Priscilla Hawkins
734 Wilderness Trail Drive,NC
Summary
Hardworking experienced Customer Service Advocate/ Medical Biller/ Employee Benefits Enrollment Specialist/ Medical and Dental Claims Adjudicator/ Durable Medical Equipment Intake Specialist. I over 20 years experience. I am committed to maintaining professional relationships with clients to increase profitability and drive business results. I have the following NC licenses Notary Public Electronic Notary and Loan Signing Agent /Health and Accident Insurance Producer, Medicare Long term Supplemental.
Overview
33
33
years of professional experience
Work History
Intake Clinical Review Coordinator
SGS Consulting/Highmark Blue Cross Blue Shield
02.2023 - 03.2023
- Review medical records for completeness and forward to Nurse for authorization approval.
- Follow exact procedures for handling transfers and other releases of medical records.
- Input data into computer programs and filing systems.
- Generated and maintained statistical data related to medical records.
- Scan and uploaded medical records into electronic medical records system.
- Answered incoming calls from Providers and Members
- Communicated effectively with staff, patients, and insurance companies by email and telephone.
- Maintained accuracy, completeness, and security for medical records and health information.
- Assisted in preparation of medical reports for external parties.
- Followed up with medical staff regarding missing information in patient records.
- Sorted and distributed incoming and outgoing medical records.
CSR Adjudicator Claims Specialist
Artech/IBM State Of New Jersey
12.2021 - 09.2022
- Use critical thinking skills to determine if application submitted for Utility payment assistance met qualifications for payment.
- Assist customers via email and phone calls to request all electronic submissions of all missing documentation. In order to approve or deny the claim for Utility payment assistance.
- Answered customer telephone calls promptly to avoid on-hold wait times.
Ny Dept of Labor Pandemic Relief Claims Coordinator
Infinite Computer Solutions 40 Hours Per Week
04.2021 - 10.2021
- Responded to callers questions regarding claim and certification issues. Resolved issues by processing missed certifications, going over payment history as well as advising when claimants were not eligible and provided appropriate responses to clearly explain eligibility.
- Executed appropriate results to ensure all positions were covered to ensure escalating was the appropriate next level.
- Analyzed and solved multi-faceted problems that effected executive leaders and business initiatives.
- Resolved issues through active listening and open-ended questioning, escalating major problems to the Supervisors.
- Interceded between Supervisors during arguments and diffused tense situations.
Crew Member
Randstad USA/ Vanguard
10.2020 - 02.2021
- Worked flexible hours based on business needs.
- Assisted new investment clients with registering and signing up on the Vanguard secured portal and assisted with navigation on the website explaining how to use the system.
- Answered incoming calls for purposesof getting clients to the call on to the correct journey which required being knowledgeable of all investment types.
Intake Coordinator / DME Retail Sales/ Order Processor
Adapt Home Health Formely Advanced Home Care Inc. Over40hours
11.2008 - 09.2020
- Assisted customers in the retail store by providing information on how to use properly use medical equipment to ensure safety according to injuries.
- Updated merchandise pricing to match new values and special promotional rates.
- Processed customer payments billed insurance when necessary.
- Processed orders for medical equipment for the home required per Dr's prescribed orders both office and hospital orders. Billed to Medicare, Medicaid and Commercial Insurances making sure all documents, authorizations and CMNs were accurately obtained prior to billing.
Medical Biller
Home Medi Service 40 Hours
10.2007 - 10.2008
- Reviewed patient records, identified medical codes and created invoices for billing purposes.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Prepared billing statements for patients and verified correct diagnostic coding.
- Delivered timely and accurate charge submissions.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
- Gathered information from multiple sources to simplify billing and organize accounts.
Claims Adjudicator Over 40 Hours as Needed
Cigna Healthcare / Cigna International Expatriate Benefits
04.1990 - 07.2007
- Investigated high volume of insurance claims to determine validity and coverage eligibility.
- Communicated with clients to explain policy coverage and regulations.
- Collaborated with team members and management to meet goals.
- Determined claim status and negotiated to reach reasonable settlements or denials.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Processed CMS1500, UB04 billing forms
- Using codes CPT, ICD-9, HCPCS coding guidelines
Employee Benefits Specialist
Crawford Slevin And Hicks 40 Hours
07.2000 - 09.2002
- Directed and controlled 401K, medical, dental and vision benefit packages.
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email and in-person interactions.
- Checked employees' benefits enrollm..-.ent for accuracy and inputted all data into PeopleSoft software..
- Coordinated submission and processing of life insurance claims.
- Trained new team members in policies and procedures and offered insight into best ways to manage job tasks and duties.
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
ASP Insurance Verification/ EOB Specialist
Perioperatives ASP (Anesthesia Group)
11.2002 - 09.2004
- Determined appropriateness of payers to protect organization and minimize risk.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Posted payments to accounts and maintained records.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Observed strict procedures to protect sensitive patient information, medical records and payment data.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
Medical Biller
Eye Center Of Delaware Wilmington DE
06.2005 - 06.2006
- Prepared billing statements for patients and verified correct diagnostic coding.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Reviewed patient records, identified medical codes and created invoices for billing purposes.
- Collected payments and applied to patient accounts.
- Managed billing calendar and scheduled claims for payments.
- Translated and interpreted medical billing codes with strong accuracy to enable swift payment from insurance agencies.
- Posted surgical charges for practice providers.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
- Adhered to established standards to safeguard patients' health information.
Education
Diploma - General
Thompson High School
Alabaster, AL05.1984
Medical Billing And Coding - Medical Billing Certification
Cecil Community College
North East, MD06.2005
Health And Accident Ins Producer / Notary Public -
Central Piedmont Community College
Charlotte, NC05.2014
Skills
- ICD9- ICD10-CPT-HCPC
- Technical Support
- Service standard compliance
- Training development aptitude
- Multi-line phone talent
- Medical terminology knowledge
- Professional telephone demeanor
- 80 hours of coding eligible to sit for the AAPC exam
- Records review
- Medical billing code accuracy
- Medicare Benefits Advisor AEP and SEC Rx
Timeline
Intake Clinical Review Coordinator
SGS Consulting/Highmark Blue Cross Blue Shield
02.2023 - 03.2023
CSR Adjudicator Claims Specialist
Artech/IBM State Of New Jersey
12.2021 - 09.2022
Ny Dept of Labor Pandemic Relief Claims Coordinator
Infinite Computer Solutions 40 Hours Per Week
04.2021 - 10.2021
Crew Member
Randstad USA/ Vanguard
10.2020 - 02.2021
Intake Coordinator / DME Retail Sales/ Order Processor
Adapt Home Health Formely Advanced Home Care Inc. Over40hours
11.2008 - 09.2020
Medical Biller
Home Medi Service 40 Hours
10.2007 - 10.2008
Medical Biller
Eye Center Of Delaware Wilmington DE
06.2005 - 06.2006
ASP Insurance Verification/ EOB Specialist
Perioperatives ASP (Anesthesia Group)
11.2002 - 09.2004
Employee Benefits Specialist
Crawford Slevin And Hicks 40 Hours
07.2000 - 09.2002
Claims Adjudicator Over 40 Hours as Needed
Cigna Healthcare / Cigna International Expatriate Benefits
04.1990 - 07.2007
Diploma - General
Thompson High School
Medical Billing And Coding - Medical Billing Certification
Cecil Community College
Health And Accident Ins Producer / Notary Public -
Central Piedmont Community College
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