Lesia Gilles
124 Delphia Road, Tioga,WV
Summary
Detail-oriented professional with a robust history in customer service management and documentation proficiency. Committed to maintaining high standards of service while ensuring data confidentiality and effective communication with clients and vendors.
Overview
22
22
years of professional experience
Work History
Business Manager
C&S Logging, LLP
03.2011 - 12.2019
- Managed financial operations for the business, ensuring accurate budgeting and timely invoice processing.
- Resolved financial discrepancies and customer billing issues with timely attention.
- Enhanced customer satisfaction by addressing inquiries promptly and resolving issues professionally.
- Oversaw budget management, ensuring appropriate allocation of resources across departments.
- Ensured compliance with regulatory requirements while maintaining high standards of service delivery.
- Updated reports, managed accounts, and generated reports for company database.
- Ensured compliance with company policies and industry regulations through regular audits and process updates.
- Communicated with customers and vendors positively with particular attention to problem resolution.
- Negotiated contracts with suppliers and vendors, securing favorable terms for the company while maintaining strong relationships.
- Oversaw financial operations, maintaining accurate records and ensuring compliance with industry regulations.
- Processed vital documentation, completed forms and obtained appropriate insurance verification and authorization for services.
Group Home Manager
ResCare, Inc.
06.2002 - 11.2010
- Managed daily operations of group home, ensuring compliance with regulatory standards.
- Oversaw staff training programs, improving team performance and service delivery.
- Coordinated scheduling and resource allocation to optimize operational efficiency.
- Kept accounts, resident files and regulatory paperwork current and accurate with diligent attention to administrative requirements.
- Protected clients' monies and property by tracking spending and reconciling accounts.
- Conducted regular staff meetings to communicate updates and gather feedback, fostering collaborative team atmosphere.
Medical Insurance Specialist-Ambulance
General Ambulance Company
05.2000 - 06.2002
- Processed insurance claims efficiently, ensuring compliance with industry regulations and organizational policies.
- Analyzed patient data to identify discrepancies and resolved issues impacting claim approvals.
- Coordinated with healthcare providers to obtain necessary documentation for timely claim submissions.
- Collaborated with medical staff to obtain necessary documentation for accurate claim submissions.
- Conducted thorough reviews of denied claims, identifying errors or missing information before resubmitting corrections for payment approval.
- Reduced claim denials by verifying patient eligibility and coverage details prior to submission.
- Improved cash flow by promptly following up on unpaid claims and resolving billing discrepancies.
- Maintained strict confidentiality of sensitive patient information, adhering to HIPAA guidelines and other applicable regulations in all aspects of the role.
- Provided exceptional customer service, assisting patients in understanding their insurance benefits and financial responsibilities.
- Achieved timely resolution of claim issues through effective communication with insurance carriers and healthcare providers.
- Contributed to positive relationships with insurance companies through consistent follow-up and prompt issue resolution.
- Maintained compliance with industry regulations by staying updated on coding changes and guidelines.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Identified and resolved discrepancies between patient information and claims data.
Medical Insurance Specialist-Ambulance
Sophia Volunteer Ambulance Service/Home Based
01.1998 - 03.2000
- Processed medical insurance claims efficiently, ensuring compliance with regulations and guidelines.
- Analyzed policy coverage details to provide accurate information regarding benefits and eligibility.
- Aided in boosting revenue by identifying opportunities for additional reimbursements through audits of past claims.
- Demonstrated adaptability during software transitions, quickly learning new systems to maintain productivity levels throughout implementation periods.
- Enhanced data accuracy by meticulously updating patient records and insurance information in the system.
- Increased patient satisfaction by efficiently processing insurance claims and addressing inquiries.
- Researched and resolved complex medical claims issues to support timely processing.
- Verified patient insurance coverage and benefits for medical claims.
- Monitored and updated claims status in claims processing system.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Responded to correspondence from insurance companies.
- Followed up on denied claims to verify timely patient payment and resolution.
- Reduced claim denials by verifying patient eligibility and coverage details prior to submission.
- Improved cash flow by promptly following up on unpaid claims and resolving billing discrepancies.
- Maintained strict confidentiality of sensitive patient information, adhering to HIPAA guidelines and other applicable regulations in all aspects of the role.
- Provided exceptional customer service, assisting patients in understanding their insurance benefits and financial responsibilities.
- Achieved timely resolution of claim issues through effective communication with insurance carriers and healthcare providers.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Maintained compliance with industry regulations by staying updated on coding changes and guidelines.
- Identified and resolved discrepancies between patient information and claims data.
Education
NREMTP Certification - National Registry Paramedic
Bluefield State College
Bluefield, WV06-1990
High School Diploma -
Richwood High School
Richwood, WV06-1982
No Degree - Medical Assistant
Clarksburg School of Business
Clarksburg05-1986
Skills
- Financial management
- Staff management
- Data collection
- Financial oversight
- Verbal and written communication
- Customer service management
- Team leadership
- Client account management
- Records organization and management
- Payroll administration and timekeeping
- Employee management
- Documentation and reporting
- Customer relationship management
- Decision-making
- Customer relations
- Client relationship management
- Documentation proficiency
- Employee scheduling
- Data confidentiality
Timeline
Business Manager
C&S Logging, LLP
03.2011 - 12.2019
Group Home Manager
ResCare, Inc.
06.2002 - 11.2010
Medical Insurance Specialist-Ambulance
General Ambulance Company
05.2000 - 06.2002
Medical Insurance Specialist-Ambulance
Sophia Volunteer Ambulance Service/Home Based
01.1998 - 03.2000
NREMTP Certification - National Registry Paramedic
Bluefield State College
High School Diploma -
Richwood High School
No Degree - Medical Assistant
Clarksburg School of Business