Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Timeline
Generic

Regina Fleming

Brentwood,TN

Summary

Over 20 years in the Legal Service, Healthcare, Call Center, Compliance, Dispute Resolution and Insurance Claims.

Overview

22
22
years of professional experience
1
1
Certification

Work History

Mediator

Fleming Mediation, LLC
07.2021 - Current
  • Facilitate communication between two opposing parties in a dispute to help guide them to a mutual agreement
  • Hold introductory meetings with disputing parties to explain the arbitration process
  • Interview both disputing parties and witnesses
  • Examine documents as needed to get information about the dispute at hand
  • Coordinate negotiations between parties and execute all contracts.

Medical Scheduling Specialist

Receivable Solutions, LLC
04.2023 - 11.2023
  • Respond to patient referrals request via email or outbound call
  • Gather essential information to ensure patient is connected to the right Physician aligned with the patient's medical needs
  • Reach out to patients for appointment scheduling and conduct health assessments
  • Enter patient information and interactions within the electronic health records (EHR/EPIC) system.

Case Manager/Administrative Assistant of Disaster Recovery

IEM/Pennsylvania Housing Assistance Fund-LHH Recruiting
05.2022 - 03.2023
  • Complete Disaster Needs Assessments on applicants claim
  • Assist applicant with application, service plans and individual recovery plans
  • Assign appropriate Housing Counselor or Legal Service Provider per County to applicants for additional recovery services
  • Ensure case files documentation is legible, accurate and complete
  • Routinely monitor and escalate any shut off notices, sheriff sales, liens and foreclosures files
  • Maintain knowledge of State and County growth strategies and market analysis
  • Conduct risk assessments to identify and mitigate potential compliance risks
  • Develop strategies to address emerging compliance challenges.

Patient Enrollment Specialist

Aspire Healthcare
10.2019 - 03.2020
  • Make outbound calls for prospective patients to confirm the efficient scheduling of initial in-home appointments
  • Ensuring that the patient receives a detailed explanation of Aspire services
  • Expedite emergency clinical calls as needed
  • Process new appointments or changes to existing appointment
  • Own, manage, convert, and enrolling an assigned referral base
  • Schedule appointments at the 'best time' by considering the needs of our patients within the context of the APP's overall schedule and availability
  • Work collaboratively and efficiently with other corporate and field-based team members to ensure patients receive exceptional service
  • Document accurate and concise patient/family feedback and special needs during each call in our computer systems, enabling our market-based clinicians to provide excellent care during each appointment
  • Ensure the organization's compliance with all relevant federal, state, and local regulations and laws pertaining to health services, including but not limited to HIPAA and state regulations.

Corporate Document Tracking Specialist

Brookdale Senior Living
10.2017 - 10.2019
  • Report held Claims to Medicare and Medicaid for processing
  • Verify with each Physician the delivery requirements of orders and face to face encounter notes to be signed
  • Responsible for data entry associated with Home Health episodes for tracking documentation, orders sent, orders received with signatures, and ensuring accuracy of data entry in accordance with daily and weekly reconciliation procedures
  • Ensures orders, and episode discharge summary are sent to physicians in a timely manner
  • Ensures credentials are met by; preparing and submitting credentialing applications and supporting documentation for the purpose of enrolling Physicians and Physician groups with payers
  • Provide professional customer service to physicians, physician's office personnel and other referral sources
  • Tracks and provide follow-up actions for any outstanding physician orders and face-to-face encounter visit notes
  • Adhere to confidentiality standards as required by Brookdale and HIPAA concerning patient information.

Credentialing Specialist

HEOPS
07.2018 - 03.2019
  • Verify and Report that Medical Providers are compliant with Medicare and Medicaid laws and guidelines
  • Obtain and verify professional state licenses for Medical Professionals
  • Maintain up to date state license requirements to be able to start license process upon request
  • Complete all state license applications and gather required documentation to submit with licensure applications
  • Process state applications in a timely manner to insure we meet all internal and external deadlines
  • Partner with internal and external customers to ensure that all license requirements are met and to stay abreast of all deadlines
  • Comply with all state licensing requirements and operations guidelines to obtain state licenses
  • Maintain confidentiality in all provider and licensing.

