Nikki Tolley
Lizemores,WV
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Skilled administrative team member with in-depth understanding of medical standards, compliance requirements and operational procedures. Practiced problem-solver with friendly and caring mentality and excellent communication skills. Expertise in inventory management, customer service and inner-office operations.
Overview
2
2
years of professional experience
Work History
Pre-Certification Specialist
Charleston Area Medical Center Health System Inc.
Charleston, WV
03.2022 - 08.2023
- Conducted pre-certification process for medical procedures and services to ensure compliance with insurance requirements.
- Analyzed patient information, benefit coverage details, and other pertinent data to determine eligibility for benefits.
- Reviewed claims denials from insurance companies and worked with providers to resolve issues in a timely manner.
- Assisted providers in obtaining prior authorization approvals by submitting paperwork via fax or electronically.
- Responded promptly to provider inquiries regarding the status of their requests.
- Identified trends in denials and rejections due to incorrect coding or lack of documentation.
- Collaborated with other departments within the organization as needed.
Registration Representative
Charleston Area Medical Center Health System Inc.
Charleston, WV
03.2021 - 03.2022
- Reviewed patient information and verified accuracy of demographic data in order to register patients.
- Assisted with scheduling appointments, verifying insurance coverage, and collecting payments.
- Provided excellent customer service by answering inquiries and resolving any issues that arose.
- Entered all patient information into the registration system accurately and efficiently.
- Sorted incoming documents such as medical records, lab results, referrals., ensuring they were properly routed to the appropriate departments within a timely manner.
- Collaborated with clinical staff members to ensure proper documentation was completed prior to patient being seen by physician or specialist.
- Maintained confidentiality of protected health information according to HIPAA guidelines.
- Answered phones promptly and professionally; responded appropriately and courteously to caller inquiries.
- Communicated effectively both verbally and in writing with patients, families and healthcare professionals in a professional manner at all times.
- Scanned documents into EMR system; updated and maintained files according to established protocol.
Education
High School Diploma -
Valley High School
Smithers, WV05-2006
Skills
- Insurance Verification
- Organizational abilities
- Medical terminology expertise
- Patient Scheduling
- Electronic Recordkeeping
- HIPAA Regulations
- Documentation Review
- Data Entry
- Multitasking
- Documentation and Recordkeeping
- Medical Charting
- Time Management
Timeline
Pre-Certification Specialist
Charleston Area Medical Center Health System Inc.
03.2022 - 08.2023
Registration Representative
Charleston Area Medical Center Health System Inc.
03.2021 - 03.2022
High School Diploma -
Valley High School
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