KRISTINA WINTERS
San Antonio
Summary
Dynamic healthcare professional with extensive experience at Conviva Care Center, excelling in patient advocacy and insurance verification. Proven ability to enhance patient satisfaction through exceptional communication and problem-solving skills. Proficient in electronic health record systems and adept at managing sensitive information while ensuring HIPAA compliance. Committed to improving operational efficiency and patient care outcomes.
Skilled in patient communication and administrative tasks, embodying reliability and adaptability.
Overview
26
26
years of professional experience
Work History
Senior Patient Care Representative
Conviva Care Center Formerly Partners in Primary Care
08.2017 - Current
- Managed sensitive patient information while maintaining strict confidentiality according to HIPAA regulations.
- Ensured smooth transition of care for discharged hospital patients by coordinating follow-up appointments with primary care providers.
- Promoted a positive and welcoming environment by providing exceptional customer service to all patients, visitors, and staff members.
- Evaluated ongoing initiatives for effectiveness in improving overall patient experience; made recommendations for improvements as necessary.
- Answered incoming calls, scheduled appointments and filed medical records.
- Verified patient insurance eligibility and entered patient information into system.
- Assisted patients with navigating complex healthcare systems by providing guidance on available resources and support services.
- Supported insurance verification processes by gathering necessary documentation from patients and insurers in a timely manner.
- Contributed to team success by cross-training in various roles within the clinic to provide coverage when needed (Medical Records, in obtaining and faxing out patient information)
- Maintained accurate patient records through diligent data entry into electronic health record systems.
- Conducted pre-appointment confirmation calls to reduce no-shows and improve appointment scheduling.
- Acted as an advocate for patients and their families by actively listening to concerns, providing support, and collaborating with healthcare team members to address issues.
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Trained new staff on filing, phone etiquette and other office duties.
Medical Billing
Texas Med Clinic
02.2016 - 08.2017
- Reviewed all incoming denials for HMO's (Cigna, TPA's, Humana, Aetna) for appropriate coding
- Maintained contact with Insurance for timely filing
- Worked aging report for falling claims due to lack of insurance information.
- Submission of documentation for claim processing.
- Out reach to patient to find a resolve in billing and payment.
Assistant Manager
Five Branches Acupuncture Clinic/School
02.2005 - 11.2006
- Supervised day-to-day operations to meet performance, quality and service expectations.
- Maintained a clean, safe, and organized clinic environment to enhance the patient customer experience.
- Scheduled prospective patient tours, New Patient and established patient appointments.
- Insurance verification and collection of all copays.
- Provided prospective student tours to the school and clinic.
- Managed local annual Health Fairs at the Santa Clara Convention Center- Living Well Expo.
- Improved customer satisfaction by addressing and resolving complaints promptly.
- Coordinated Student Internship with Clinicians
Provider Services Representative
Regence BlueShield
06.1999 - 03.2002
- Demonstrated knowledge of multiple coverage inquires, prior coverage information and eligibility issues.
- Maintained health Insurance Portability Accountability Act (HIPPA) compliance.
- Enhanced customer satisfaction by efficiently resolving provider inquiries and concerns when it comes to check disbursements, EOB's, and medical review approvals and denials.
- Streamlined operations by managing a high volume of incoming calls from medical providers seeking information for assistance in payment reimbursement, member and provider enrollment.
- Acted as a Hospital Benefit liaison for Seattle /Tacoma Hospitals.
- Effectively communicating concerns and feedback to facilitate continuous improvement in our deliverance to providers and members.
Education
Associate of Arts - Medical Office
Gavilan College
Gilroy, CA07-2015
High School Diploma -
Perris Lake High
Perris, CA06-1985
Skills
- Experienced with Lexmark office printers and scanners for document management
- Proficient in Novitasphere for Medicare eligibility and preventive service management
- Proficient in ECW, TeleMynd, Availity, Athena, and Sales Force
- Skilled in Microsoft Office applications
- Typing speed of 70 WPM
- Proficient in healthcare and office software system
- Clear interpersonal communication
- Integrity in professional conduct
- Skilled in using Concur and Coupa for office procurement
- Knowledgeable in Genesys communication platforms
Timeline
Senior Patient Care Representative
Conviva Care Center Formerly Partners in Primary Care
08.2017 - Current
Medical Billing
Texas Med Clinic
02.2016 - 08.2017
Assistant Manager
Five Branches Acupuncture Clinic/School
02.2005 - 11.2006
Provider Services Representative
Regence BlueShield
06.1999 - 03.2002
Associate of Arts - Medical Office
Gavilan College
High School Diploma -
Perris Lake High
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