Renita Lloyd
Philadelphia,PA
Summary
Highly-motivated Medical Reimbursement Specialist with desire to take on new challenges. Organized employee working with billing and credentialing coordinators. Meticulous worker identifies discrepancies and issues related to billing and reimbursements and implements corrective actions and adjustments. Maintains patient confidence by keeping important information confidential. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
24
24
years of professional experience
Work History
Medical Reimbursement Specialist
Main Line Health Homecare & Hospice
Radnor , PA
2015.08 - Current
- Reviewed, processed, and tracked medical claims for reimbursement from insurance companies.
- Interpreted complex medical codes related to billing procedures.
- Adhered to HIPAA regulations when handling confidential information.
- Analyzed data trends in order to identify areas of improvement in reimbursement processes.
- Communicated with other departments regarding changes or updates that may affect reimbursement rates.
- Provided training and guidance to staff members on proper coding procedures.
- Responded promptly to inquiries from insurance companies regarding claim disputes.
- Developed strategies for increasing efficiency in the reimbursement process.
- Maintained detailed records of all communications related to claim processing activities.
- Protected medical office operations and integrity by keeping patient information confidential.
- Attended provider meetings and workshops when appropriate.
- Investigated past due invoices and delinquent accounts to generate revenues and reduce number of unpaid and outstanding accounts.
- Performed insurance verification, pre-certification and pre-authorization.
- Trained new team members on company policies and accounting systems to keep team operations productive and efficient.
- Understood and followed oral and written directions.
- Demonstrated leadership by making improvements to work processes and helping to train others.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Planned and completed group projects, working smoothly with others.
- Reviewed authorization requests for accuracy and completeness.
- Researched patient eligibility, coverage information, and benefit levels.
- Verified insurance authorizations with payers via telephone or web-based systems.
- Processed prior authorization requests in accordance with departmental guidelines.
- Assisted in the development of new processes and protocols to improve operational efficiency.
- Tracked authorization statuses using electronic databases or manual filing systems.
- Coordinated communication between providers, patients, payers, and other departments as needed.
- Prepared appeal letters on behalf of clients when necessary to resolve disputes with insurers.
- Ensured timely submission of accurate documentation to support payment of services rendered by providers.
- Performed data entry into various computer systems including but not limited to EMRs and CRMs.
- Created spreadsheets utilizing Microsoft Excel for tracking authorization status updates from payers.
- Analyzed denials received from third party payers to identify trends in denials and develop proactive measures for resolution.
- Participated in meetings with staff members from other departments such as billing and coding teams to provide clarification on policies related to authorizations.
- Conducted training sessions for new employees regarding company policies related to the authorization process.
- Monitored daily workflow queues within the department ensuring all tasks are completed accurately and timely.
- Investigated discrepancies identified during audits of claims submitted for reimbursement by providers.
- Generated monthly reports detailing productivity metrics such as number of authorizations processed per day, week, month.
- Attended continuing education seminars on topics relevant to the role such as coding changes or insurance policy updates.
- Managed intake of new claims and performed routine follow-ups.
- Explained reasons behind application denials and recommended further action.
- Entered client information and files into databases for further review and tracking.
- Responded to client inquiries and concerns and escalated complex problems to department supervisors.
- Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
Assistant Store Manager
DSW Shoe Warehouse
Philadelphia , PA
2009.01 - 2015.06
- Managed the day-to-day operations of the store, including customer service, inventory management and staff scheduling.
- Monitored sales activities to ensure that customers receive satisfactory service and quality goods.
- Developed strategies for increasing store profitability by analyzing financial data and implementing cost-saving measures.
- Supervised a team of employees and provided ongoing training to ensure high levels of customer satisfaction.
- Maintained accurate records of all transactions, stock levels and employee performance metrics.
- Resolved customer complaints in a timely manner and addressed any issues that may arise during store hours.
- Ensured compliance with all safety regulations throughout the store premises.
- Created promotional campaigns to increase brand awareness and attract new customers.
- Implemented strategic marketing initiatives to drive revenue growth across multiple channels.
