Kiresha Gates
Summary
I have worked for as a M&R Claims Representative Associate for almost 2 years. After my Initial training for my current role I proceeded to do up training to learn more processes for my role and become more proficient. In my time in this role I have worked in the D-SNP inventory and assist team members one on one to better understand certain processes.
Overview
15
15
years of professional experience
Work History
Claims Representative Associate, Claims Operations
UnitedHealthcare
06.2022 - Current
- Responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims.
- Authorizes the appropriate payment or refers claims to investigators for further review.
- Conducts data entry and re-work; analyzes and identifies trends and provides reports as necessary.
- Some work is completed without established procedures
- Works with others as part of a team.
Clinic Patient Representative
CHRISTUS Health
12.2021 - Current
- Greets, instructs, directs and schedules patients and visitors
- Serves as a liaison between patient and medical support staff
- May assist with various duties within the clinic
- Verifies insurance benefits and assists with referrals
- Collects payments and prepares cash for deposits.
Teacher Assistant
NEISD
08.2019 - 11.2021
- Reinforces instruction for students under the supervision of the teacher
- Assists children with making healthy food selections
- Reinforces self-help skills and table manners during supervision of breakfast and lunch
- Assists/supervises the arrival and dismissal of students
- Assists the teacher with student assessment
- Escorts individual students to the nurse, office, and other school locations as needed
- Assists teacher in gathering and preparing materials
- Assists teacher in preparing for class assignments and daily lessons
- Assists/supervises outdoor activities
- Maintains confidentiality of information
- Reports to work on time every day
- Performs all other tasks and duties as assigned.
Certified Medical Assistant
Diabetes & Glandular Disease Clinic, P.A
09.2018 - 08.2019
- Assists with direct patient care procedures and related tasks; checks in patients, assists in obtaining patient histories, takes vital signs, prepares charts, and assists with medical examinations
- Maintains accurate documentation in electronic patient record
- Performs routine specialized procedures, such as venipuncture and sterile dressing changes under established protocols
- Obtains pertinent labs and other tests as needed by the provider
- Manages inventories of medications and medical supplies
- Educates and advises patients on specific medical issues within established parameters to include obtaining prescription information
- Directs patient flow in accordance with provider schedules/patient appointments
- Maintains assigned examination rooms
- Coordinates routine office activities and administrative functions to support clinic activities
- Practices safety, environmental, and/or infection control methods.
Medical Assistant Externship
Piedmont Family Practice
05.2018 - 07.2018
- Assists in the examination and treatment of patients under the direction of a physician or nursing staff
- Performs phlebotomy functions and routine laboratory tests
- Performs clerical/administrative duties related to office operation as requested
- Supports Quality Team LPNs
- Processes Physician orders
- Coordinates information relative to direct, diagnostic, therapeutic, and indirect patient care
- Provides basic nursing to patients and assists with patient care
- Assists with the clerical operations of the assigned unit
- Procures the necessary supplies, equipment, and materials for daily operations
- Input information via Athena.
CCEP Property Control Tech
The Logistics Company
08.2015 - 05.2017
- Coordinate Asset Management Program, Maintain Asset Tracking Database/Master Equipment Lists, Coordinate material shipping, logistics, export control, and associated paperwork, Maintain software control, Perform property reporting - Compile data to create reports (PIDS, MELs, etc.), Perform material audits, Coordinate logistics and paperwork for excess equipment, Assist in developing and updating property procedures and processes, Provide Asset Management training to staff and subcontractors, Type and proofread reports, letters, and memos for the office, Support corporate Asset Management Program, Organize, and maintain general office records, and Additional duties as required.
Automated Logistical Specialist
United States Army
06.2009 - 09.2012
- Completed work orders and ordered parts using the SAMS Box (a computer system)
- Filed paperwork using the AIMS system
- Completed dispatches for customers and performed customer service
- Created PowerPoint and word documents for presentations
- Picked up parts from the SSA daily
- Updated the system and closed out work orders
- Worked in the medical maintenance shop as well as the motor pool.
Education
AAS in Medical Assisting -
Chattahoochee Valley Community College
Phenix City, AL07.2018
Skills
- Microsoft office suite (10 years)
- Medical terminology, proficient in English, verbal and written communication skills
- CMA (Certifed Medical Assistant)
- Patient Care
- EMR (2 years)
- Customer service (10 years)
- Medical Office Experience
- Athenahealth
- ICD-10
- Clerical Experience (10 years)
- Medical Billing
- Medical Scheduling
- Transcription
- Medical Records
- Insurance Verification
- D-SNP Inventory
- M&R Claims Uptraining
- Time Management
Military Service
Army, United States, E3, 06/2009, 09/2012
Timeline
Claims Representative Associate, Claims Operations
UnitedHealthcare
06.2022 - Current
Clinic Patient Representative
CHRISTUS Health
12.2021 - Current
Teacher Assistant
NEISD
08.2019 - 11.2021
Certified Medical Assistant
Diabetes & Glandular Disease Clinic, P.A
09.2018 - 08.2019
Medical Assistant Externship
Piedmont Family Practice
05.2018 - 07.2018
CCEP Property Control Tech
The Logistics Company
08.2015 - 05.2017
Automated Logistical Specialist
United States Army
06.2009 - 09.2012
AAS in Medical Assisting -
Chattahoochee Valley Community College
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