KIAYA RIEDHAMMER
Beachwood,NJ
Summary
Experienced in pharmacy insurance benefits, customer service, records management, data entry, and back office operations. Former stay-at-home mom seeking an entry-level medical coding/billing data entry position. Recently completed a 12-month medical billing and coding program and currently working towards CPT certification. Recognized for friendly and positive demeanor, with strong work ethic, adaptability, and excellent time management and analytical skills. Consistently regarded as a valuable and reliable team member.
Overview
31
31
years of professional experience
Work History
Pharmacy Customer Care Associate
Geisinger Health Plan
10.2022 - 05.2023
- Took incoming and made outgoing calls in a fast-paced remote call center environment.
- Possessed an extensive knowledge of the company's numerous prescription plans and educated members on coverage, copay structures, and cost shares.
- Thoroughly documented each call and recorded all all pertinent data into the company's system-wide database in a timely manner.
- Aided members, pharmacies and providers with all inquiries/concerns included initiating prior authorizations and appeals, as well as analyzed claim denials and preformed any and all necessary corrections and overrides for claim resolution within the scope of my authority.
- Maintained a positive, helpful attitude on each and every call to maintain the company's standard of 5-star exceptional service and received 100% audit scores by quality oversight management.
- Followed up on outstanding issues to complete resolutions and maintain customer satisfaction.
- Participated in weekly meetings with management teams regarding goals progress updates.
- Maintained strict confidentiality of sensitive patient information, adhering to HIPAA guidelines and safeguarding against potential data breaches.
Medical Office Manager
Marcus Riedhammer, MD
07.2003 - 08.2009
- Managed daily administrative tasks to ensure smooth operations and proper revenue cycle management.
- Processed accounts payable, included receiving and recording all expenses, as well as printing and mailing out any payments.
- Processed accounts receivable, such as incoming payments from various health insurance companies and private payers in addition to reconciling patient accounts.
- Oversaw payroll checks and maintained employee records.
- Compiled all relevant data to submit to the accountant and acted as a liaison between the medical office and the accountant to process any relevant requests and to discuss subsequent submissions to the IRS.
- Filed appropriate tax forms, made monthly and quarterly IRS payments, and completed the necessary journal entries.
- Performed data entry in Quick Books Medical and Amazing Charts and generated budget reports upon request.
- Communicated and provided necessary information to the medical billing company for claim submissions.
- Contacted health insurance companies, Medicare and Medicaid, as well as patients for claims follow-up.
- Made appropriate adjustments, secured payments and obtained pertinent information for claim resolution.
- Maintained strict confidentiality of sensitive patient information, adhering to HIPAA guidelines and safeguarding against potential data breaches.
Hairstylist/Nail Technician
Self-Employed
05.2000 - 06.2003
- Provided services for clients including but not limited to haircuts, hair color, acrylic nails, gel nails, manicures, pedicures and waxing
Hairstylist/Nail Technician
JCPenny Salons
08.1996 - 05.2000
- Oversaw the salon when the manager was not present.
- Took all necessary steps to provide stylists with tips from credit cards by following JCPenney's gratuity protocol, only 3 employees out of 30 were tasked with this responsibility.
- Provided services for clients including but not limited to haircuts, hair color, acrylic nails, gel nails, manicures, pedicures and waxing.
- Consistently maintained cleanliness of the workspace, ensuring a safe and welcoming environment for clients.
- Built a loyal clientele through exceptional customer service, attention to detail, and flawless execution.
Hairstylist/Nail Technician
Golden Comb
08.1992 - 08.1996
- Provided services for clients including but not limited to haircuts, hair color, acrylic nails, gel nails, manicures, pedicures and waxing.
- Consistently maintained cleanliness of the workspace, ensuring a safe and welcoming environment for clients.
- Built a loyal clientele through exceptional customer service, attention to detail, and flawless execution.
Education
Medical Billing And Coding - Certificate of Completion
Lock Haven University
Online Program11-2024
Associate of Arts -
Ocean County Community College
Toms River, NJ01.1996
Cosmetology Certificate -
Ocean County Vocational-Technical School
Toms River 01.1992
Skills
- Analytical Problem Solving
- Proficient Multitasking
- Detail-Oriented Analysis
- Effective Time Management
- Independent Decision-Making
- Proficient Written Communication
- Strong Interpersonal Skills
- Customer Support Experience
- Accurate Data Entry
- Adaptability and flexibility
- HIPAA compliance
- Active listening
- Empathy and patience
- Customer education
Timeline
Pharmacy Customer Care Associate
Geisinger Health Plan
10.2022 - 05.2023
Medical Office Manager
Marcus Riedhammer, MD
07.2003 - 08.2009
Hairstylist/Nail Technician
Self-Employed
05.2000 - 06.2003
Hairstylist/Nail Technician
JCPenny Salons
08.1996 - 05.2000
Hairstylist/Nail Technician
Golden Comb
08.1992 - 08.1996
Medical Billing And Coding - Certificate of Completion
Lock Haven University
Associate of Arts -
Ocean County Community College
Cosmetology Certificate -
Ocean County Vocational-Technical School
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