EPIC
RaeDawn James
Healthcare Management and Nurses Assistant
Lithonia,GA, Georgia
Summary
15+ years of healthcare CSR experience HEDIS Medical Records Coordinator EMR experience Credentialing / Reappointing Scheduler Research Department Insurance authorization experience Patient Registration Home Health Practice Manager Supervisor Administrator Front Office Professional and positive attitude Team Player Able to multitask
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
19
19
years of professional experience
Work History
Licensing Specialist
ApolloMD Physician Partners
11.2022 - Current
- Stayed up-to-date on State laws and licensing requirements to complete accurate and efficient reviews.
- Maintained fiscal records and accounts.
- Issued various permits and licenses such as marriage, hunting or dog licenses and collected appropriate fees.
- Created documents with applicant information and verified data against Type database information.
- Verified authenticity of foreign identification or immigration documents.
- Informed customers by mail or telephone of additional steps needed to obtain licenses.
- Performed routine data entry or document management.
HEDI Coordinator, Administrative Assistant
Centene, Peachstate, Cherokee County Jail
01.2020 - 03.2020
- Company was shut down due to the COVID-19 Pandemic
- Well path
RaeDawn James
02.2016 - 01.2020
- Ensures confidentiality of all medical records information and completes forms for release of information
- Ensures all medical records filing is up to date
- Performs Clerical/Technical duties: Pull and file medical records daily as needed
- Prepare and type reports/correspondence as requested by the doctors and medical staff
- Answer telephone, relay messages, and transfer calls as appropriate
- File loose documentation generated from inside and outside the institution such as laboratory reports, radiology results, completed consultant reports, medication administration records, etc
- Schedule patients for medical appointments as requested
- Preparing periodic statistical reports and other management information system requirements
- Promotes Quality Improvement standards by actively participating in the quality of care screen audits
- Abides by the security regulations of the assigned facility., Lovelynraedawn@gmail.com
- Managing a private Internal and Pediatrics Practice
- Staff included: 10 employees, 2 doctors and
- Check-in and Out, Billing, EHR, scheduling, claims processing, credentialing
- Insurance authorization and billing
- Credentialing / Reappointment
- Physician Licensing
- Address staff issues and conducts regular performance reviews
- Computer System: AdvanceMD, Microsoft Office, Outlook, Excel, Power Point, 3839
- Lovelynraedawn@gmail.com
- Monitors all aspects of health care provider referrals with completion of required documentation
- Evaluates benefits and eligibility of all patients for reimbursements as well as verification of accounts with appropriate resources
- Maintain as well as update pertinent information regularly on hospital information systems and record all patient data
- Prepare and revise staffing schedules and evaluate job performance of peers
- Coordinate with patients and schedule routine visits as required
- Manage all patient data regarding admissions and update discharge of automated systems
- Routinely performs research activities for automated systems with license verification for all health care providers
- Participates in various quality improvement projects
- Skills: Customer Service, Medical Ethics, Generally Accepted Accounting Principles, Healthcare Management and
- Cash Handling
- Computer System: Microsoft Office, NextGen, EPIC, McKesson (Star), SMS, Outlook, Citrix XenApp,
- Excel
Department Assistant Manager
Piedmont Heart Institute/Marcus Heart Valve Center of Research
02.2019 - 01.2019
- I support and facilitate the overall day to-day operations for the Marcus Heart Value and Surgery Center
- I have about a 135 employees,4 chief surgeons ( Vascular, Thoracic, Cardiac and the CEO of Piedmont Atlanta (18 providers, 30
- APPs and 50 Clinical and non-Clinical staff members), establishes and maintains an effective operating environment which assures effective, efficient, and safe operations that respond to patient, physician, and staff needs
- I am the liaison between physicians and office employees to resolve conflicts and to promote cohesiveness in the practice; as well as serving as liaison between the practice and other clinical and administrative components of the Marcus Heart
- Valve Center (MHVC) Piedmont Heart Institute (PHI)
- Making sure all Physicians file maintenance, photocopying, mail distribution and similar routing duties
- Duties may include directing phone calls to appropriate person or area, and assisting and directing visitors to different department areas, scheduling meetings, and computer or data entry
- I monitor the submission of timely, accurate and complete billing information to the business office to ensure the maximization of professional services reimbursement; research disallowance reports for unusual reimbursement practices; remain up-to-date on coding and insurance practices as necessary and interact with the Central Business
- Office to update, change or delete codes and charges when determined to be ineffective, unprofitable and/or obsolete
- Oversee and/or perform the following tasks as they impact timely, accurate, and complete billing information
- Key Responsibilities
- General office administration duties to include, but not limited to: mail processing, ordering and managing supplies, scheduling appointments, timekeeping, maintaining director’s calendar, data entry, etc
- Gathers information and prepares reports, project materials and composes documents
- Creates, maintains, updates and reconciles various types of documents, such as organizational charts, contact lists, vendor contacts, routine reports, etc
