Keisha Williams
Atlanta,GA
Summary
Accomplished individual who goes above and beyond basic administrative tasks and takes on multiple projects at once. I have over 20 years of experience in the Medical Field. Excellent work ethic and strong ability to learn new tasks. Quality-focused and committed to approaching administrative tasks with tenacity and attention to detail Seasoned Referral Specialist with demonstrated experience in the healthcare industry. Skilled in facilitating communication between patients and medical professionals, ensuring proper patient care through accurate referral processes. Known for problem-solving abilities, interpersonal skills, and commitment to maintaining high standards of confidentiality and professionalism. Previous roles have resulted in enhanced operational efficiency and improved patient satisfaction.
Overview
19
19
years of professional experience
Work History
Intake Referral Specialist
Mckesson
01.2023 - Current
- Manages, processes and tracks all referrals
- Ensures forms needed in the referral process are completed
- Manages various work queues daily to ensure timely processing and completion of referrals
- Responds to all incoming calls, emails and faxes regarding referrals, ensuring proper action is taken and documentation is completed and linked to the referral
- Input client information into computer database, follow all necessary steps for navigating client database system
- Search Providers in the nppes systems
- Obtains pre-authorization from payers
- Answer calls from provider office requesting status updates on referral & summary of benefits of Lupron prescription
- Make outbound calls to patients to discuss our program and their benefits and their eligibility to Lupron saving card
- Input & update provider information into icms database
- Outbound calls to pharmacy to get shipment status
Epic Help Desk Analyst II
Nuance
07.2020 - 10.2022
- Worked directly with physicians, nurses, or other healthcare professionals to address troubleshoot technical problems impacting patient care
- Received incoming calls from client community, provide first level support, document each call verifying customer information and all troubleshooting steps
- Research, resolve, and respond to clinical and technical questions received via telephone calls, emails, and other channels
- Callbacks in a timely manner and escalate problems to appropriate individual/group
- Validates and approves adult/minor proxy myChart access and provides help desk technical support for patient portal issues
- Assisted in the resolution of user and support issues among company sites to ensure timely distribution of knowledge and positive impact on user satisfaction
- Routinely contribute to Clinical Knowledge Base
- Provided accurate and creative solutions to user problems of moderate nature to ensure user productivity
- Acquired and maintain current knowledge of relevant clinical and technical product offerings and support policies to provide technically accurate solutions to customers
- Participated in team projects that enhance the quality or efficiency of the resolution center and assist with special Clinical product-related issues as needed
Health Information Specialist
Emory Healthcare
Atlanta, GA
08.2019 - 07.2020
- Read request letters, subpoenas, or any other pertinent documents, notating information requested
- Verified authorizations for releases prior to processing ROI requests
- Retrieved and scan patient medical records in accordance with an ROI request
- Validated shipping and billing addresses to ensure the proper delivery of all requests
- Scanned relevant components of the medical record to support reviews performed (Hedis)
- Worked with on-site software such as Epic, All Scripts, Cerner, and Eclinical to retrieve EMR information
- Maintained confidentiality, security, and standards of ethics in compliance with HIPAA regulations
- Tested and trained for upcoming laws and programs that were utilized at various sites
Field Reviewer (Hedis)
Discovery
Atlanta, GA
02.2018 - 05.2020
- Accurately and efficiently conducted medical record review/abstraction services
- Managed and meet deadlines
- Scanned relevant components of the medical record to support reviews performed
- Electronically download review assignments to the laptop and data collection tool
- Upload completed assignments and scanned medical records
- Wrote daily reports to outline the events of the day for the company and facilitate communication between Discovery and our clients
- Participated in required training
- Traveled to medical facilities in specified area of region from home to complete review services as assigned by Discovery
- Represented Discovery with medical facility staff professionally with skilled verbal and written communication
Provider Credentialing Specialist
Mahone Group
Atlanta, GA
09.2018 - 07.2019
- Responsible for processing provider applications, credentialing/re-credentialing and primary source verification of providers (Commercial/Tricare accounts)
- Perform and audit timely, accurate credentialing/re-credentialing of all providers
- Reviewed systems to determine provider network status
- Contacted providers for missing information were applicable, via Fax, Phone or letter
- Performed Primary Source Verification of practitioner credentials per NCQA standards
- Prepared provider files for presentation to the National Credentialing Committee for approval or denial
Health Information Specialist
Emory Healthcare
Atlanta, GA
02.2010 - 06.2018
- Sorted prioritize prepare input and respond to all incoming documentation via in person, phone, fax, mail/email for Release of Information (ROI) requests utilizing Health Information Management (HIM) access in Epic within department, state and federal and accrediting regulated time frames
- Validated whether requests require an authorization from the patient and/or parent/legal guardian or other patient representative
- Retrieved and prepare paper and/or electronic records for processing
- Validated each record for correct patient name and dates of requested information