Sound Board Specialist

Sound Physicians
08.2016 - 07.2018
  • Verify and Report that Medical Providers are compliant with Medicare and Medicaid laws and guidelines
  • Ensure that necessary intake information is obtained, and Providers are presented with coherent and complete information from Payer Enrollment Specialists and Privileging Consultants
  • Performs customer service function by reaching out to new Providers to ensure needs are identified and met within established timeframes during the onboarding process
  • Assist with I9 verifications and Ultipro Login
  • Travel to new sites to assist with go-lives and assists with facilitating the new hire/orientation process
  • Identifies potential problem areas and recommends/implements solutions as appropriate
  • Manage a professional relationship with regional leadership team
  • Proactively communicates to the regional leadership team regularly regarding issues with Payer Enrollment and Privileging
  • Ensures excellent customer service by establishing long term relationships with doctors, including knowing their sites/locations and other basic information
  • Update and process any status changes and terminations with the Physicians at the direction of the People Support Manager.

Legal Administrator/Paralegal/Office Manager

Kenn Law Firm, LLC
10.2011 - 02.2014
  • Report and set up insurance injury claims to Medicare and Medicaid according to Medicare and Medicaid guidelines
  • Draft complex legal documents for review and use by attorneys
  • Request and prepare medical records and medical bills for insurance demand package that includes; understanding medical CPT/ICD 10 codes and diagnosis
  • Report and set up personal injury claims to insurance adjusters
  • Collect relevant information and supportive documents from clients
  • Create and maintain a claim spreadsheet and database
  • Manage and pay expense for client records, reports and settlement
  • Prepare and complete demand settlements to insurance adjusters
  • Screen all incoming calls
  • Schedule appointments and maintain calendars
  • Categorize and interpret data; review and analyze reports, responses and records produced by opposing counsel
  • Assist attorneys in all aspect of legal case preparation and file management
  • Investigate, coordinate and process medical and indemnity workers compensation claims involving multiple states to determine compensability, entitled benefits, average weekly wage and benefit rate, per the applicable State Law Workers' Compensation Statute.

Office Manager/Paralegal/ Intake Specialist

Marketing, LLC
06.2002 - 02.2010
  • Report and set up settlement claims according to Medicare and Medicaid guidelines
  • Interview clients for large class action cases that include interviewing clients, request and provide evidence and supportive documents from the clients to the attorneys for review
  • Set up and maintain client personal files
  • Screen all calls for Class Action Cases
  • Manage Call Center Support Staff
  • Complete a conflict-of-interest search on new cases
  • Research class action lawsuits for upcoming Class Action Campaign Ads on; Consumer Law, Insurance and Annuities Fraud cases.

Education

Juris Doctorate Degree -

Miles College School of Law
Birmingham, Alabama

Bachelor of Arts Degree - English/Law Major -

Rust College
Holly Springs, Mississippi

High School Diploma -

French Camp Academy
French Camp, Mississippi

Skills

  • Microsoft Word
  • Office Suite & Excel
  • Corel WordPerfect 7&8
  • Pro Law
  • Westlaw
  • Lexis
  • Summation iBlaze v 25
  • Time Matters 70
  • Soft Solutions
  • Lotus
  • Needles
  • Worldox GX3
  • Plaintiff
  • Case Map
  • Office of Indigent Defense Service
  • Internet/Email
  • SIMS
  • Dictation
  • OneView
  • SharePoint
  • Law Base
  • Campus Vue
  • Wonderlic
  • Symed
  • UltiPro
  • QuickBooks
  • Homecare Homebase
  • Forcura
  • Fuze
  • Torch
  • FIVE 9
  • EMR Scheduling Dashboard
  • HAIQ
  • EPIC
  • Salesforce

Accomplishments

  • 1999 Candidate for the Office of Justice Court Judge, Attala County, Mississippi
  • Published Author of Thorns Beneath my Feet

Certification

Rule 31 Tennessee Supreme Court Civil Mediator

Compliance

Timeline

Medical Scheduling Specialist

Receivable Solutions, LLC
04.2023 - 11.2023

Case Manager/Administrative Assistant of Disaster Recovery

IEM/Pennsylvania Housing Assistance Fund-LHH Recruiting
05.2022 - 03.2023

Mediator

Fleming Mediation, LLC
07.2021 - Current

Patient Enrollment Specialist

Aspire Healthcare
10.2019 - 03.2020

Credentialing Specialist

HEOPS
07.2018 - 03.2019

Corporate Document Tracking Specialist

Brookdale Senior Living
10.2017 - 10.2019

Sound Board Specialist

Sound Physicians
08.2016 - 07.2018

Legal Administrator/Paralegal/Office Manager

Kenn Law Firm, LLC
10.2011 - 02.2014

Office Manager/Paralegal/ Intake Specialist

Marketing, LLC
06.2002 - 02.2010

Juris Doctorate Degree -

Miles College School of Law

Bachelor of Arts Degree - English/Law Major -

Rust College

High School Diploma -

French Camp Academy

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Regina Fleming