Orlandria Washington
Loganville,GA
Summary
Efficient professional in insurance claims and policy processing, known for high productivity and the ability to complete tasks with precision. Specialized in analyzing claim details, navigating policy databases, and managing customer communications. Excel in problem-solving, adaptability, and teamwork, leveraging these soft skills to navigate complex situations and achieve positive outcomes.
Overview
7
7
years of professional experience
Work History
Patient Service Representative
American Health Imaging
Suwanee, GA
04.2024 - Current
- Managed patient check-in process, ensuring accurate data entry of personal and insurance information
- Scanned completed forms, identification and insurance cards, maintaining patient documents folder
- Scheduled and confirmed patient appointments with patients and healthcare professionals
- Handled all incoming phone inquiries with efficiency
- Coordinated with healthcare providers to obtain missing information or clarification on claims.
Customer Service Representative
Foundever/Cigna
Remote, GA
11.2021 - 01.2024
- Handled complex healthcare inquiries for Cigna members, resolving issues efficiently while maintaining high customer satisfaction, and HIPAA compliance
- Applied knowledge of coding systems such as CPT-4 and HCPCS codes for proper reimbursement.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Answered inbound calls, chats and emails to facilitate customer service
- Streamlined claims processing workflows by integrating cross-platform healthcare databases, enhancing member data accuracy, and resolution speed.
- Conducted a thorough analysis of healthcare claims data to identify patterns and resolve complex member inquiries, enhancing service quality.
Patient Care Nursing Assistant
Piedmont Augusta Hospital
Augusta, GA
10.2017 - 06.2021
- Coordinated with nursing staff to implement care plans, document patient progress, and ensure compliance with healthcare protocols and safety standards
- Maintained accurate patient records while monitoring health indicators, reporting status changes, and supporting infection control measures
- Delivered compassionate bedside care while assisting nurses with vital signs monitoring, and patient mobility support, enhancing overall care quality
Education
Bachelor of Science - Health Services Administration
Augusta University
Augusta, GA05.2021
Associate of Science - Pre-Nursing
Georgia Military College
Milledgeville, GA05.2017
Skills
- Technical & Industry Knowledge
- Medical Billing & Coding
- CPT, ICD-10, and HCPCS Codes
- Insurance Claims Processing
- Knowledge of Medicare, Medicaid, and Commercial Insurance
- HIPAA Compliance
- Electronic Health Records (EHR) & Practice Management Software
- Data Entry & Document Management
- Analytical & Problem-Solving Skills
- Claims investigation and adjudication
- Accuracy and attention to detail
- Fraud Detection & Prevention
- Reviewing & Resolving Denials
- Policy & Benefit Interpretation
- Appeals & Dispute Resolution
- Customer Service & Communication
- Verbal & Written Communication
- Patient & Provider Support
- Conflict Resolution
- Handling Confidential Information
- Working with Insurance Adjusters & Healthcare Providers
- Administrative & Organizational Skills
- Multitasking & Time Management
- High Volume Claims Processing
- Workflow Prioritization
- Team Collaboration
Timeline
Patient Service Representative
American Health Imaging
04.2024 - Current
Customer Service Representative
Foundever/Cigna
11.2021 - 01.2024
Patient Care Nursing Assistant
Piedmont Augusta Hospital
10.2017 - 06.2021
Bachelor of Science - Health Services Administration
Augusta University
Associate of Science - Pre-Nursing
Georgia Military College
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