Summary
Overview
Work History
Education
Skills
References
Timeline
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Mamie Moore

Easley,SC

Summary

Experienced healthcare and insurance professional with a strong track record in patient care coordination and claims processing. Skilled in adapting to new technologies, and committed to improving operational efficiency. Proven ability to communicate effectively and work collaboratively in fast-paced environments. Seeking to leverage expertise in a challenging new role within the healthcare industry.

Overview

14
14
years of professional experience

Work History

Patient Care Coordinator II

Upstate OMS
Easley, SC
03.2024 - 03.2025
  • Adapted seamlessly to new healthcare software to enhance patient service delivery.
  • Delivered top-tier customer service by prioritizing patient care, and resolving inquiries efficiently.
  • Scheduled appointments and communicated procedure details to optimize patient preparedness.
  • Coordinated insurance benefit verification to ensure accurate billing and payment processing.
  • Collaborated with departments to optimize referral verification, improving patient flow.

Medical Billing Specialist/AR

Find Great People
Greenville, SC
11.2023 - 02.2024
  • Identified errors and re-filed denied or rejected claims quickly to prevent payment delays.
  • Addressed discrepancies between EMR and billing software to ensure claim resolution.
  • Resolved claim scrubs and edits efficiently.
  • Handled payer denials.
  • Conducted follow-ups on overdue accounts receivables.
  • Processed and sent appeals.
  • Executed submission of primary and secondary claims through digital transfer or physical documentation.
  • Resolved payer and clearinghouse discrepancies by understanding common rejection reasons.
  • Delivered exceptional service during client and patient engagements.
  • Entering of claims.
  • Prepared and attached referrals, treatment plans or other required correspondence to reduce incidence of denials.
  • Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.

PASS, Urgent Admission Specialist

Prisma Health Upstate
Greenville, SC
01.2021 - 11.2023
  • Interviewed patients and representatives per HIPAA and EMTALA guidelines to gather financial status.
  • Ensured timely completion of initial notification, insurance verification, and authorization activities to secure patient accounts financially.
  • Works with cross-functional teams to streamline processes.
  • Serves as primary point of contact for all payors regarding Inpatient admissions and Observation.
  • Ensured timely submission of necessary documentation to payors for initial authorization purposes.
  • Collected relevant patient statistical information and maintained effective communication with payors.
  • Confirm insurance coverage and benefits through online systems or telephone inquiries.
  • Obtains financial, demographic, employment information from patients within HIPAA and EMTALA regulations.
  • Optimizes insurance priority accuracy with adherence to third party criteria and COB.

Claims Adjudicator 2

NaphCare
Birmingham, AL
02.2017 - 10.2020
  • Processed, adjusted, and determined outcomes of claims based on policies.
  • Leveraged claims processing expertise and familiarity with Medicare and Medicaid to process payments within deadlines.
  • Handle daily workload swiftly and accurately.
  • Show proficiency in handling substantial data volumes.
  • Provided mentorship to team members with a focus on skill enhancement.
  • Exhibited meticulous detail orientation during claims resolution.

Inquiry Analyst 2

Blue Cross Blue Shield of Alabama
Birmingham, AL
09.2014 - 01.2017
  • Utilized a comprehensive understanding of ICD-9 and ICD-10 codes.
  • Conducted extensive research and applied contract benefits.
  • Processed facility, professional, drug, and dental claims in compliance with established timelines.
  • Rendered prompt, respectful service to subscribers, providers, host/home plans, and internal customers regarding claims and inquiries.
  • Identified the needs of customers promptly and efficiently.
  • Utilized a document management system to organize company files, keeping up-to-date, and easily accessible data.
  • Maintained accurate records of all data collected during analysis processes.
  • Monitored operations, and reviewed records and metrics to understand company performance.

Financial Care Specialist

T-Mobile USA Incorporated
Birmingham, AL
05.2012 - 09.2014
  • Uphold T-Mobile's commitment to exceptional customer service.
  • Assessed and adjusted accounts according to customer requests, balancing their needs with T-Mobile's credit policies.
  • Offered reassurance and support for T-Mobile customers with past due accounts and billing disputes.
  • Adjusted bills and refunded money to resolve customers' service or billing complaints.
  • Strengthened customer retention by offering discount options.
  • Excelled in exceeding daily credit card application goals.
  • Monitored customer accounts to detect any suspicious activity or fraudulent transactions.
  • Prepared and evaluated CRM reports to identify problems and areas for improvement.

Payment Processor/accounts Payable

Pangeatwo/Infinity
Birmingham, AL
01.2012 - 03.2012
  • Handled customer inquiries, policy assistance, and software navigation.
  • Disseminated detailed information and appropriate documentation to insured, lien holder, and insurance agent.
  • Verified patient insurance coverage, created financial plan according to treatment schedules for collections and communicated between patient and billing company regarding health insurance.
  • Performed data import, scanning, or manual keying processes to verify invoice accuracy.
  • Communicated effectively with clients to ensure timely collections.
  • Prepared and submitted accounting documents and reports for review, authorization and processing.

Financial Crimes Investigator

Wells Fargo & Company
Birmingham, AL
11.2010 - 05.2011
  • Managed files, organized records, and maintained databases.
  • Researched and documented findings on financial abuse and case actions for potential referrals in Suspicious Activity Reports, Identity Theft Operations, and suspected incidents.
  • Reviewed and verified customer transactions to detect financial criminal activities.
  • Shortened criminal investigation lead time, executing operational protocol for criminal and non-criminal violations.
  • Employed logic and analytical skills to solve complex problems and identify patterns indicative of criminal activity.
  • Coordinated with cybersecurity teams to investigate and respond to incidents involving digital fraud and data breaches.

Education

Criminal Justice

Miles College
Fairfield, AL
05-2014

Skills

  • Healthcare documentation and insurance claims processing
  • Electronic health records management
  • ICD coding proficiency
  • HIPAA compliance
  • Patient care coordination

References

References available upon request.

Timeline

Patient Care Coordinator II

Upstate OMS
03.2024 - 03.2025

Medical Billing Specialist/AR

Find Great People
11.2023 - 02.2024

PASS, Urgent Admission Specialist

Prisma Health Upstate
01.2021 - 11.2023

Claims Adjudicator 2

NaphCare
02.2017 - 10.2020

Inquiry Analyst 2

Blue Cross Blue Shield of Alabama
09.2014 - 01.2017

Financial Care Specialist

T-Mobile USA Incorporated
05.2012 - 09.2014

Payment Processor/accounts Payable

Pangeatwo/Infinity
01.2012 - 03.2012

Financial Crimes Investigator

Wells Fargo & Company
11.2010 - 05.2011

Criminal Justice

Miles College

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