and access available resources.
Processed payments for services rendered including co-pays and deductibles.
Guided patients through the completion of consent and other required medical forms.
Processed patient co-pays, deductibles, and other payments, ensuring accurate financial records.
Verified documentation methodically to avoid critical errors impacting care delivery and payments for services.
Performed administrative tasks such as scanning documents into the EHR system.
Attended departmental meetings regularly to stay updated on policy changes.
Submitted fees and claims to insurance companies manually or digitally.
Obtained authorization numbers from insurance companies when needed before providing services.
Entered medical codes into the electronic health record system accurately.
Applied HIPAA privacy and security regulations while handling patient information.
Participated in training sessions to stay updated on healthcare policies and registration software.
Verified demographics and insurance information to register patients in computer system.
Reported liabilities and risk management concerns to supervisor for review.
Completed registration procedures for patients, expertly inputting information to meet provider, facility and legal requirements.
Obtained informed consent and payment documentation from patients and filed in system.
Maintained confidentiality of all medical records according to HIPAA regulations.
Adhered to HIPAA regulations while handling confidential patient information.
Audited charts for completeness prior to submission of claims to insurance companies or government agencies.
Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
Senior Clerk/Billing Clerk
State of Florida Department of Health
Fort Walton Beach, FL
07.2020 - 04.2022
Highly responsible for performing administrative duties in the Clinical Services Branch of the Okaloosa County Health Department. Works closely with the Clinical Services Sr. Community health nurses perform clerical support for program management. Provides administrative support for the Florida Breast and Cervical Cancer, and Family Planning Waiver Programs.
Drafted summary memos describing audit findings, conclusions, and recommendations for management review.
Monitored customer accounts for overdue payments and took appropriate steps to collect outstanding funds.
Reviewed company financial statements for accuracy, completeness, and compliance with legal and regulatory requirements.
Assessed internal controls within insurance organizations to identify areas of non-compliance.
Evaluated customer claims to ensure they are legitimate and validly submitted.
Documented all audit activities, results, and conclusions in accordance with established protocols.
Provided direction on regulatory requirements related to HIPAA compliance.
Established policies and procedures for data security, privacy, and compliance.
Maintained knowledge of advances in information technology systems and applications.
Provided support to clinical staff by answering questions regarding patient scheduling matters.
Routed laboratory or diagnostic results to appropriate staff.
Collaborated with physicians and other healthcare staff to ensure patients were scheduled for the appropriate services.
Responded promptly and professionally to customer service inquiries through phone calls or emails.
Provided administrative support to medical staff, including document preparation and patient communication.
Conducted regular follow-ups with patients who had missed their scheduled appointments to reschedule them at another time.
Transmitted medical records and other correspondence by mail, e-mail, or fax.
Handled incoming calls and inquiries from patients, providing timely and accurate information.
Verified insurance information for all new patients prior to scheduling visits.
Followed up with patients and confirmed appointments.
Operated cash register to process cash, check, and credit card transactions.
Followed confidentiality rules to preserve data quality and reduce potential information compromise.
Completed daily clerical tasks to support smooth operations.
Makes appointments when necessary. Provides receptionist duties for all services related to Okaloosa CHD programs. This includes each department in the facility, clinical and dental services, vital statistics, environmental health, and immunizations.
Collected and entered payment data into system, maintaining complete confidentiality and accuracy.
Updated logs with timely and accurate information meet internal requirements and DOT recordkeeping demands.
Responsible for providing clerical duties in the Florida Department of Health, Okaloosa Immunization Program.
Responsible for determining client eligibility for the Vaccines for Children Program (VFC) programs.
Schedules and checks for all immunization clients are entered into the HMS and FL SHOTS database.
Accurately inputs all demographic, financial, and third-party insurance information into the database.
Checks FLMMIS for Medicaid eligibility and enters data into HMS accurately for billing. Completes the encounter document for billing using appropriate forms, and ensures all immunization data is accurately imported into the HMS system within 7 days of vaccine administration. Verifies insurance eligibility and benefits.
Enters historical immunization records and information into the FL SHOTS database to determine the immunization status of clients seeking services. Processes clients for nurse encounters to receive needed vaccines. Produces and creates DH 680 and 681 forms per policy, and reviews for accuracy.
Monitored changes in regulations related to risk management activities.
Followed operational standards, promoting security, risk management and compliance.
Implemented strategies for risk management across all operational activities.
Monitored the organization's risk management strategy and insurance coverage needs.
Coordinated internal audits to evaluate risk management processes and procedures.
Implemented measures for risk management and data security protocols.
Ensures strict confidentiality.
Worked closely with IT personnel in order to develop effective cyber security protocols for protecting sensitive data.
Reviewed reports from external auditors regarding cyber security issues or risks.
Researched new technologies to improve the organization's cyber security posture.
Maintained knowledge of current trends in cyber security industry best practices.
Conducted workshops with groups of students on topics such as social media safety, website design fundamentals and cyber security awareness.
Senior Provider Relations Advocate, Account Manage at UnitedHealth Care, UnitedHealth GroupSenior Provider Relations Advocate, Account Manage at UnitedHealth Care, UnitedHealth Group
Clinical Transformation Manager at UnitedHealth Group- UnitedHealth Care DivisionClinical Transformation Manager at UnitedHealth Group- UnitedHealth Care Division