QUANETTE CALDWELL-EDWARDS

• Conducting weekly quality assurance audits for each team member via reports, and Microsoft Excel; Verifying data integrity & accuracy. Scheduling 1:1 meetings with individuals- rendering audit feedback, coaching, & training. Identifying areas of weakness & generating systematic plans to avoid future errors when processing accounts.

• Maintaining comprehensive knowledge of healthcare billing practices, staying current on industry updates and changes in regulations.

• Monitoring daily inbound ACD calls taken by staff via global navigation system; enhancing agents skillset through the development and delivery of customized training programs based on identified needs from monitoring activities.

• Variance research on patient balances to identify discrepancies with our pre-service estimated costs vs. actual billed costs to patients via EOB's, billing statements, cpt codes, & charge integrity data.

• Management of internal department to department mailbox, fulfilling daily incoming requests from multispecialty, internal medicine, and same day surgery clinical staff seeking to ascertain financial estimates on behalf of patients.

• Adhering to the No Surprises Act guidelines; managing/monitoring (NSA) Work Que daily; completing self-pay estimates in a timely manner; applying appropriate current procedural terminology and charge integrity.

• Managing external digital mailbox; correspondence with patients via their patient portal- assisting with financial questions, such as payment plans, estimate concerns, & conveying benefit information.

• Outbound calls to patients to obtain payment on high dollar pre-service estimates/international payments for upcoming Same Day Surgeries; Providing financial counseling-ensuring understanding of financial liability.

• Attending weekly strategy meetings with leadership across the organization; rendering feedback, reporting & discussing issues; engaging in collaboration with colleagues, achieving efficient & effective processes for optimal revenue cycle outcomes.

• Supported cross-functional relationships to discuss and seek resolution to issues discovered during analysis of various reports and data.

• Organizing & conducting weekly meetings with team members to discuss ongoing cases, share insights, and coordinate resources effectively. Fostering a collaborative environment by encouraging open communication and active participation from all attendees.

• Overseeing team's daily activities & providing ongoing training/coaching with questions pertaining to insurance plans, inbound calls, estimates, IT issues, patient escalations, etc. Ensuring staff members adhere to standard operating procedures.

• Maintaining and updating employee occurrence data spreadsheet for reporting & tracking purposes; ie- unexcused absences, tardies, early & late departures, etc.

• Demonstrating flexibility in adapting to changing priorities as needed throughout the workday, contributing positively to overall team morale.

• Training new hires, providing educational resources, & creating smooth onboarding acclimation to team process. Identifying individual needs & developing a learning style for new team members. ongoing training for current staff.

• Building & maintaining successful professional relationships with efficient and clear communication, active listening, perception checks, and effective leadership.

• Demonstrating problem-solving capabilities and timely decision making, identifying solutions and considering short and long-term impacts on departmental & organizational goals.

• Adhering to HIPAA & PHI compliance.

• Annual evaluation rated as meets or exceeds goals in role.

• Contributed to increased team productivity by consistently meeting or exceeding individual processing goals. Completing Work Que/Account goals daily in a timely and accurate manner.

• Effectively answered inbound ACD calls from patients, insurance companies, and clinical staff.

• Assisted patients with understanding their benefits coverage, providing clear explanations regarding out-of-pocket expenses and reimbursements.

• Contacted patients to discuss payment schedules and set up or immediately process payments.

• Demonstrated efficiency at working independently and collaboratively in a team environment.

• Team's point of contact for insurance/benefit questions & understanding specific plans.

• Supporting colleagues by developing others as a Senior Rep; Mentored junior team members, sharing industry expertise and best practices for providing exceptional patient support. Coordinated and rendered Epic training and technical assistance to new and current employees.

• Used electronic systems for data entry, tracking and analysis.

• Screen patients for referral to other funding sources.

• Attended weekly team meetings, taking meeting notes & issuing recap of targeted goals & key expectations to team members via email; Promptly responded to inquiries and requests from staff.

• Annual evaluation rated as meets or exceeds goals in role.

• Regulated financial clearance of patients for upcoming clinical appointments; verified, updated and added new & existing patient insurance, demographic & guarantor information, and registered cases in tracking system. Demonstrated exceptional attention to detail while verifying patient data.

• Answered inbound ACD calls from internal clinics seeking to add, remove, & verify insurance; removing technical hard stops on patients accounts- enabling clinical staff to proceed with a seamless check-in process; exceeded call productivity standards with 90-120 calls taken per day.