- Conducted regular performance reviews with staff members to assess individual progress and set goals for future development.
- Collaborated with other departments within the organization to coordinate promotions, events, and special projects.
- Developed an effective system for tracking inventory levels, ensuring stock is available when needed.
- Provided leadership support during peak business hours by motivating staff members to meet targets.
- Oversaw daily cash handling procedures, reconciling discrepancies as necessary.
- Organized weekly meetings with department heads to review progress on key objectives.
- Assisted in recruiting efforts by interviewing candidates for open positions in the store.
- Prepared detailed reports summarizing sales activity, customer feedback, and other relevant information.
- Answered customer questions and addressed problems and complaints in person and via phone.
- Handled complaints from customers by empathetically listening, recording details and offering solutions.
- Completed frequent walk-throughs and directed team members to correct issues impacting store appearance or professionalism.
- Supervised cashiers in processing credit, debit and cash payments to streamline sales.
- Handled scheduling for store shifts to achieve adequate staffing.
- Maintained inventory by checking merchandise to determine levels.
- Delegated assignments based on team strengths to optimize floor coverage and service levels.
- Coached and developed store associates through formal and informal interactions.
- Oversaw aspects of maintenance, inventory and daily activity management.
- Assisted in continuous development of effective store associates to achieve desired sales and results.
- Checked monthly sales and performance reports to support operational planning and strategic decision-making.
- Provided mentorship for employees to generate sales, promote effective upselling and cross-sell to improve retail productivity.
- Interviewed and vetted job applicants to make effective hiring decisions and fill vacancies with strong team members.
- Oversaw coaching and guidance of store employees to foster advancement in work operations.
- Completed thorough opening, closing and shift change functions to maintain operational standards each day.
- Used excellent verbal skills to engage customers in conversation and effectively determine needs and requirements.
- Delegated work to staff, setting priorities and goals.
- Prepared staff work schedules and assigned team members to specific duties.
- Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
- Used strong issue resolution and communication skills to cultivate and strengthen lasting client relationships.
- Reviewed financial statements and sales or activity reports to measure productivity or goal achievement.
- Structured HR consulting services to support clients during organizational developments and changes.
Seasonal Mail Clerk
Interal Revenue Service
Philadelphia , PA
2000.01 - 2003.06
- Sorted and distributed incoming mail according to predetermined routing procedures.
- Organized outgoing mail for dispatch, including arranging for pickup or delivery by the postal service.
- Maintained records of all incoming and outgoing mail packages.
- Scanned documents into electronic filing systems.
- Prepared invoices and other documents for mailing purposes.
- Assisted with inventory control of postage supplies such as stamps, envelopes, labels.
- Responded to inquiries from internal staff regarding mailroom services and procedures.
- Inspected outgoing mail for accuracy prior to distribution and mailing.
- Performed data entry tasks associated with the maintenance of mailing lists, address databases and other relevant information.
Education
Associate of Arts - Course Work in Biology
Community College of Philadelphia
Philadelphia, PA2005-05
High School Diploma -
Philadelphia High School For Girls
Philadelphia, PA2003-06
Skills
- Insurance Verification
- HIPAA Compliance
- Healthcare Regulations
- Medical Coding
- Administrative Support
- Manual Processing
- Eligibility Verification
- Client Service
- Microsoft Office
- Data Recording
- Word Processing
- Customer Service
- Correspondence Preparation
- Teamwork and Collaboration
- Work Planning and Prioritization
- Problem-Solving
- Problem-Solving Abilities
- Time Management
- Goal Setting
- Team Building
- Task Prioritization
- Work Coordination
- Attention to Detail
- Reliability
- Written Communication
- Deadline Adherence
- Team Collaboration
References
References available upon request.
Timeline
Medical Reimbursement Specialist
Main Line Health Homecare & Hospice
2015.08 - Current
Assistant Store Manager
DSW Shoe Warehouse
2009.01 - 2015.06
Seasonal Mail Clerk
Interal Revenue Service
2000.01 - 2003.06
Associate of Arts - Course Work in Biology
Community College of Philadelphia
High School Diploma -
Philadelphia High School For Girls
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