- Provides customer service to internal and external customers
- Credentialing and Reappointing for all Physicians, PA’s and APPs
- Physician Licensing
- Physician and Research Staff Reimbursement
- Facilitating all areas of the Marcus Heart Value and Surgery Center
- Computer System: EPIC, Microsoft Office, Outlook, Qgenda, Tableau, Avaya, NASCO GUI, WGS/CCB CallCare, WMDS,
- MaxMc
Office Manager
The Pearls of Health Medical & Dental
07.2015 - 02.2017
Insurance Verification Specialist
Piedmont Healthcare
06.2016 - 08.2016
- Contacting insurance companies, physicians, and patients to ensure that accurate patient demographic and insurance information is collected, and that pre-certification and/or pre-authorization determination can be made
- This may include liaising with physician offices and third-party payers
- Managing Medicare and Medicaid accounts as well other Commercial Insurance
- Posting services claims work on a
- Local level
- Determines contract and benefit eligibility; provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service
- Obtain pre-certifications, authorizations, and referrals to ensure managed care compliance for necessary appointments
- Fulfill notification requirements for inpatient admits
- Enter the information gathered into the computer system
- Perform any other function deemed necessary to perform financial or clinical clearance
- Apply critical thinking skills to identify and resolve problems proactively to maximize reimbursement
- Deliver positive patient experience
- Adhere to Piedmont organizational policies and procedures for relevant location and job scope
- Complete and/or attend mandatory training and education sessions within approved organizational guidelines and timeframes
- Computer System: EPIC, Microsoft Office, Avaya, NASCO GUI, WGS/CCB CallCare, WMDS, MaxMc
Customer Service/Precertification Representative
Anthem
05.2014 - 06.2016
- Managing incoming calls or incoming post services claims work on a National level
- Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
- Refers cases requiring clinical review to a Nurse reviewer
- Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate
- Responds to telephone and written inquiries from clients, providers and in-house departments
- Conducts clinical screening process
- Authorizes initial set of sessions to provider
- Checks benefits for facility-based treatment
- Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner
- Computer System: Microsoft Office, Avaya, NASCO GUI, WGS/CCB CallCare, WMDS, MaxMC
Patient Access Specialist
WellStar Health System
09.2010 - 06.2013
ER Secretary/ Patient Access Specialist
Children’s Healthcare
09.2004 - 07.2012
- Assisting 50 doctors and the Medical staff in a Level 1 Children’s Trauma Center and ER
- Recorded information on medical charts and scheduled appointments
- Handled Pre-authorizations and pre-certifications
- Charted information with accuracy using medical terminology while being discreet
- Accommodated patient’s needs when checking into the health facility
- Answered multi calls with professionalism while following the Personal Health Information guidelines
- Completed patient registration as well as processing all patient information for inpatient admissions in the emergency room
- Charging Posting for Two Major Hospitals
Education
Associated of Science - Healthcare Management
Brown Mackie College
High School Diploma - undefined
Ramona High
Bachelors of Science - Healthcare Management
South College
Atlanta, GA05.2022
Skills
- Obtain and maintain security clearance
- Emergent situations and accurately follow standardized procedures that may call for deviations
- Must be able to apply sound judgment beyond a specific set of instructions and apply knowledge to different factual
- Situations
- Post orders, if applicable, per site contract form and other duties as assigned
- Computer System:
- ERMA, AdvanceMD, Microsoft Office, Outlook, Excel, and Power Point
- Microsoft Office, NextGen, EPIC, McKesson (Star), SMS, Outlook, Citrix XenApp
- Loan Applications
- Human Resources Department Processes
- Detailed Meeting Minutes
- Office Meetings
- Payroll Processing
- Clerical Support
- Administrative Support
- Critical Thinking
- Business Correspondence
- Purchase Orders
- Office Procedures
- Weekly Payroll
- Accounts Payable and Accounts Receivable
- Project Requirements
- Communications Strategies
- Complaint Resolution
- Customer Communication
- Team Meetings
- Filing Documents
- Outbound Calls
- Client Needs Assessment
- Public Relations
- Customer Inquiries
- Office Supplies and Inventory
- Application Verification
- Office Equipment
- Meeting Support
- Organizational Systems
- Microsoft Word
- Business Recordkeeping
- Travel Arrangements
- Financial Management
- Employee Performance Evaluations
- Confidential Records Management
Software
ERMA
AdvanceMD
Microsoft Office
Qgenda
NexGen
McKessen
Certification
- CNA - Certified Nursing Assistant
- CMT - Certified Medication Technician
- HHA - Home Health Aide
- HCA - Home Care Aide
- CPR and First Aid Certified
- BLS Certified
Timeline
Licensing Specialist
ApolloMD Physician Partners
11.2022 - Current
HEDI Coordinator, Administrative Assistant
Centene, Peachstate, Cherokee County Jail
01.2020 - 03.2020
Department Assistant Manager
Piedmont Heart Institute/Marcus Heart Valve Center of Research
02.2019 - 01.2019
Insurance Verification Specialist
Piedmont Healthcare
06.2016 - 08.2016
RaeDawn James
02.2016 - 01.2020
Office Manager
The Pearls of Health Medical & Dental
07.2015 - 02.2017
Customer Service/Precertification Representative
Anthem
05.2014 - 06.2016
Patient Access Specialist
WellStar Health System
09.2010 - 06.2013
ER Secretary/ Patient Access Specialist
Children’s Healthcare
09.2004 - 07.2012
Associated of Science - Healthcare Management
Brown Mackie College
High School Diploma - undefined
Ramona High
Bachelors of Science - Healthcare Management
South College
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