Malondy Black
Conyers
Summary
Experienced Claims professional with a proven history in managing complex claims processes and resolving disputes efficiently. Adept at enhancing customer satisfaction and reducing claim life cycles through strategic decision-making. Demonstrated expertise in risk assessment and compliance with industry regulations.
Professional coordinator with a strong background in managing surgical schedules and ensuring seamless operations. Skilled in patient communication, time management, and coordinating with medical staff. Known for reliability, adaptability, and achieving results through effective team collaboration. Strong focus on meeting changing demands while maintaining high standards of care and efficiency.
Overview
24
24
years of professional experience
Work History
Surgery Scheduling Coordinator
Piedmont Orthopedics by Orthoatlanta
06.2016 - Current
- Schedules in-office procedures and surgeries at various hospital and ambulatory surgery centers for multiple physicians
- Pre-certify patients for procedures by contacting insurance companies and obtaining coverage authorizations
- Prioritize urgent cases when scheduling surgeries based on medical necessity and availability of resources
- Obtain payments for patient co-pays, deductibles, and coinsurance
- Prepares and collates surgical paperwork and ensures timely delivery to the surgical site
- Review chart for completeness and accuracy by ensuring all pertinent studies/diagnostics are available before pre-operative testing and surgeries
- Manages surgeon's calendars by scheduling surgeries in consultation with patients and families
- Posts surgical charges daily per established guidelines
- Develop strong working relationships with surgeons, nurses, anesthesiologists, administrators, and ancillary staff across various departments
Sleep Medicine - Billing Assistant Front Office
Laureate Medical Group
04.2014 - 06.2016
- Assisted with overseeing patient accounts on a timely basis
- Researched and resolved customer billing inquiries or concerns and set up payment arrangements
- Proactively determined solutions for handling unique billing situations
- Worked directly with insurance companies, healthcare providers, and patients to get claims processed and paid
Medical Administrative Assistant /Billing
Dr. James E. Dopson M.D.
08.2008 - 04.2014
- Provided secretarial and clinical support to the Physicians and performed administrative duties necessary to deliver quality patient care
- Responsible for multiple tasks that included communicating with patients for case histories, scheduling appointments, electronic medical coding, filing insurance claims, updating, and maintaining records, and processing insurance claims for receivable and payable accounts
- Verified insurance benefits, documented plan type, co-payments, co-insurance, out-of-pocket, and deductible amounts, and determined contract and benefit eligibility
Sr. Claims Representative- Property Damage & PIP
Liberty Mutual
01.2001 - 01.2006
- Improved team productivity by providing ongoing training and support to junior claims representatives.
- Reduced backlog of pending claims by introducing an effective triage system based on priority levels.
- Collaborated with legal and medical professionals to promptly and professionally investigate and negotiate fair, accurate, and timely settlements.
- Conducted investigations to determine liability, including recorded statements, and appraised damages for accuracy and reasonableness
- Enhanced customer satisfaction with timely and accurate resolution of claims disputes.
- Recommended and set reserves based on expected payouts.
- Expedited the approval process for genuine claims, maintaining a high level of trust among policyholders.
- Conducted thorough investigations of disputed claims, gathering evidence to support decision-making processes.
- Reduced claims processing time by implementing efficient workflow and prioritizing tasks.
- Managed a large caseload while maintaining strict deadlines and delivering consistent results under pressure situations.
- Worked productively in fast-moving work environment to process large volumes of claims.
Education
High School Diploma -
Plainfield High School
Plainfield, NJ06-1995
Skills
- HIPAA Regulations Compliance
- Care Coordination
- Health Insurance Verification Expertise
- Efficient Procedure Scheduling
- Facility Coordination
- Coverage verification
- Claims Management
- Proficient in Settlement Negotiation
- Skilled in Analytical Investigations
- Proficient in Complex Claims Handling
- Investigation Expertise
- Effective Time Management
- Strategic Decision-Making
- Accident investigations
Timeline
Surgery Scheduling Coordinator
Piedmont Orthopedics by Orthoatlanta
06.2016 - Current
Sleep Medicine - Billing Assistant Front Office
Laureate Medical Group
04.2014 - 06.2016
Medical Administrative Assistant /Billing
Dr. James E. Dopson M.D.
08.2008 - 04.2014
Sr. Claims Representative- Property Damage & PIP
Liberty Mutual
01.2001 - 01.2006
High School Diploma -
Plainfield High School
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