- Data entry of request into electronic health record
- Scan request into patient electronic health record
- Send records via mail, fax or other methods
- Answered phone calls and emails regarding status of requests
- Verbal and written communication with patients, attorneys, law enforcements auditors and insurance companies and state and federal agencies
- Interacted with physicians and staff including social service and the utilization review department
- Provided patient assistance in completing authorizations forms guiding then on the process of ROI and completed their requests with high patient satisfaction
- Invoiced and maintained billing and received checks
- Processed chart audit requests by following department guidelines
- Processed internal insurance appeals requests while keeping open communication with other hospital departments
- Knowledge of HIPAA and other release regulations or the motivation to learn
- Obtain guidance from Health Information Manager as needed
Health Information Specialist
Atlanta Medical Center
Atlanta, GA
02.2006 - 01.2010
- Locating, retrieving, requesting, logging, delivering, filing, prepping and scanning of medical records and/or reports
- Answered/processed telephone requests
- Assisted Medical Staff in completion of records
- Charged retrieval
- Filed loose documents
- Maintained the department in a neat, clear and orderly manner with special attention to personal work area
- Collected and prepared all medical records for scanning into EHR system
- Ensured daily chart runs are performed on a scheduled basis
- Printed daily clinic schedules for reference when organizing records to be scanned
- Sorted gathered charts/documents according to physicians daily schedule while making notes of missing or incomplete records
- Scanned all documents directly into patient record or batch as appropriate
- Ensured quality control of electronic documents images on a daily basis
- Adjusts and deletes images as needed
- Responded to medical records requests and supplies appropriate information as requests
- Ensures signatures and authorizations are on file
- Answered calls and takes messages in accordance with department and hospital policies
- Maintained 100% accuracy in prepping of Outpatient/Clinic Charts (i.e., correct document in the correct patient visit; correct patient in respective chart)
- Assisted medical, hospital staffs and visitors promptly and efficiently
- Understands and practices proper release of information for patients and/or requestors, maintaining confidentiality policies
- Understands hospital Dictation System and how to look up dictations
- Monitored individual sent and received tasks on a daily basis
- Demonstrated understanding of policies and procedures and priorities, seeking clarification as needed
- Monitored, flags and stamps of unsigned verbal/telephone orders of in-house charts
- Participated in continuously assessing and improving departmental performance
- Understands Cerner Functionality Standards
- Sorted and distributes incoming fax communication
- Served as liaison with Records management vendors to store and retrieve charts as needed
- Picked up and distributes mail, is familiar with handling of urgent mail
- Performed other duties as requested/assigned by Director, Supervisor or designee
Education
Certified Patient Account Representative -
01.2023
Provider Credentialing Specialist Certificate -
01.2023
Medical Billing and Coding Essentials Certificate -
MedCerts
01.2023
Healthcare IT Support Specialization -
Coursera
01.2023
Healthcare Data Security, Privacy, and Compliance Certificate -
01.2023
Computer Hardware & Software Certificate -
01.2023
Foundations of Cybersecurity Certificate -
01.2023
Play It Safe: Manage Security Risks Certificate -
01.2023
Python for Beginners Certificate -
01.2023
Connect and Protect: Networks and Network Security Certificate -
01.2023
Medical Billing & Coding Diploma -
Everest technical College
01.2008
Skills
- Excellent communication skills
- Customer service-oriented
- Flexible
- Accurate and detailed
- Excellent planner and coordinator
- Works well under pressure
- ICD 9 & 10 Coding
- Filing and data archiving
- HIPAA compliance
- Strong Microsoft Office Suite Knowledge
- Critical thinker
- Advanced clerical knowledge
- Hedis
- Experienced in all Medicare measures ABA
- Experienced in all Medicare measures CBP
- Experienced in all Medicare measures CDC
- Experienced in all Medicare measures COA
- Experienced in all Medicare measures COL
- Experienced in all Medicare measures MRP
- Google Suite Proficiency
- Data entry proficiency
- Patient confidentiality
- Medical terminology knowledge
- Physician Authorizations
- Multi-line telephone operation
- Multi-line phone proficiency
- Follow-up skills
- Insurance Verification
- Patient records oversight
- Accurate Documentation
- Organizational abilities
- Referral tracking
- Record preparation
- Referring physician communication
- Medical Terminology
- Outbound calls
- MS Office expertise
- HIPAA Regulations
- Electronic patient charts
- Scheduling Software
- Patient Scheduling
Timeline
Intake Referral Specialist
Mckesson
01.2023 - Current
Epic Help Desk Analyst II
Nuance
07.2020 - 10.2022
Health Information Specialist
Emory Healthcare
08.2019 - 07.2020
Provider Credentialing Specialist
Mahone Group
09.2018 - 07.2019
Field Reviewer (Hedis)
Discovery
02.2018 - 05.2020
Health Information Specialist
Emory Healthcare
02.2010 - 06.2018
Health Information Specialist
Atlanta Medical Center
02.2006 - 01.2010
Certified Patient Account Representative -
Provider Credentialing Specialist Certificate -
Medical Billing and Coding Essentials Certificate -
MedCerts
Healthcare IT Support Specialization -
Coursera
Healthcare Data Security, Privacy, and Compliance Certificate -
Computer Hardware & Software Certificate -
Foundations of Cybersecurity Certificate -
Play It Safe: Manage Security Risks Certificate -
Python for Beginners Certificate -
Connect and Protect: Networks and Network Security Certificate -
Medical Billing & Coding Diploma -
Everest technical College
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