Summary
Overview
Work History
Education
Skills
Certification
Related Qualifications
Timeline
Generic

Radie Waters

Henderson,N.C.

Summary

Dedicated and detailed professional with 7+ years’ experience in healthcare operations and claims management. Excels at identifying client needs and concerns to improve engagement strategies and overall service. Seeking a remote claims/healthcare position to contribute to the success of a progressive healthcare organization

Overview

8
8
years of professional experience
1
1
Certification

Work History

Program Supervisor- Hub Operations

Mercalis
11.2023 - Current
  • Responsible for performance management including but not limited to, coaching and mentoring subordinates, employee counseling, employee performance appraisals, conflict resolution and schedule adherence
  • Liaison between Program Manager and Team
  • Keeps the Program Manager abreast on all aspects concerning the Program
  • Plans daily schedule, assigns tasks, and ensures daily goals are met
  • Submits daily and weekly reports to the Program Manager regarding productivity statistics at both the team and employee level
  • Enhanced team productivity through effective delegation, task prioritization, and clear communication.

Patient Care Coordinator (Team Lead)

Mercalis
04.2023 - 11.2023
  • Primary point of contact for client field personnel (sales representatives, field reimbursement personnel / dependent on program design).
  • Assist patients and healthcare providers with understanding insurance coverage, billing, reimbursement of the product, as well as delivery benefit results as requested.
  • Maintain electronic records in compliance with the SOP.
  • Perform as a SME for product and HUB specific programs.
  • Assist in training new Care Coordinators and Support Coordinators.
  • Managed sensitive patient information with strict adherence to HIPAA guidelines, maintaining confidentiality and privacy at all times.

Patient Care Coordinator

Mercalis
11.2021 - 04.2023
  • Handle day-to-day HUB specific tasks.
  • Serve as an advocate for patients and health care providers in designated regions.
  • Assist patients and healthcare providers with understanding insurance coverage, billing, reimbursement of the product, as well as delivery benefit results as requested.
  • Review and evaluate patient eligibility for copay assistance, foundation assistance, nurse navigator support, safe returns, and other support programs.
  • Maintain electronic records in compliance with the SOP.
  • Managed sensitive patient information with strict adherence to HIPAA guidelines, maintaining confidentiality and privacy at all times.


Reimbursement Case Manager

Aston Carter
11.2019 - 11.2021
  • Maintained status of Prior Authorizations/Pre-Certifications/Appeal request results of specialty medicine as liaison between Health Insurance Companies and Healthcare Providers
  • Determines patient's eligibility and conducts patient enrollment activities
  • Collects and review all patient information, to the degree authorized by the SOP of the program
  • Processed all questions, concerns and payments via telephone and email with focus on accuracy and efficiency.
  • Maintained patient records in accordance with HIPAA regulations.
  • Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.

Healthcare Customer Service Representative

Continuum Global
09.2017 - 10.2019
  • Gathered information, assessed, and fulfilled callers' needs and educated on important policies and procedures.
  • Identified, analyzed, and researched systemic issues and made recommendations for resolution.
  • Handled customer service inquiries in person, via telephone and through email.
  • Filed and maintained patient records in accordance with HIPAA regulations.
  • Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.

Education

GED -

College of The Albemarle
Elizabeth City, NC
05-1999

Skills

  • Accurate data entry
  • Proficient in MS Office
  • Interdepartmental communication skills
  • Database management
  • Knowledgeable in medical terminology
  • Healthcare operations
  • Claims resolution management
  • Effective multitasking
  • HIPAA compliance expertise
  • Verbal and Written Communication
  • Operational leadership
  • Staff development

Certification

  • Medical Office Assistant- 2019
  • Medical Terminology, Continuum Global Solutions - 2018

Related Qualifications

  • Call de-escalation and resolution support.
  • Inbound and Outbound call handling expert.
  • Patient centric focused.
  • Strategic planner and critical thinker.
  • Product/Program subject matter expert.
  • Goal oriented.
  • Verbal and communication skills.
  • Continued self-training in the MLC.
  • Program SME.

Timeline

Program Supervisor- Hub Operations

Mercalis
11.2023 - Current

Patient Care Coordinator (Team Lead)

Mercalis
04.2023 - 11.2023

Patient Care Coordinator

Mercalis
11.2021 - 04.2023

Reimbursement Case Manager

Aston Carter
11.2019 - 11.2021

Healthcare Customer Service Representative

Continuum Global
09.2017 - 10.2019

GED -

College of The Albemarle

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