• Kept abreast & knowledgeable of commercial payor plans & appropriate rules and regulations on insurance policies; maintained educational data of in and out of network insurance plans as it relates to the organization. Demonstrated a Breadth of knowledge regarding CMO approval processes, single case agreements, and self-pay guidelines.

• Collaborated with team members to achieve shared goals and maintain a high level of productivity within the department; exceeded work que productivity metrics; assisted colleagues with productivity goals once mine were completed.

• Trained new employees on departmental process & standard operating procedures. Ability to interpret and explain rules/regulations that are ambiguous or unclear.

• Completed mandatory overtime hours as mandated to meet departmental goals.

• Annual evaluation rated as meets or exceeds goals in role.

• Collected, arranged, and input information into database.

• Adequately answered inbound calls from patients regarding balances, appointments, etc- redirected calls as needed to appropriate departments.

• Processed patient payments over the phone; (statement balances & pre-service collections); maintained high collection rates.

• Served as liaison with insurance companies, third party payors, clinical and administrative staff members; communicating effectively, following up on requests and tasks to point of completion.

• Initiated refund process with upper management.

• Demonstrated a high level of accuracy with account maintenance and note documentation.

• Exceeded assigned productivity goals; completed various administrative tasks when requested.

• Annual evaluation rated as meets or exceeds goals in role.

• Adhering to pier diem policies & requirements as a member of Vanderbilt's float team staff since 2016.

• Consistent monthly self-scheduling of open shifts on billboard.

• Floating to pediatric after hours clinics (five locations in Middle Tennessee) based on clinical and administrative registration needs during night and weekend hours.

• Patient registration process, confirming data accuracy and completeness.

• Continuously demonstrates success working within a fast-paced environment; managing multiple duties at once with ease and efficiency (checking in patients, answering calls, assisting with patient portal sign- ups, creating school & work notes, printing patient armbands & labels, etc)

• Effective communication with nurse, doctor, & on call administrator regarding patient care, wait times, and clinical needs.

• Answering incoming phone calls, collecting point of service payments, creating and activating patient portals, scanning documents into patient records.

• Training new hires, and new float members to after- hours procedures, processes, and insurance verification/loading; providing support/guidance on provider specific practices & preferences.

• Receptive and adept to last minute clinical changes and redirected routes based on last minute employee call-outs.

• Improved patient satisfaction by providing exceptional customer service during check-in and check-out processes.

• Assisted with insurance verification tasks, ensuring accurate billing and timely reimbursement for services rendered.

• Collaborated with clinical staff to coordinate care plans, resulting in improved patient outcomes.

• Processed medical records requests efficiently, safeguarding patient privacy while ensuring timely information access for healthcare providers.

• Facilitated patient registration by accurately entering demographic and insurance information into electronic health record systems.

• Provided compassionate support for patients facing financial challenges, assisting them in navigating available resources and payment options.

• Increased overall practice revenue by diligently collecting copayments and outstanding balances at the time of service.

• Reduced no-show rates through consistent appointment reminder calls, leading to improved clinic productivity.

• Actively participated in team meetings focused on improving workflows and enhancing overall practice performance.

• Supported new Patient Service Representatives orientation process by sharing expertise on office procedures.

• Conducted peer to peer interviews with new hire candidates as requested by manager; rendering feedback of interview.

• Coordinated referrals efficiently between primary care providers and specialists, ensuring a seamless patient experience.

• Filed and maintained patient records in accordance with HIPAA regulations.

• Balanced deposits and credit card payments each day;

prepared cash deposits and hand delivered them to central depository.

• Trained new staff on filing, phone etiquette, appointment scheduling, Provider templates, and other office duties.

• Facilitated communication between patients and nurses/physicians via daily management of digital message basket. identifying & taking immediate action on time sensitive messages such as chest pain, shortness or breath, etc-alerting clinical staff.

• Demonstrated efficient team work by answering inbound patient, pharmacy, and medical staff calls for eight Providers in internal medicine clinic, with 0% call failure. (105-125 calls taken per day).

• Maintained confidentiality of sensitive information on high profile and celebrity patients being seen in clinic; strictly adhered to privacy practices and HIPAA compliance.

• Organized office events such as holiday parties, potlucks, physician and nurse appreciation luncheons, and team-building activities, promoting a positive office culture and boosting employee morale.

• Managed reception area; maintained a clean & orderly appearance of office space; made coffee for patients daily and delivered to reception area for self- serve access.

• Performed other administrative duties as requested.

• Annual evaluation rated as meets or exceeds goals in role.