Summary
Overview
Work History
Education
Skills
Personal Information
Timeline
Generic

Rachel Gladney

Cordova,TN

Summary

Tenured medical office professional with experience in reviewing and correcting health records to identify proper diagnosis and procedure code. Diplomatic and tactful with professionals at all levels. skillful at completing projects with minimum supervision. Accustomed to handling sensitive, confidential records with accuracy. Completed medical billing and coding course and currently taking courses for Administrative Medical Assistant certification.

Overview

8
8
years of professional experience

Work History

Billing and Reimbursement Rep

Accredo
Memphis , TN
08.2023 - Current
  • Responsible for coordinating all insurance benefits to ensure patient responsibility.
  • Ensures that healthcare providers and organizations are appropriately reimbursed for their services.
  • Ensure patients make payments, or set up bill payment plans, process insurance reimbursement requests, and issue refunds.
  • Assist with other administrative task
  • Coordinate compensations and benefits

Prior Authorization Rep

Express Scripts
Memphis, TN
02.2020 - 08.2023
  • Responds to requests for authorization of services via phone and written correspondence to and from healthcare professionals, including pharmacists and doctors, to verify patients' pharmacy approval, eligibility-deductible, copays, and to initiate prior authorization
  • Maintain minimum production standards
  • Provides telephone, clerical, and data entry support for the Care Review team
  • Screened and reviewed patient eligibility requests in accordance with benefit plan design, client specifications, and clinical criteria (the current procedural terminology codes or CPT codes)
  • Utilized various electronic medical records and online authorization platforms to expedite the claims process such as CoverMyMeds
  • Processed an average of 10-15 prescriptions and contracted medical claims daily for timely clearance to the pharmacy

Patient Care Representative

Baylor University Medical Center/Touchstone Imaging
Memphis, TN
11.2016 - 05.2019
  • Responsible for obtaining current & accurate demographics and insurance information in order to register patients
  • Data entry
  • Verify insurance coverage and eligibility via phone, fax, and/ or online
  • Responsible for confirming correct billing information to minimize reimbursement risks associated with providing care to patients
  • Provide patient education and prep for various diagnostic exams
  • Escort patients and verify correct prep followed for various modalities

Education

Medical Insurance Billing and Coding -

Everest College
01.2010

Skills

  • EHR Management
  • HIPPA
  • MS word
  • Excel
  • PowerPoint
  • Medical terminology
  • 10 key entry
  • Interpersonal
  • 60 WPM
  • Proofread and editing
  • Medical Billing
  • ICD-10
  • Documentation Review
  • Analysis
  • Data Entry
  • EPIC
  • Order problem solving
  • Sales reporting
  • Client relationship building

Personal Information

Title: Medical Representative

Timeline

Billing and Reimbursement Rep

Accredo
08.2023 - Current

Prior Authorization Rep

Express Scripts
02.2020 - 08.2023

Patient Care Representative

Baylor University Medical Center/Touchstone Imaging
11.2016 - 05.2019

Medical Insurance Billing and Coding -

Everest College
Rachel Gladney